Strength in numbers: building influence through coalitions

Today's health care environment has become so complex, challenging and full of politics, it is more important than ever to build our influence through external collaboration. The need for a strong voice to speak on behalf of primary care, and internal medicine in particular, has never been greater. With the strength of our membership behind us, ACP can unify the internal medicine community and create a better environment for internists through policy, advocacy and education.

One important way we effect change is by collaborating with and gaining the support of like-minded organizations and by holding leadership positions in coalitions. All of these efforts help ensure that the interests of internists and their patients are heard and reflected when decisions are made.

The Patient-Centered Medical Home (PCMH) is an example of successful collaboration and continues to gain momentum with key constituents. We co-founded the Patient-Centered Primary Care Collaborative, an influential coalition of more than 200 employers, physicians, health plans, and consumers advocating for primary care and the PCMH. The coalition now includes almost 100 Fortune 500 companies representing over 50 million employees, consumer groups and physician organizations.

By working together, the collaborative believes that the PCMH can improve the health of patients and the viability of the health care delivery system. We have agreed that to achieve our goals, supporting a better model of compensating physicians is essential. The College has also joined with the AAFP, AAP, and AOA to work with the National Committee for Quality Assurance to revise its Physician Practice Connections module to better align this practice assessment tool with PCMH attributes and characteristics.

Our relationships with various subspecialty societies are also a priority. Interactions with organizations such as the Renal Physicians Association, Endocrine Society, the Infectious Disease Society, the American Society of Allergy, Asthma, Immunology, the American College of Emergency Physicians, and the American College of Rheumatology help ACP foster ongoing relationships that once again, can help all of us reach like-minded goals for a better system and quality patient care.

ACP extends our collaborative efforts with various international medical societies such as the International Society of Internal Medicine and we also work closely with several Societies of Internal Medicine, for example the Swiss Society of Internal Medicine. The College sends speakers to the annual meetings of many societies, which frequently leads to closer relationships and collaboration. I have been privileged to speak at the Bangladesh Society of Internal Medicine and the Taiwan Society of Internal Medicine and I look forward to attending the European Federation of Internal Medicine's Congress in May 2009 in Istanbul, Turkey.

ACP also works with several groups and coalitions and has a leading role improving health quality, health information and performance measurement. We design and contribute to demonstration projects and studies to validate the concepts of care management, the chronic care model, and pay-for-performance. For example, the joint principles on patient-centered care were developed in conjunction with the American Academy of Family Physicians, American Osteopathic Association and the American Academy of Pediatrics. The College is also a leader working toward the broader adoption of health information technology, researching practice improvement techniques and providing tools for enhancing the patient relationship, increasing efficiencies, and improving practice environment.

We are also leading efforts to identify appropriate and scientifically valid quality improvement measures, and to develop a national framework for performance measurement and public reporting. ACP members helped draft the first set of standards for the Certification Commission for Healthcare Information Technology (CCHIT), which is responsible for creating a voluntary program to assess the functionality of Electronic Health Record products. Our involvement with all of these communities and coalitions, as well as the AQA (formerly the Ambulatory Care Quality Alliance), and Electronic Health Initiative (EHI), ensure that the interests of internal medicine physicians are considered when decisions are being made in these areas.

In addition to our own evidence-based clinical guidance, ACP often works collaboratively with other clinical organizations to release joint clinical guidelines and statements on clinical topics. A few examples of this include a statement on adult immunization released in conjunction with the Infectious Disease Society of America, and joint guidelines released with the American Pain Society on the diagnosis and treatment of low back pain.

And finally, our continued legislative efforts are beginning to pay off. Earlier this year, the Government Accountability Office, Congress' investigative arm, issued a report concluding that the “move toward primary care medicine, a key to better quality and lower costs, is impeded by [the] health care system's current financing mechanisms” and that “payment systems that undervalue primary care appear to be counterproductive.” We consider this progress, and will continue to be a voice on Capitol Hill on behalf of internal medicine.

Together, we can accomplish even more—greater influence with regulators, clinical excellence, and most importantly, a louder voice for internal medicine.