Basic Health Access

The list of distractions from True Reform are impressive. For decades True Reform has been specifically avoided as primary care worsens within practices and from outside. The demise is most specifically about the financial design. Unless there is a focus on True Reform, there is little hope for Basic Health Access. This may not make as much sense to those outside of family medicine. Family physicians not familiar with AAFP may also be clueless. If you think that you can fix primary care with more technology, more rearrangements, more types of health professional graduates, or more expansions of training - think again. None of these have any hope of working without financial design changes - major changes. The following are various concepts that dominate the discussions at AAFP and primary care meetings and media releases of associations and foundations and institutions. Members, staff, media releases, programs, and personnel have been reviewed.  There is little about...

Just in from Annals of Family Medicine (Miller, Rubenstein, Howard, Crabtree) Shifting Implementation Science Theory to Empower Primary Care Practices Hope for primary care, generalists, rural health, and care where needed requires a very different perspective after decades of failed designs. Not surprisingly this will need to come from inside of these practices and places. Not surprisingly policies and practices dictated from outside have been not only a poor fit - but have been abusive to the populations most in need of care and the practices that serve them. There is hope from the primary care research community. The perspective must be inside of practice looking out - instead of outsiders forcing changes. Qualitative research explores and discovers and reflects as Ben, Will, and others taught me along with the various rural family physicians interviewed and researched in the 1990s in Nebraska. The current focus on quantitative research has demonstrated little to ...

Once again a most important area of primary care is being ignored. The primary care workforce has moved from the most experienced workforce to the least experienced - without so much as a warning. The focus for primary care has been elsewhere other than significant changes in the workforce in areas such as consumer focus, convenience, quality, metrics, or lower costs. But there has not been much about changes in the primary care workforce itself. No, this is not about the movement from physicians to non-physicians, although this change is a big factor in the changing of primary care experience. All of the primary care workforce is impacted - MD DO NP and PA. Fewer enter and even fewer remain. Because they depart and take their primary care experience with them, the remaining workforce is more and more likely to be inexperienced. Not even researchers are asking many of the important questions with regard to primary care.  How is the primary care workforce changing and ...

The Value Based Movement lacks Value. It is important to understand how AAFP, Commonwealth, and others have arrived at their misguided focus about what is value.You will hear the various promotions constantly in journals, policy papers, and in the media. The following are more critical evaluations via Jha, Soumerai, Sullivan, CBO, Annals of IM, and others with my comments, critique, and assumptions regarding the real influences on outcomes. I still have hope for associations and foundations, but they need new leadership and a return to missions such as health access – real health access.Their staff need to be re-educated regarding the true value of family physicians and others serving in teams on the front lines despite that greater challenges of the value-based focus. Value, P4P, Performance Based Evidence Is Lacking Annals of IM 1/17 in a comprehensive review did not indicate value for performance based incentives. Only process was improved.   It is hard to stop a...