President’s Message

Offering a cash prize to encourage innovation is a useful and time-honored concept. In 1714, the British Parliament created the Longitude Prize, which prompted John Harrison and others to solve the problem of accurately determining longitude—a breakthrough in navigation and exploration. And it was the $25,000 Orteig Prize that inspired Charles Lindbergh to attempt the first non-stop trans-Atlantic airplane flight in 1927. In a sense, these prizes helped give birth to modern aviation. 

That same spirit of radical innovation lives on today in the X Prize Foundation. Widely known for sponsoring awards for private space exploration and 100-mpg cars, the Foundation recently announced a new challenge: A $10 million prize for creating "an optimal health paradigm that empowers and engages individuals and communities in a way that dramatically improves health value." 

After reading the Foundation's press release, two questions came to mind. First, is $10 million a sufficient incentive? After all, we spend over $2.4 trillion on health care each year. Surely, creating a new paradigm for an industry that consumes 17 percent of GDP deserves a more impressive award. 

The second question: Don't we already have an "optimal health paradigm"? 
 
I think we do. It's call the Patient-Centered Medical Home (PCMH). In case you haven't heard about this concept, the PCMH is an approach to providing health care that is coordinated and outcomes-driven. It envisions a payment system that reflects the added value of patient-centered care management, rather than simply paying for the volume of services provided. At the core of the PCMH is the personal physician, charged with providing continuous and comprehensive care. This model is capturing the attention of employers, health plans, advocacy groups, and legislators. And it promises to be a key component of future payment reform. 

The evidence for the benefits of Family Medicine and the PCMH model continues to grow: 
  • A study produced by the Robert Graham Center and published in the March/April issue of Health Affairs, demonstrated that having a family physician as the "usual source of care" resulted in significantly lower costs compared to patients who used sub-specialists as their usual source of care. 
  • According to data from the Patient-Centered Primary Care Collaborative, adults who are cared for by a primary care physician rather than a specialist had 33 percent lower health care costs and 19 percent lower mortality. 
  • The Blue Cross Blue Shield North Dakota PCMH project targeting diabetics reduced costs by 26 percent, and reduced hospitalization rates by 28 percent. 
  • The North Carolina Medicaid PCMH demonstration project saved the state $244 million in overall health care costs in 2004. 
  • According to the Commonwealth Fund, Denmark has successfully organized its entire health care system around a medical home model. Consequently, it has the highest patient satisfaction levels among Western nations while being one of the lowest in per capita expenditures.
The principle underlying the Longitude and Orteig prizes—and the latest X Prize—is that radical innovation often comes from unexpected quarters. Aviation experts considered Lindbergh an amateur; and who would have expected the solution to global navigation to come from John Harrison. a self-educated clockmaker? It will be a fitting testimony to this principle if the solution to our health care conundrum arises from the humble field of Family Medicine rather than bureaucracies and blue ribbon commissions.

Family physicians should take the initiative now to turn their practices into medical homes. Some will rightly note that reimbursement for all this effort is the missing piece of the puzzle. But that's the problem with being a radical innovator. You have to build it before they will come. Lindbergh didn't win the Orteig Prize by talking about his airplane. He actually had to fly it to Paris. 

At no other time has it been more important for family physicians to get involved with promoting our profession and lobbying for reform. We need to encourage our colleagues to participate in the Academy—both on the state and national level. While we will probably never see any of that $10 million prize, the stakes are high, and the reward will be a reinvigorated profession, improved care for our patients, and a health care system that is financially sustainable. 

Let's get started. Contact the Academy and find out how you can help. Whether by serving on a committee or commission, contacting your legislator, or supporting the Academy with your membership dues. Your Academy needs you. 
 
And remember to join us in July for our first ever week-long Annual Assembly.

This article was published in South Carolina Family Physician.