Primary Care America's Health in a New Era (1996) / Chapter Skim
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Implementation Strategy
Implementation Strategy
Pages 247-262
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From page 247... ...
It will also require a commitment to action by public and private health policymakers and funders, the health professions, health care organizations, and those responsible for health professions education. To provide focus for the implementation effort, this chapter presents specific means for implementing the committee's recommendations and identifies the many parties whose commitment will be necessary.
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From page 248... ...
Federal and state policymakers have also shown growing interest in the availability of primary care, particularly in rural areas, in the training of adequate numbers of primary care clinicians, and in the removal of legal barriers to the wider involvement of nurses and other types of health professionals in primary care. The rapid development of Medicaid managed care programs, and the likely continued growth of the enrollment of Medicare beneficiaries in managed care arrangements, will continue to merge the
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From page 249... ...
the many health professions that have a role in primary care as firstcontact professionals for specific functions, such as dentists, optometrists, pharmacists, and others; · medical specialists who have some primary care responsibilities or whose referral specialty functions require a relationship to and understanding of the appropriate scope of primary care clinicians; · managed care plans, other health care insurers, integrated health care systems, community and rural health centers, and other organizations providing or arranging for the provision of primary care; · academic health centers (AHCs) and other educational institutions providing education and training for primary care; .
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From page 250... ...
A PRIMARY CARE CONSORTIUM Mission of a Public-Private Consortium Coordinated implementation by many participants over time is unlikely to take place unless there is in place an entity whose purpose is to monitor and facilitate implementation, including building appropriate coalitions of the parties necessary for action. The committee regarded the creation of such an organization as central to the accomplishment of much of the primary care agenda laid out in the earlier chapter of this report.
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From page 251... ...
This information dissemination function could be a source of information about "best practices" in primary care, an action that might help to overcome the tendency of health care organizations to limit dissemination of improved methods that are providing the organization with advantages in a highly competitive market. The consortium could organize national meetings on primary care on a regu
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From page 252... ...
The recommendation that health policymakers, professional groups, and AHCs adopt the committee's definition of primary care is crucial, because building coalitions for action on other recommendations will be facilitated if all parties have agreed on a uniform definition of the primary care function. Even disagreements should have more focus if the beginning point of the discussion is the
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From page 253... ...
Recommendation 5.1 Availability of Primary Care for All Americans The responsible parties for the full implementation of Recommendation 5.1 are funders of health care, both public and private. Specifically, adequate federal and state support needs to continue for primary care delivery systems for those underserved populations that are not yet being served by managed care plans and integrated delivery systems, including rural populations.
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From page 254... ...
Recommendation 5.3 Payment Methods Favorable to Primary Care The principal implementers of Recommendation 5.3 are the managed care plans, integrated health delivery systems, health insurance companies, and federal, state, and local governments that pay for health care services. Most of these payers are already using or developing ways of paying for care that are more favorable to primary care than past payment methods.
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From page 255... ...
Because of the many organizational and attitudinal barriers to be overcome, and because of the resource constraints that face parties in both primary care and public health, full implementation in many communities probably lies 5 to 10 years in the future. Recommendation 5.8 Primary Care and Mental Health Services Primary care clinicians and mental health professionals are the main implementers of Recommendation 5.8, but payment policies and managed care arrangements must be changed.
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From page 256... ...
Recommendation 5.10 Quality of Primary Care The research community, the existing programs for monitoring quality for public and private programs, primary care clinicians in practice, and representatives of the public all need to be involved in developing improved means for monitoring and improving quality (Recommendation 5.10~. Support from private foundations, federal and state governments, and health care plans will continue to be necessary.
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From page 257... ...
Recommendation 6.1 Programs Regarding the Primary Care Workforce The current funders of primary care training at the federal and state levels, and to a lesser extent the foundations, are the principal parties for maintaining the current level of support (Recommendation 6.1, first part)
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From page 258... ...
The controlling factor of the speed of implementation is the availability and adequate funding of primary care sites for training. Recommendation 7.2 and Recommendation 7.3 Common Core Competencies Emphasis on Common Core Competencies by Accrediting and Certifying Bodies Implementation of Recommendations 7.2 and 7.3 will involve primary care clinicians from all of the groups involved in comprehensive primary care, the relevant specialty boards and equivalent professional bodies, accrediting bodies, certifying organizations for primary care training programs, state licensure officials, and educators.
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From page 259... ...
Some states might initiate such action themselves through state legislation that provides some form of tax on health insurance premiums. The full implementation of such a sweeping change will require a supportive legislative environment, absent a major health care reform proposal.
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From page 260... ...
Recommendation 8.3 Research in Practice-Based Primary Care Research Networks The agency designated by the Secretary of DHHS as the lead agency for primary care research would be the principal implementer of Recommendation 8.3. Assuming available funding, support could be provided within the year.
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From page 261... ...
FINAL COMMENT ON IMPLEMENTATION With the apparent demise of comprehensive health care reform, the climate for moving ahead on a reform agenda affecting primary care might seem to be unfavorable. Yet, as noted at the beginning of this report, the pace of change in the health care systems of communities around the country remains very rapid.
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From page 262... ...
262 PRIMARY CARE: AMERICA 'S HEALTH IN A NEW ERA This is a time when creative effort and collaboration can influence the forces driving health care change to take the directions defined by this committee. It will not be a time for weak hearts or quick fixes but the promise of improving health care for Americans should be motivation enough to stay the course set out in this report.
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