Managed Care - June 2008 - (Page 35)

about orthopedics and other specialties, and follow up, and that’s a huge waste of expertise when they returned, the government paid hosand money. And the fourth challenge is to intepitals to train them as specialists. It has been grate care. People will have to go to specialists downhill since then. when they have uncommon or unusual problems, and it’s a primary care physician’s job to inMC: What are the three best things we can do to tegrate that into ongoing care. turn this around? STARFIELD: We need another Flexner Report. MC: What should primary care physicians do that Flexner was a smart man, and he realized that they are not doing today? medical education should take social phenomena STARFIELD: Our biggest challenge is to make priinto account. But he didn’t believe we had mary care more comprehensive. Primary care enough scientific knowledge about it to incorphysicians here don’t provide care that primary care physicians in other countries do, porate it into medical education at such as minor surgery and minor orthe time. But if we didn’t have sci- Payment shouldn’t entific evidence for the social basis shape things. You have thopedics. In most countries, people are not referred to specialists for such of medicine then, we have it now. to have ideas that procedures as suturing, joint aspiraSo another Flexner Report would shape things, and then tions, and routine casting. In this balance the specialty focus with the find a way to pay for country, we now have more visits to primary care focus. The second specialists than we have to primary thing we can do is change our re- them. That’s why our health care costs are so care physicians. Primary care is getimbursement policies. That has to ting less and less comprehensive. start with the federal government high, because we are because of the Medicare program. focusing on paying. MC: Are primary care physicians We have to start paying primary equipped to provide those kinds of care physicians and specialists equally. The third services? thing is to start putting into practice what we STARFIELD: They could be. Family physicians are know about primary care. We know exactly what much more comprehensive in the care they proprimary care is and what it accomplishes, and we vide than are general internists and general pehave to start using that evidence to change the diatricians. But they can be taught to do it. way physicians practice and refer. MC: Does all of this tie into the medical home concept? MC: How do you define the primary care mandate? STARFIELD: Primary care has four functions, and STARFIELD: The patient-centered medical home, you have to have all of them to have good prithe PCMH, that is being proposed by the four mary care. The first is that people have to know primary care societies — the American Academy that they can get access to their primary care of Pediatrics, the American Academy of Family doctor when they have a new problem. The secPhysicians, the American Osteopathic Associaond is that care has to be person-focused, not distion, and the American College of Physicians — ease-focused. We tend to think about priority relies on the evidence we have produced that diseases, but we are making diagnoses earlier all primary care is useful. Everyone says to me, “You the time, so even young people and middle-aged should feel terrific. Finally you’ve gotten your people have multiple morbidities. You need message across.”And I guess I do feel terrific that person-focused care over time — not diseasemy work has been recognized. My worry is that focused care, because most people have mixtures it’s going to be misused. of different types of illnesses. The third funcMC: What is the potential for misuse? tion of primary care is comprehensiveness. That STARFIELD: Focusing on the wrong things for primeans primary care has to address all the commary care, like leaving comprehensiveness out of mon needs in the population and only refer to discussions and focusing on chosen diseases inspecialists what specialists are trained to do, stead of on dealing with peoples’ problems. These which is not routine follow up. Half of what spephysician groups agree on the four functions of cialists in this country do today is simply routine primary care, and those four functions are in JUNE 2008 / MANAGED CARE 35

Table of Contents Feed for the Digital Edition of Managed Care - June 2008

Managed Care - June 2008 Editor’s Memo Contents Viewpoint Letters News and Commentary Legislation & Regulation Medication Management Compensation Monitor Plans Chart Course in Rough Waters A Conversation With Barbara Starfield, MD Smoke Signals from Payers Slow Going for Clinical Decision Support Back Pain and Physical Therapy Formulary Files PlanWatch Outlook

Managed Care - June 2008

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