The value of primary care

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Slides from the Patient-Centered Primary Care Collaborative, documenting the benefits of having good primary care, improving both cost and outcomes.

Slides from the Patient-Centered Primary Care Collaborative, documenting the benefits of having good primary care, improving both cost and outcomes.

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  • 1. What is a Patient Centered Medical Home ?
    • Patient Centered Medical Home (PCMH) is an approach to providing comprehensive primary care to adults, youth and children.
    • PCMH will broaden access to primary care, while enhancing care coordination .
  • 2. Background Information
    • Employers are facing rising medical costs that have now exceeded the growth of earnings.
      • This is a “game over” scenario: it cannot go on anymore.
    • There are currently over 46 Million Americans without any form of Medical Coverage.
    • ~ 40% of Americans do not have a Primary Care Provider or a Medical Home.
      • >300,000,000 Americans growing at 1.3%/year
    • The median household income in the U.S. is $46,326
    • U.S. Health Care System is ranked 37 th by the W.H.O. and we spend the most per patient.
    • U.S. has worst record of the 19 developed economies in adding years of life using medical interventions.
    • The U.S. health care system has to change.
  • 3. “ Across the globe doctors are miserable because they feel like hamsters on a treadmill. They must run faster just to stand still… The result of the wheel going faster is not only a reduction in the quality of care but also a reduction in professional satisfaction and an increase in burnout among doctors.” Morrison and Smith, BMJ 2000;321:1541 Primary Care: Currently an Impossible Job?
  • 4.
    • Because of inadequate reimbursement, primary care physicians need excessively large patient panels to keep their practices viable. The average US primary care patient panel is 2300 .
    • A primary care physician with a panel of 2500 average patients would need to spend 7.4 hours per day performing recom-mended preventive care [YARNALL ET AL. AM J PUBLIC HEALTH 2003;93:635]
    • A primary care physician with a panel of 2500 average patients would need to spend 10.6 hours per day performing recom-mended chronic care [OSTBYE ET AL. ANNALS OF FAM MED 2005;3:209]
    Primary Care: Currently an Impossible Job?
  • 5. Primary Care Score vs. Total Expenditures , 1997 Starfield 10/00 00-133 US NTH CAN AUS SWE JAP BEL FR GER SP DK FIN UK Starfield 10/00 IC 1731
  • 6. Primary care score vs rank in outcomes * Rank based on patient satisfaction, expenditures per person, 14 health indicators, and medications per person in Australia, Belgium, Canada, Denmark, Finland, Germany, Netherlands, Spain, Sweden, United Kingdom, United States
  • 7.  
  • 8. Total cost of healthcare vs availability of Primary Care
  • 9. Total cost of healthcare vs availability of Specialists
  • 10. Quality Rank vs availability of Primary Care
  • 11. Quality Rank vs availability of Specialists
  • 12. The numbers say: primary care delivers better health outcomes
    •  mortality
    •  morbidity
    •  medication use
    •  per capita expenditures
    •  patient satisfaction
    • SOURCE: B. Starfield, et al, “The Effects of Specialist Supply on Populations’ Health,” Health Affairs (March 2005); W5-97
  • 13. Patient-Centered Care is:
    • *Patient Engagement in Care
    • *Clinical Information Systems supporting QI
    • *Care Coordination
    • *Integrated and Comprehensive Team Care
    • *Routine Patient Feedback to Physicians
    • *Publicly Available Data on Physician Performance
    • *Superb Access to Care
    • SOURCE: Karen Davis, Stephen Schoenbaum, MD, Anne-Marie Audet, MD, “A 2020 Vision of Patient-Centered Primary Care”, 2006 Commonwealth Fund Annual Report
  • 14. Addressing Care Coordination through the PC-MH
    • Care coordination is inherent as part of Primary Care through training, continuity, and relationships
    • Critical new focus on Family Medicine and primary care as a Team Sport –
      • Physicians
      • Other clinicians and office staff
      • ‘ Organized’ Referral Networks based on ‘value’
      • ‘ Organized’ Community Resources
  • 15. Principles of the Patient Centered Medical Home
    • - Approved by the AAFP, ACP, AAP, and AOA
        • Personal Physician
        • Team Based Medical Practice
        • Whole Person Orientation
        • Care is Integrated and/or Coordinated
        • Quality and Safety
        • Enhanced Access to Care
        • Payment Reform
  • 16.
    • “ … studies have demonstrated that a primary care–based health care system has the potential to reduce costs while maintaining quality .
    • The hospitalization rates for diagnoses that could be addressed in ambulatory care settings are higher where access to primary care physicians is more limited .
    • States with a higher ratio of generalist to population have lower per-beneficiary Medicare expenditures and higher scores on 24 common performance measures than states with fewer generalist physicians and more specialists per capita. ”
    Primary Care — Will It Survive? Thomas Bodenheimer, M.D. Perspective August 31, 2006
  • 17.
    • “ Fixing primary care requires actions on the part of primary care practices (microsystem improvement) and the larger health care system (macrosystem reform).
    • A covenant is needed between those who pay for health care and those who deliver primary care: primary care must promise to improve itself, and in return, payers must invest in primary care.”
    Primary Care — Will It Survive? Thomas Bodenheimer, M.D. Perspective August 31, 2006