Stephen C. Shannon, DO, MPH
President

Health Reform Dialogue Focuses on Access, Quality, Cost Efficiency and Primary Care

The pace of discussions on health care reform is picking up in the nation’s capital and elsewhere around the nation. President Obama has made it clear that health care reform is on his first-year agenda, and the chairs of the committees of jurisdiction in both houses of Congress are coordinating planning and deliberations to seek agreement on reform measures by late summer or early fall. Federal agencies already are implementing ‘stimulus’ spending to support reform-oriented changes in the health care infrastructure (e.g., information technology, community health center and National Health Service expansion), and the consumer, business, hospital, insurance and health professional associations are actively engaged in churning out policy positions and plans of their own. (For further details on policy developments, read AACOM's latest Federal Updates and click on 2009 Developments on Key Federal Issues.)

Of course, health insurance coverage for all is a big part of these discussions. As I have written about previously (http://www.aacom.org/resources/ome/2009-02/Pages/president.aspx), improving access, quality and cost efficiency are key components of virtually every proposed plan.  However, there is recognition that the current structure of our health care system does not deliver an equitable distribution of these qualities, and increasing costs and other stresses have heightened the public’s awareness that changes are needed.

With evidence that a well-functioning primary care infrastructure is a necessary component of any high-quality health care system, policy makers are focusing on changes that would incentivize improvements in this area. There is a growing call for health care reform to be built upon a foundation of a reinvigorated primary care system—a system that is patient-centered, coordinated, technologically-integrated, multi-professional and team-based, transparent for quality and patient safety, and focused on the prevention and coordinated care of chronic diseases. This concept, often termed the “medical home,” usually envisions a reimbursement system in which payment for health care services would be made for care coordination and quality measures as well as traditional fee-for-service. Private and public payers are currently implementing a number of medical home demonstration projects around the country, and many plans for health reform are incorporating these principles. But a focus also has been on the quantity of workforce itself, with a strong emphasis on increasing the numbers of primary care providers in all recent policy discussions, reports and media coverage related to health care reform.

Inevitably, questions arise as to what role medical education should play in the nation’s health care reform efforts: To what extent does our current method of health professional training contribute to the problems in the current system, and how can it be part of the solution?  What changes are needed in policy, payment systems and education to address reform goals? Over the past month, I’ve had the opportunity to participate in a number of policy meetings on these issues. There is general recognition that medical and health professional education and workforce policy will be central to whatever changes might occur. At recent meetings of the Advisory Committee on Training in Primary Care Medicine and Dentistry (of which I am a member) and the Council on Graduate Medical Education—both of which advise Congress and the Secretary of Health and Human Services—discussions and work on policy recommendations centered on changes in education and training that would be necessary to attract sufficient numbers of medical and other health professional students into primary care careers and train them in ways that would support the establishment of a ‘medical home-type’ primary care infrastructure for the health care system. The groups have discussed a variety of issues, including medical student debt, determinants of specialty choices, graduate medical education funding policies, curriculum changes needed for team-based training, community-based and out-of-hospital clinical training, faculty development needs, information technology implementation, and a host of other topics relevant to educating physicians for a revitalized U.S. primary care-based system. Many of these themes were also prominent in the Mayo Clinic National Symposium on Medical and Health Care Education Reform in which I also recently participated. And many of the policy speakers at this year’s AACOM Annual Meeting had a similar focus.

With our collective tradition of producing primary care providers, this emphasis provides a rich opportunity for osteopathic medical education. Our educational system overall has a great deal of experience in recruiting primary care-inclined students and delivering a curriculum that emphasizes the importance of a primary care perspective as the foundation for osteopathic medical students’ training, regardless of whatever specialty they may ultimately select. However, while we can bring this experience to the policy and educational change discussions, there is also much we can learn from participation in the discussions. Interprofessional collaboration, systems-based practice, information technology integration, professionalism development, care coordination and prevention are all areas of competency focus receiving innovative attention in our schools and throughout health professional education.

AACOM is increasing its efforts to ensure a continued place at the policy-making table so that we can present a unified voice regarding ways to mitigate physician shortages and support our members’ efforts to develop innovative educational solutions. We will be working to secure sufficient resources, coordinate communication and provide the necessary forums to address these issues within osteopathic medical education and in collaboration with our other health professional colleagues.

AACOM’s April 15 - 18 Annual Meeting was one example of our efforts. With a focus on policy, innovation, collaboration and collegiality, it was an enjoyable meeting at an exciting time: “The meetings, speakers and entertainment were all top notch.” “The sessions I attended were great, and the presentation of the various awards during the dinner banquet was professional and comprehensive.” “From the hotel to the programming, it was an extremely enjoyable and informative experience.” These are just a few of the comments we’ve received complimenting the Annual Meeting. More than 400 individuals from the osteopathic medical education community attended the meeting, and I hope you were among them. Please see the Annual Meeting recap below for a summary and photo gallery of meeting events.