Will the New AAFP President Worsen or Improve Triple Threat?

As Michael Munger MD takes over as AAFP president he indicates "One of my real concerns is around payment reform. And it's a multilevel concern. Will we really see meaningful payment reform?" Your responses at the AAFP site indicate that you are asking the right questions...

But under your leadership will AAFP work effectively and successfully to combat the Triple Threat -
  1. Revenue too little, 
  2. Accelerating costs of delivery (including the shift to value based), and 
  3. Complexity increasing in multiple practice, patient, community, and other dimensions?
Who will help AAFP to see through innovation, digitalization, certification, and regulation as adding to costs of delivery and worsening Triple Threat? How many more dozens of articles are needed to be added to the evidence basis that indicates that performance incentives fail to change health outcomes. Even worse, they discriminate against the patients and populations that best fit the description of those cared for by family physicians and others that most stand between some access and none.

Will your leadership be the difference between past failure and future success? How will AAFP this year be different from past decades of failure to address Triple Threat?

Do you not see Triple Threat as defeating all that family physicians can be and all that AAFP could do to help them?

Triple Threat defeats family practice, primary care, mental health, rural health, small practices, cognitive services, and care where most needed across 2621 lowest physician concentration counties with 40% of the US population. Triple Threat hurts access for insured and uninsured - thus defeating insurance expansion as an intervention. Triple Threat is what renders each and every MD DO NP and PA training intervention as ineffective as a solution for health access - including Teaching CHC programs. How can anyone be for Triple Threat?

As front line family physicians are asked to do more and are forced to do more because of Triple Threat, only a direct response to Triple Threat matters.

Triple Threat is a major reason
  1. For burnout, 
  2. For the declining reputation of primary care, 
  3. For insufficient time with patients
  4. For insufficient time with family
  5. For too few team members and limitation in the ability to address higher primary care functions
  6. For worsening access to care, and 
  7. For increasing use of more expensive services. 
Not addressing Triple Threat results in too little too late and being forced to pull the bodies out of the river rather than attacking the upstream causes.

We Are the Good Guys and Fighting Triple Threat Is Essential

Addressing Triple Threat is also about addressing equity and disparities as primary care and basic services are best distributed - and impact access, jobs, social determinants, and therefore health outcomes.

Why is it so hard to demonstrate this to those who design health care and those who resist true reform?

Survival of the Frailest

You should indeed worry about survival of family physicians in small practices and in rural communities as their financial design is the most broken with lowest revenue, most cost of delivery increases, most adjustments to make, greatest care complexity, and least local resources.

Time Marches On - and So Should We

Which year and which administration will bring a change in the right direction as compared to past and future decades with ever higher proportions of Americans left behind by design?

Most Americans and the family physicians who most serve them need AAFP to conquer Triple Threat - not worsen it.

Family Medicine Must Move Beyond the 1960s Design to Hope to Address the 2040s 

The Ultimate Shared Principles for Primary Care and for Primary Care for Most Americans


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