Major Obamacare provisions aim to lower national health care costs by encouraging primary care and healthy living habits. The hope is that by having patients take advantage of preventative care provisions and communicating with their practitioners, Americans will live healthier lifestyles that do not require long-term, expensive care.

But Obamacare’s funding for community health clinics and prevention measures is not enough to realize the dream of a healthier America. The medical profession itself must change the way it does business, beginning with an increased focus on medical school training for family care and general practitioners.

According to a Kaiser Health News piece, elite schools tend to focus on producing highly-skilled and highly-specialized doctors at the expense of much-needed family doctors. New York’s Mount Sinai School of Medicine has responded to this growing need by starting a new Department of Family Medicine:

Students like Demetri Blanas, 26, who were interested in becoming family doctors found little support. For the first three years of school, his training focused almost exclusively on taking care of extremely ill patients in the hospital.

“I want to spend my career keeping people healthy rather than trying to bring them back from a very serious illness,” says Blanas. “I think it is what society needs right now, and that is important to me.”

Blanas says many of his professors discouraged him from going into primary care, telling him it was too much work, the pay was lousy, the job was boring, and it simply wasn’t as intellectually rigorous as being a specialist. [...] Yet he remained committed to pursuing family medicine. [...]

Dr. Dennis Charney, dean of the medical school, says that the new department represents a fundamental change in Mount Sinai’s mission. “It’s a big deal for our institution. We want to be one of the leading medical schools that educates the next generation of primary care doctors,” he says. And it comes not just because of the health overhaul law, but also because there is a growing interest among students in primary care, he added.

The fundamental role that primary care and family doctors will play in transitioning America from a system of “sick care” to “health care” is undeniable. But the country’s top schools must embrace the urgency of that reality by following Mount Sinai’s example, expanding their general and primary care departments, and encouraging talented young doctors like Blanas to devote their skills to non-specialized practices.

In a Medicare Advantage hearing before the House Ways and Means Health Subcommittee on Friday, America’s Health Insurance Plans (AHIP) President Karen Ignagni confirmed that Obamacare is encouraging health care providers and private insurers to adjust their business models, just as the law was intended to do.

Although Ignagni noted that some of Obamacare’s provisions — such as its modifications to Medicare Advantage’s repayment structure — concern the insurance industry, she nonetheless acknowledged that the law has prompted health care providers, government agencies, and insurance companies to coordinate their care strategies while reexamining payment models:

REP. RON KIND (D-WI): Miss Ignagni, I know you and the plans that you represent in that, have been at the forefront when it comes to a lot of these changes and reforms. I think we need to be doing it on a parallel path between Medicare and the private plans out there. I don’t think doing it in isolation is going to work. Could you give us a quick update on what you’re seeing happening, especially in the private sector right now,with these types of delivery and payment reforms that are happening?

IGNAGNI: [...] There are very significant changes going on all across the country. [...] The story is about collaboration, health plans and clinicians collaborating inpatient-centered medical homes to bring more value to, and case management to, those with chronic illnesses, and taking those strategies into Medicare Advantage, Medicaid plans, SNIPS, and so on and so forth. [...] What is very significant now as a result of these strategies, health plans are showing in peer reviewed journal data that they’re working, with respect to re-admissions, emergency rooms, so we’re not finished by any means…but we have taken a major step and it clearly has to be the future, more coordinated care, more prospective payment, and partnerships between plans and clinicians and hospitals.

Watch it:

Coordinated case management is essential to providing patients with more efficient care. The more that hospitals, insurance providers, and clinicians cooperate and bundle their services and payments, the easier it becomes for American consumers to seek out flat-rate, quality care. As Ignagni mentions, there has been evidence in states such as Massachusetts that coordinated-care facilities treating dedicated patient pools for prospective, bundled fees (pre-determined flat rates) are accruing savings while maintaining high Medicare quality-metrics.

In its quest to sell more and more specifically targeted ads, Facebook has embarked on a new partnership with data-mining company Datalogix, which tracks the real effect of online ads on consumer behavior. Datalogix compiled data on the purchasing habits of 70 million American households from loyalty card memberships of more than 1,000 retailers, including drugstores. Although Facebook and Datalogix claim not to share individual data with one another, they will match up Facebook accounts with real life identities to determine whether a Facebook ad led that person to buy a product — and Facebook will use this data to show advertisers what kinds of ads are most effective.

As the Atlantic Wire points out, one of Datalogix’s sources is the CVS ExtraCare card program, which catalogs regular drug purchases by members in order to reward them with discounts. Facebook is keeping the profiles anonymous, but the potential for abuse is significant.

Pharmaceutical industry giants spent about $1 billion on online advertisements in 2010, but are hobbled on social media by FDA guidelines that require the disclosure of all risks alongside benefits. Facebook helped Big Pharma satisfy this regulation by allowing drug companies to block comments on their Facebook pages and control their content. When Facebook eventually required them to open comments, many companies got rid of their pages — but according to some reports, Big Pharma representatives still kept tabs on Facebook groups and pages meant to offer support to people with health problems. This isn’t a new strategy; even before Facebook existed, companies sent representatives to milk cancer support groups. But on Facebook, it’s even easier to identify sick people vulnerable to certain types of marketing.

So Facebook’s consumer information allows pharmaceutical companies to maximize their social media influence without being directly involved in the data collection. By studying regular drug purchasing habits, a company can draw conclusions about the types of ailments and demographic traits that make someone more susceptible to their advertisements — all without actually violating the FDA’s advertising requirements.

You can opt out of Datalogix’ collection through this link.

Last year, New York City started a pilot program to provide free birth control — including emergency contraception, commonly known as Plan B — in 13 of its public schools in an effort to combat the city’s high rates of teen pregnancy. Health officials announced yesterday that the program has “encountered little resistance from parents” since it begun in 2011.

The Department of Education sent notices to parents to allow them to opt their children out of the pilot program, but officials reported that hardly any parents chose to do so:

Only 1 percent to 2 percent of parents returned a form to opt out of the program. The form allowed them to select any or all of four types of reproductive services that they did not want their child to receive, including emergency contraception, birth control pills, pregnancy testing or condoms. [...]

New York is among 21 states and the District of Columbia that allow all minors access to contraceptive services, according to the Guttmacher Institute, a research group in Washington that supports abortion rights. But because of a court decision in the early 1990s, some form of parental notification and the right to opt out is required at school.

The year-old CATCH program, which stands for Connecting Adolescents to Comprehensive Healthcare, is an expansion of an existing program run by privately-operated health centers in schools around the city. Although the private program has been operating in New York City schools for the past several years, only about a quarter of the city’s high school students are currently able to access contraceptive services through those health centers. The newer, city-run program intends to extend services to an additional 5 percent of students. The schools in the pilot program were chosen because health officials identified their student bodies at a greater risk for unintended pregnancy, partly because they lack sufficient health services to educate students about birth control.

A health department spokesperson pointed out that since over 7,000 New York City students become pregnant before the age of 17, city officials are “committed to trying new approaches, like this pilot program in place since January 2011, to improve a situation that can have lifelong consequences.” New York City enacted a comprehensive sexuality education policy last year that requires public schools to include accurate information about physiology, conception, and birth control methods in their health class curricula. Free condoms are already available at high schools across the city.

New York City’s education department is modeling a way forward for schools in the rest of the state, which a recent report exposed as having “shocking gaps” in their sex ed programs in the absence of state-wide requirements for comprehensive sexuality courses.

During a 60 Minutes interview with Scott Pelley on Sunday evening, Mitt Romney suggested that there are already adequate measures in place to protect Americans who lack health insurance. According to Romney, Americans should just go to the hospital to seek care, regardless of the crippling expenses they may incur without adequate health coverage:

PELLEY: Does the government have a responsibility to provide health care to the 50 million Americans who don’t have it today?

ROMNEY: Well, we do provide care for people who don’t have insurance, people — we– if someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.

PELLEY: That’s the most expensive way to do it…In an emergency room.

ROMNEY: Different, again, different states have different ways of doing that. Some provide that care through clinics. Some provide the care through emergency rooms. In my state, we found a solution that worked for my state. But I wouldn’t take what we did in Massachusetts and say to Texas, “You’ve got to take the Massachusetts model.”

However, as Pelley points out, ambulatory care is extraordinarily expensive and shifts costs from often-uninsured emergency room patients into the overall health care market, effectively driving up everyone’s cost of care.

All Americans are entitled to care though the Emergency Medical Treatment and Active Labor Act or (EMTALA), a law Ronald Reagan signed. It requires hospitals that accept Medicare or Medicaid funding to treat patients for emergency medical conditions regardless of legal status or ability to pay. But EMTALA only applies to medical emergencies. “So, yes, if you’re actively giving birth, you can expect to receive care at an emergency room,” Austin Frakt and Aaron Carroll explain. “If you’re actively having a heart attack, you can also get emergency room care. If you’ve been seriously harmed in a car accident, you can go to the emergency room.” Patients with chronic conditions that don’t require emergency interference — the millions of Americans with diabetes who need “regular access to medication to stay alive,” asthma patients, or women diagnosed with breast cancer — would not be able to access needed treatments.

Although Obamacare and Romney’s own health reform law in Massachusetts both overcome this hurdle by mandating and subsidizing health insurance for all residents, irrespective of pre-existing conditions, Romney no longer seems to believe that his own program — which has improved the lives of millions in Massachusetts while nearly eliminating the children’s uninsured rate in the state — is effective enough to be implemented in other states.