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Prevention is the Best Practice

We call the field of medicine "health" care, but we currently have a system that essentially provides "sick" care. In the U.S., we frequently get "more" care, not necessarily better care than people in other industrial countries.
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Bringing primary care doctors back to the center of patient care is an idea that resonates with many patients and doctors, and is gaining increased traction thanks to the spotlight on health care reform.

My recent blog on the "medical home," an emerging model for care, which emphasizes the vital role of primary care doctors in keeping us well, drew numerous responses and support for reforms that are in the best interest of the patient. This type of dialogue and exchange of experiences helps create greater momentum for innovations that will help keep us healthier.

Improvements in primary and preventive care must be at the top of the list.

As I pointed out earlier, studies show that mortality rates drop by 19 percent and costs dip by one-third when Americans have their own primary care doctor.

In addition to the emerging model of the medical home, another innovative idea that supports the importance of primary care is known as Accountable Care Organizations (ACOs).

This concept, which is supported by the American Academy of Family Physicians, the American College of Cardiologists, and the American Medical Association, is being tested in pilot studies in Vermont, Colorado, and Massachusetts. A Medicare pilot, authorized by the health care reform legislation, is slated to be underway in 2012.

Proponents of ACOs maintain that a team approach to medicine, which works so well at large world-class institutions, such as the Mayo Clinic and Geisinger Health Systems, can also benefit smaller physician groups in regions throughout the United States.

I agree. Collaborative care teams, including primary care doctors, specialists, nurses and therapists, are at the heart of world-class medicine. Therefore, extending this best practice model across the U.S. could help deliver optimal care and improve our system as a whole, ACOs supporters say.

In ACOs, doctors are accountable for improving the health of their patients. ACOs tap into existing communities of physicians and other health professionals in order to build a stronger team culture. In these practices, doctors are rewarded for meeting targets that improve outcomes and lower costs. Their benchmarks are set to regional, not national standards, so that local factors impacting health can be taken into account.

Like the medical home, this approach also needs effective use of information technologies to communicate among care professionals as well as with patients.

I am eager to see the results from the pilot studies now underway. I believe the ACO concept, allied with the medical home model, has the potential to transform U.S. health care.

Others before me have pointed out that we may call the field of medicine "health" care, but unfortunately we currently have a system that essentially provides "sick" care. In the U.S., we frequently get "more" care, not necessarily better care than people in other industrial countries.

The paradigm needs to shift toward promoting health and wellness. We need to move toward robust primary and preventive care and a structure that drives accountability.

Otherwise, a decade from now we will still be talking about the high cost of our system and the need to improve the quality of care. Only by then will we be facing the health consequences of an aging population, as well as a younger population with high rates of obesity, which will mean more people needing treatment for high blood pressure, heart disease and diabetes. The high obesity rate in children and the accompanying increase in diabetes alarm me greatly.

As a physician, I recognize the need for people who are sick to receive good care. But I also believe, if given a choice, most of us would prefer to be well and avoid chronic illness. In life, the best strategy is to stay as healthy as possible for as long as possible.

Prevention is better for the patient, and less costly to our society and our heath care system. Primary care is the best tool we have to achieve those results.

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