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NAPCRG celebrated 50 years of leadership and service at its 2022 meeting. A varied team of primary care investigators, clinicians, learners, patients, and community members reflected on the organization's past, present, and future. Started in 1972 by a small group of general practice researchers in the United States, Canada, and the United Kingdom, NAPCRG has evolved into an international, interprofessional, interdisciplinary, and intergenerational group devoted to improving health and health care through primary care research. NAPCRG provides a nurturing home to researchers and teams working in partnership with individuals, families, and communities. The organization builds upon enduring values to create partnerships, advance research methods, and nurture a community of contributors. NAPCRG has made foundational contributions, including identifying the need for primary care research to inform primary care practice, practice-based research networks, qualitative and mixed-methods research, community-based participatory research, patient safety, practice transformation, and partnerships with patients and communities. Landmark documents have helped define classification systems for primary care, responsible research with communities, the central role of primary care in health care systems, opportunities to revitalize generalist practice, and shared strategies to build the future of family medicine. The future of health and health care depends upon strengthening primary care and primary care research with stronger support, infrastructure, training, and workforce. New technologies offer opportunities to advance research, enhance care, and improve outcomes. Stronger partnerships can empower primary care research with patients and communities and increase commitments to diversity and quality care for all. NAPCRG offers a home for all partners in this work. Key words: primary care; family practice; general practice; research; organizations; NAPCRG; interdisciplinary research; community-based participatory research, INTRODUCTION NAPCRG celebrated its first 50 years at its 2022 annual meeting. A varied group of members reflected on the organization and its place in family medicine and primary care [...]

People working on behalf of population health, community health, or public health often experience confusion or ambiguity in the meaning of these and other common terms--the similarities and differences and how they bear on the tasks and division of labor for care delivery and public health. Shared language must be clear enough to help, not hinder people working together as they ultimately come to mutual understanding of roles, responsibilities, and actions in their joint work. Based on an iterative lexicon development process, the authors developed and propose a definitional framework as an aid to navigating among related population and community health terms. These terms are defined, similarities and differences clarified, and then organized into 3 categories that reflect goals, realities, and ways to get the job done. Goals include (a) health as well-being for persons, (b) population health as that goal expressed in measurable terms for groups, and (c) community health as population health for particular communities of interest, geography, or other defining characteristic--groups with shared identity and particular systemic influences on health. Realities are social determinants as influences, health disparities as effects, and health equity as both a goal and a design principle. Ways to get the job done include health care delivery systems for enrollees and public health in population-based civic activities--with a broad zone of collaboration where streams of effort converge in partnership with served communities. This map of terms can enable people to move forward together in a broad zone of collaboration for health with less confusion, ambiguity, and conflict. Key words: population health; lexicon; definitions; primary care public health integration, THE IMPERATIVE AND THE PROBLEM The terms population health, community health, and public health are often used interchangeably, yet imprecisely, leading to conceptual and practical misunderstandings. Each term relates in [...]

Electronic health record (EHR) tools such as documentation shortcuts and ordering templates are designed to enhance both the efficiency and quality of care delivery. Use of such tools vary widely in primary care. Understanding patterns of use as a means to identify priority areas for improvement are lacking. Objective: This study is designed to identify and understand patterns of EHR efficiency use among primary care clinicians as a means to inform training support needs. Study Design: Retrospective observational study. Setting or Dataset: 340 Community Health Centers (CHCs) across 48 US states from the OCHIN Network. Population Studied: The OCHIN's network and 2033 primary care clinicians engaged in patient care at least 2 days a week during DEC 2019-FEB 2020. Methods: Six EHR efficiency indicators were drawn from the Epic EHR Signal efficiency indicators which are automatically generated monthly for clinicians. Indicators include: use of quick actions, preference lists, level of service and diagnosis speed buttons and chart search functions and notes written with smart tools. A weighted score of these indicators represented overall EHR proficiency with a possible range of 0- 10 with higher scores suggesting higher efficiency. Latent profile analysis (LPA) was used to identify clusters of clinicians defined by distinct patterns of efficiency indicators. Results: The median EHR proficiency score was 4 and ranged from 0 to 9.5. The 9 cluster LPA solution the best overall fit. Clusters represented different patterns with notable strengths and deficiencies in EHR use efficiency. Cluster 2 was large (n=518) and characterized by being low on all indicators except for chart search. In contrast, cluster 9 was very small (n=12) and characterized by high scores for 4/6 indicators and low on quick actions. Conclusions: Substantial variation in EHR use efficiency among primary care clinicians was observed and can be represented by nine different patterns of indicators. These patterns show strengths and deficiencies in EHR use efficiency and could guide a tailored training approach to improve EHR efficiency., Presenters Jeremy Erroba, Miguel Marino, PhD, Rachel Gold, PhD, MPH, Rachel Springer, MS, Jennifer DeVoe, MD, DrPH, FAAFP, DPhil, Susan Flocke, PhD, David Boston, MD, [...]

Context: Acute complications are responsible for the majority of morbidity and mortality of patients with diabetes. Health insurance increases access to needed healthcare and receipt of diabetes-related preventive care. The Affordable Care Act (ACA) Medicaid eligibility provision was enacted in 2014 with the goal of expanding coverage to all US citizens and legal residents. The ACA led to improvement in healthcare access and health outcomes among patients with diabetes. Objective: To understand whether patients with diabetes in states that expanded Medicaid had greater reductions in the rate of acute complications post-ACA than those in states that did not expand Medicaid. Study Design: Retrospective observational cohort study. Setting or Dataset: Electronic health record data: 274 community health centers from the Accelerating Data Value Across a National Community Health Center Network clinical research network. Population Studied: Non-pregnant adults (n=5,176) aged 19-64 without Medicare coverage history, newly diagnosed with diabetes in 2013 with [greater than or equal to] 1 visit in each of the following periods: 2013, 2014-2016, 2017-2019. Outcome Measures: Rates of acute complications identified using ICD-9/10-CM codes and counted distinctly if the interval between each diagnosis was at least 10 days. Patients' annual acute complication rates were compared using a covariate-adjusted GEE Poisson model clustering on patients assuming an exchangeable working correlation. Outcome trends over time between expansion and non-expansion states were tested using interaction terms for time and expansion status. Results: From 2013 through 2019, annual acute complication rates declined overall for patients in both expansion (2013: 0.35; 2019: 0.18) and non- expansion (2013: 0.13; 2019: 0.10) states, with higher observed rates of acute complications in expansion (compared to non-expansion) states throughout the study period. Trends in acute complication rates were not parallel over time between expansion and non-expansion states (p, Presenters Nathalie Huguet, PhD, Dang Dinh, MSc, Hojun Hwang, MS, Miguel Marino, PhD, Heather Angier, PhD, MPH, Annie Larson, PhD, MPH, Irina Chamine, PhD, Jennifer DeVoe, MD, DrPH, FAAFP, DPhil, [...]

Earlier this year, the National Academies of Sciences, Engineering, and Medicine (NASEM) published the first formal consensus study of primary care in 25 years. The consensus committee's report, 'Implementing High-Quality [...]

During a pandemic, primary care is the first line of defense. It is able to reinforce public health messages, help patients manage at home, and identify those in need of hospital care. In response to the COVID-19 pandemic, primary care scrambled to rapidly transform itself and protect clinicians, staff, and patients while remaining connected to patients. Using the established public health framework for addressing a pandemic, we describe the actions primary care needs to take in a pandemic. Recommended actions are based on observed experiences of the authors' primary care practices and networks. Early in the COVID-19 pandemic, tasks focused on promoting physical distancing and encouraging patients with suspected illness or exposure to self-quarantine. Testing was not available and contract tracing was not possible. As the pandemic spread, in-person care was converted to virtual care using telehealth. Practices remained connected to patients using registries to reach out to those at risk for infection, with uncontrolled chronic conditions, or were socially vulnerable. Practices managed most patients with suspected COVID-19 at home. As the pandemic decelerates, practices are now preparing to address the direct and indirect consequences--complications from COVID-19 infections, missed treatment for acute problems, inadequate prevention, uncontrolled chronic disease, mental illness, and greater social needs. Throughout, practices bore tremendous financial burden, laying off staff or even closing at a time when most needed. Primary care must learn from this experience and be ready for the next pandemic. Policymakers and payers cannot fail primary care during their next time of need. Key words: COVID-19; primary care; pandemic; practice transformation; public health https://doi.org/10.1370/afm.2557., INTRODUCTION In normal times, 75% of adults report 1 or more illness or injury per month. Most manage symptoms on their own, but 25% consult a clinician. (1) Our health [...]

PURPOSE The Patient Protection and Affordable Care Act (ACA) has improved access to health insurance, yet millions remain uninsured. Many patients who remain uninsured access care at community health centers (CHCs); however, little is known about their health conditions and health care use. We assessed ambulatory care use and diagnosed health conditions among a cohort of CHC patients uninsured before enactment of the ACA (pre-ACA: January 1, 2012 to December 31, 2013) and followed them after enactment (post-ACA: January 1, 2014 to December 31, 2015). METHODS This retrospective cohort analysis used electronic health record data from CHCs in 11 US states that expanded Medicaid eligibility. We assessed ambulatory care visits and documented health conditions among a cohort of 138,246 patients (aged 19 to 64 years) who were uninsured pre-ACA and either remained uninsured, gained Medicaid, gained other health insurance, or did not have a visit post-ACA. We estimated adjusted predicted probabilities of ambulatory care use using an ordinal logistic mixed-effects regression model. RESULTS Post-ACA, 20.9% of patients remained uninsured, 15.0% gained Medicaid, 12.4% gained other insurance, and 51.7% did not have a visit. The majority of patients had [greater than or equal to]1 diagnosed health condition. The adjusted proportion of patients with high use ([greater than or equal to]6 visits over 2 years) increased from pre-ACA to post-ACA among those who gained Medicaid (pre-ACA: 23%, post-ACA: 34%, P CONCLUSIONS A significant percentage of CHC patients remained uninsured; many who remained uninsured had diagnosed health conditions, and one-half continued to have [greater than or equal to]3 visits to CHCs. CHCs continue to be essential providers for uninsured patients., INTRODUCTION In 2010, the Patient Protection and Affordable Care Act (ACA) was enacted with the goal of expanding health insurance coverage to all US citizens and legal residents. (1) The [...]

The article dicusses several innovations presented at the American Academy of Family Physicians Residency Leadership Summit's annual Innovation Showcase. It mentions that these innovations include integrating diversity, equity, and inclusion into a family medicine curriculum, using milestone data and open-source software for program improvement and bias identification, and requiring resident capstone projects within a four-year curriculum.

THE INNOVATION At the front line of patient care, family physicians have questions about how to improve their practice or track an impact of ongoing initiatives, but often lack experience [...]

Context: In 2018, AHRQ developed staffing models with panel sizes, functions, ratios and financing approaches for 3 types of comprehensive primary care clinics. We used this model in an academic health system serving people of differing ages, medical complexity and social risk. Objective: Determine the usability and update the model for post-pandemic academic primary care. Study design and Analysis: Mixed methods cross-sectional observational study; comparative analysis. Setting: 9 clinics: 2 safety-net, 1 internal medicine, 4 family medicine, 2 pediatric. Population studied: Clinic faculty and staff. Intervention/Instrument: Panel size, full time equivalents (FTEs) by function, encounter volume; interviews with a sample of each clinics' members, with representation across functions. Outcome measures: Identification of staff functions, panel sizes, staffing ratios, encounter numbers. Results: AHRQ's model was usable in academic primary care, but needed to be modified to align with the blended populations served by clinics. A supplementary tool was needed to identify FTE gaps by function and support planning among clinic and system administration. Using this tool, we found that clinician panel sizes were similar to AHRQ model recommendations, but clinics were short staffed by an average of 9.5 FTE/clinic (range 1-22 FTE). Functional gaps were identified in complex care/care transitions, care coordination, and behavioral health (BH), the latter of which was an increased need since the pandemic. Non-visit-based telephone and portal encounters grew by 73,000 (32%) from 2019 to 2021 and are now approximately double the number of visit-based encounters. These communications take multiple touches and team members to complete, not all of which were counted. The explosion of non-visit-based work, according to staff, contributed to a spiral of work, burnout, and attrition. Conclusion: AHRQ's staffing model is useful in primary care, with the addition of a tool to operationalize this model for leaders and decision makers. The model, however, requires expansion for pediatrics, where not all functions are equally needed, to account for non-visit-based work, and patients expanded BH needs. This expansion requires careful consideration of financing, as clinics are experiencing a double-hit (short-staffed and seeing an explosion of work) and examination of the impact of the expanded staffing model on meaningful outcomes (e.g., patient experience of comprehensive care). [ABSTRACT FROM AUTHOR]

Purpose: Health insurance coverage affects a patient's ability to access optimal care, the percentage of insured patients on a clinic's panel has an impact on the clinic's ability to provide needed health care services, and there are racial and ethnic disparities in coverage in the United States. Thus, we aimed to assess changes in insurance coverage at community health center (CHC) visits after the Patient Protection and Affordable Care Act (ACA) Medicaid expansion by race and ethnicity.Methods: We undertook a retrospective, observational study of visit payment type for CHC patients aged 19 to 64 years. We used electronic health record data from 10 states that expanded Medicaid and 6 states that did not, 359 CHCs, and 870,319 patients with more than 4 million visits. Our analyses included difference-in-difference (DD) and difference-in-difference-in-difference (DDD) estimates via generalized estimating equation models. The primary outcome was health insurance type at each visit (Medicaid-insured, uninsured, or privately insured).Results: After the ACA was implemented, uninsured visit rates decreased for all racial and ethnic groups. Hispanic patients experienced the greatest increases in Medicaid-insured visit rates after ACA implementation in expansion states (rate ratio [RR] = 1.77; 95% CI, 1.56-2.02) and the largest gains in privately insured visit rates in nonexpansion states (RR = 3.63; 95% CI, 2.73-4.83). In expansion states, non-Hispanic white patients had twice the magnitude of decrease in uninsured visits compared with Hispanic patients (DD = 2.03; 95% CI, 1.53-2.70), and this relative change was more than 2 times greater in expansion states compared with nonexpansion states (DDD = 2.06; 95% CI, 1.52-2.78).Conclusion: The lower rates of uninsured visits for all racial and ethnic groups after ACA implementation suggest progress in expanding coverage to CHC patients; this progress, however, was not uniform when comparing expansion with nonexpansion states and among all racial and ethnic minority subgroups. These findings suggest the need for continued and more equitable insurance expansion efforts to eliminate health insurance disparities. [ABSTRACT FROM AUTHOR]

The year 2016 marked the 20th anniversary of the hospitalist profession, with more than 50,000 physicians identifying as hospitalists. The Achilles heel of hospitalist medicine, however, is discontinuity. Despite many current payment and delivery systems rewarding this discontinuity and severing long-term relationships between patient and primary care teams at the hospital door, primary care does not stop being important when a person is admitted to the hospital. The notion of a broken primary care continuum is not an academic construct, it causes real harm to patients. As a step toward fixing the discontinuity in our health care systems, we propose that every hospital needs a Chief Primary Care Medical Officer (CPCMO), an expert in practice across the spectrum of care. The CPCMO can lead hospital efforts to create systems that ensure primary care's continuum is complete, while strengthening physician collaboration across specialties, and moving toward achieving the Quadruple Aim of enhancing patient experience, improving population health, reducing costs, and improving the work life of health care providers. For hospitals operating on value-based payment structures, anticipated improvement in measurable outcomes such as decreased length of stay, decreased readmission rates, improved transitions of care, improved patient satisfaction, improved access to primary care, and improved patient health, will enhance the rate of return on the hospital's investment. The speciality of family medicine should reevaluate our purpose, and reembrace our mission as personal physicians by championing the creation of Chief Primary Care Medical Officers. [ABSTRACT FROM AUTHOR]

I had intended to spend our spring break week in Montana with my kids and my dad, going to parks and museums together. Instead, I spent the week in the hospital, helping my dad make end-of-life choices and learning more about the importance of communication in health care settings and the preciousness of close relationships in life. I am a better person and a better physician because my dad trusted me to be there while he was dying. During his last week, I was grateful to have spent years studying medicine and years getting to know my dad. This combination of professional and personal knowledge enabled me to help him choose his own end-of-life path. As someone who does not like hospitals, I have always wondered why I became a doctor; now I know. [ABSTRACT FROM AUTHOR]

The author reflects on the integration of social determinants of health (SDH) into primary care settings. Explored are issues on health disparities and enhancement of population health. The development of family medicine is discussed, along with establishment of community-oriented primary care concepts.

PURPOSE There is debate about whether community health centers (CHCs) will experience increased demand from patients gaining coverage through Affordable Care Act Medicaid expansions. To better understand the effect of new Medicaid coverage on CHC use over time, we studied Oregon's 2008 randomized Medicaid expansion (the "Oregon Experiment"). METHODS We probabilistically matched demographic data from adults (aged 19-64 years) participating in the Oregon Experiment to electronic health record data from 108 Oregon CHCs within the OCHIN community health information network (originally the Oregon Community Health Information Network) (N = 34,849). We performed intent-to-treat analyses using zero-inflated Poisson regression models to compare 36-month (2008-2011) usage rates among those selected to apply for Medicaid vs not selected, and instrumental variable analyses to estimate the effect of gaining Medicaid coverage on use. Use outcomes included primary care visits, behavioral/mental health visits, laboratory tests, referrals, immunizations, and imaging. RESULTS The intent-to-treat analyses revealed statistically significant differences in rates of behavioral/mental health visits, referrals, and imaging between patients randomly selected to apply for Medicaid vs those not selected. In instrumental variable analyses, gaining Medicaid coverage significantly increased the rate of primary care visits, laboratory tests, referrals, and imaging; rate ratios ranged from 1.27 (95% CI, 1.05-1.55) for laboratory tests to 1.58 (95% CI, 1.10-2.28) for referrals. CONCLUSIONS Our results suggest that use of many different types of CHC services will increase as patients gain Medicaid through Affordable Care Act expansions. To maximize access to critical health services, it will be important to ensure that the health care system can support increasing demands by providing more resources to CHCs and other primary care settings. [ABSTRACT FROM AUTHOR]

Purpose: The Affordable Care Act of 2010 supports marked expansions in Medicaid coverage in the United States. As of January 1, 2014, a total of 25 states and the District of Columbia expanded their Medicaid programs. We tested the hypothesis that rates of uninsured safety net clinic visits would significantly decrease in states that implemented Medicaid expansion, compared with states that did not.Methods: We undertook a longitudinal observational study of coverage status for adult visits in community health centers, from 12 months before Medicaid expansion (January 1, 2013 to December 31, 2013) through 6 months after expansion (January 1, 2014 to June 30, 2014). We analyzed data from 156 clinics in the OCHIN practice-based research network, with a shared electronic health record, located in 9 states (5 expanded Medicaid coverage and 4 did not).Results: Analyses were based on 333,655 nonpregnant adult patients and their 1,276,298 in-person billed encounters. Overall, clinics in the expansion states had a 40% decrease in the rate of uninsured visits in the postexpansion period and a 36% increase in the rate of Medicaid-covered visits. In contrast, clinics in the nonexpansion states had a significant 16% decline in the rate of uninsured visits but no change in the rate of Medicaid-covered visits.Conclusions: There was a substantial decrease in uninsured community health center visits and a significant increase in Medicaid-covered visits in study clinics in states that expanded Medicaid in 2014, whereas study clinics in states opting out of the expansion continued to have a high rate of uninsured visits. These findings suggest that Affordable Care Act-related Medicaid expansions have successfully decreased the number of uninsured safety net patients in the United States. [ABSTRACT FROM AUTHOR]

The recent confluence of: (1) changing state and national insurance-related policies, and (2) the rapid growth in electronic health record (EHR) use, yields an unprecedented opportunity for patient-centered medical homes (PCMHs) and other primary care practices or care settings to use health information technology (HIT) and health information exchange (HIE) in novel ways to impact patient health. We propose that HIT is an untapped resource for supporting clinic-based efforts to help eligible patients obtain and maintain insurance coverage. This commentary presents a conceptual model and guiding principles for this idea. Additionally, it describes insurance support tools that could be used to conduct 'inreach' and 'outreach' with patients around health insurance, similar to how HIT is used to manage chronic disease and panels of patients, and to improve population health outcomes. [ABSTRACT FROM AUTHOR]

In October 2000 the family of family medicine convened the Keystone III conference at Cheyenne Mountain Resort. Keystone III participants included members of Generation I (entered practice before 1970), Generation II (entered 1970- 1990), and Generation III (entered after 1990). They represented a wide range of family physicians, from medical students to founders of the discipline, and from small-town solo practice to academic medicine. During the conference, the three generations worked together and separately thinking about the past, present, and future of family medicine, our roles in it, and how the understanding of a family physician and our discipline had and would continue to evolve. After the conference, the 10 Generation III members wrote the article published here, reflecting on our experiences as new physicians and physicians in training, and the similarities and differences between our experiences and those of physicians in Generations I and II. Key similarities included commitment to whole-person care, to a wide scope of practice, to community health, and to ongoing engagement with our discipline. Key differences included our understanding of availability, the need for work-life balance, the role of technology in the physician-patient relationship, and the perceptions of the relationship between medicine and a range of outside forces such as insurance and government. This article, presented with only minor edits, thus reflects accurately our perceptions in late 2000. The accompanying editorial reflects our current perspective. [ABSTRACT FROM AUTHOR]

The article reflects on whether medical homes can help patients obtain and retain insurance coverage in the U.S. It informs that not having insurance has a negative impact on the health of an uninsured person and is associated with early death, which could be preventable. It informs that primary care medical homes by partnering with patients and assisting them in obtaining and maintaining health insurance coverage can reduce preventable mortality.

The authors provide an updated model of insurance premium cost and household income projections in the U.S. using the same methods applied by a study conducted by DeVoe and colleagues. They note that such studies emerged due to the implementation of the 2010 Patient Protection and Affordable Care Act (PPACA). They also include in their projection the importance of the total cost of health care for a family as most workers do nor pay the entire cost of their premiums.

The article presents a research study which examines the association between child and parent usual source of care (USC) patterns and children's access to health care services in the U.S. The authors state that children whose parents lack a USC receives fewer health care services and experience more unmet needs. They stress that ensuring better access to necessary health care services require comprehensive policy reforms that make it easier for all individuals to maintain a USC status.

The article focuses on a study related to electronic health records (EHRs) and medical claims in community health centers (CHCs) in Oregon. It informs that the study focused on the creation of individual-level association between EHR data from a network of CHCs and Medicaid claims from 2005 to 2007. The study found that EHRs provide more extensive data regarding health services received. Several charts related to the study are also presented

The article presents a study that investigates on the health care services and family health insurance patter given to American children. The study was administered by analyzing the 2002-2006 cross-sectional pooled data regarding the health care needs of children. The study reveals that uninsured children exemplify high rates of unmet health care needs and insured children with different parental insurance coverage is also at risk.

The article focuses on the barriers of public health insurance and health care access to low-income families in the U.S. Public health insurance programs expanded coverage for the poor. Family physicians provide significant services to the poor. Study shows that lack of insurance coverage, poor access to services and unaffordable costs are among the major barriers in accessing health care for children. Results indicate that these barriers can be insurmountable for low-income families.

Purpose: More than a decade ago the American Academy of Family Physicians, American Academy of Family Physicians Foundation, American Board of Family Medicine, Association of Departments of Family Medicine, Association of Family Practice Residency Directors, North American Primary Care Research Group, and Society of Teachers of Family Medicine came together in the Future of Family Medicine (FFM) to launch a series of strategic efforts to "renew the specialty to meet the needs of people and society," some of which bore important fruit. Family Medicine for America's Health was launched in 2013 to revisit the role of family medicine in view of these changes and to position family medicine with new strategic and communication plans to create better health, better health care, and lower cost for patients and communities (the Triple Aim)., Methods: Family Medicine for America's Health was preceded and guided by the development of a family physician role definition. A consulting group facilitated systematic strategic plan development over 9 months that included key informant interviews, formal stakeholder surveys, future scenario testing, a retreat for family medicine organizations and stakeholder representatives to review strategy options, further strategy refinement, and finally a formal strategic plan with draft tactics and design for an implementation plan. A second communications consulting group surveyed diverse stakeholders in coordination with strategic planning to develop a communication plan. The American College of Osteopathic Family Physicians joined the effort, and students, residents, and young physicians were included., Results: The core strategies identified include working to ensure broad access to sustained, primary care relationships; accountability for increasing primary care value in terms of cost and quality; a commitment to helping reduce health care disparities; moving to comprehensive payment and away from fee-for-service; transformation of training; technology to support effective care; improving research underpinning primary care; and actively engaging patients, policy makers, and payers to develop an understanding of the value of primary care. The communications plan, called Health is Primary, will complement these strategies. Eight family medicine organizations have pledged nearly $20 million and committed representatives to a multiyear implementation team that will coordinate these plans in a much more systematic way than occurred with FFM., Conclusions: Family Medicine for America's Health is a new commitment by 8 family medicine organizations to strategically align work to improve practice models, payment, technology, workforce and education, and research to support the Triple Aim. It is also a humble invitation to patients and to clinical and policy partners to collaborate in making family medicine even more effective., (© 2014 Annals of Family Medicine, Inc.)