In this issue of The Journal of Family Practice, Dr. Wayne Jonas explains his model for Advanced Primary Care (see page 493). The figure he uses to illustrate Advanced Primary Care is compelling, and the effectiveness of this model of health care is supported by a great deal of research and evaluation over the past 20 years. Let me provide some historical context.
The idea that healing requires more than curative, biology-based medical care dates back to Greek mythology. Asclepius, the god of medicine, had 5 daughters, Hygeia (the goddess of good health and hygiene), Iaso (cures and remedies), Aceso (healing wounds), Aegle (radiant good health), and Panacea (cures).1 Clearly, the Greeks believed that integrative care is essential for maintaining good health!
Modern, scientific medicine is a relatively recent development in human history. Other traditions of healing such as acupuncture and herbal medicines are actually much older than mainstream Western medicine. But they come together in family medicine—a specialty founded on the principles of whole person, whole family, and whole community care.
The first modern model of comprehensive care, the patient-centered medical home (PCMH), was introduced by the American Academy of Pediatrics in 1967. This idea caught on widely and was institutionalized by the National Committee for Quality Assurance in 2008 with PCMH certification.
Advanced Primary Care is the latest and best rendition of comprehensive primary health care. Funding this model through our current payment mechanisms, however, has been difficult because of the need to support social and behavioral interventions in addition to medical care—areas of care not traditionally paid for by medical premiums. In 2011, CMS collaborated with private insurers in a national demonstration project to test the financial feasibility of implementing Advanced Primary Care. Some organizations have been highly successful; others not as much.
We can no longer go “halfway” into whole-person care. The COVID-19 pandemic has put a spotlight on our need to transform payment models away from fee-for-service to reimbursement for whole person primary care. Our nation’s health and the viability of our health care system depend on it.
PS: I recommend reading Dr. Jonas’ book, How Healing Works, which provides a scientific rationale for the application of whole-person care to healing.