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8/14/2019 Advocating for Primary Care in a Budget Crisis.and Beyond
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Advocating for Primary Care in aBudget Crisis.and Beyond
Presentation to the
National Association of Community Health Centers
_________________________Kate Breslin, Community Health Care Association of New York State
Dan Lowenstein, Primary Care Development Corporation
August 24, 2009
www.nyprimarycarehome.org
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Overview
Background
Opportunities Forming the Coalition
Coalition Strategies and Tactics
Challenges
Outcomes
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Background Why?
Historically, New York has:
An extremely strong acute care system and an
undersized, disorganized primary care sector. High and rising health care costs (including but
not limited to Medicaid) with mediocre healthoutcomes.
Large disparities in access & outcomes. Highest Medicaid spending in the US, with
mediocre outcomes.
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Background Opportunities
Recognition of inefficient and expensive
health care system
Commission on Health Care Facilities in the
21st Century (Hospital Closing Commission)
formed to address costs
Governor offers a fresh start promises
to transform New Yorks health care system
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Background Challenges
Low awareness of primary care
Organized, resourced hospital sector, but
disorganized, under-resourced primary care sector Competing agendas among primary care
stakeholders
Rapidly contracting economy groups competing
for shrinking resources Governor Spitzer resigns early questions about
whether Governor Paterson would support
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Formation of the
Primary Care Coalition Primary Care Development Corporation
(founder)
Community Health Care Association of New
York State (founder)
Area Health Education Centers System
American College of Physicians
Academy of Family Physicians
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Coalition Purpose
Purpose: Place primary and preventive care
at the center of the States health reform
agenda with the objective of assuring astrong, effective primary care home for
every New Yorker.
Strategy: To build the consensus, visibilityand momentum needed to do this.
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The Primary Care Agenda
Reform the payment system to encourage primary careby enhancing reimbursement for primary care services;
Preserve and expand primary care infrastructure and
workforce capacity; Transform the current model of care to a patient-
centered healthcare home;
Aggressively promote the use and adoption of health
information technology among providers of primarycare services; and
Expand and improve coverage to remove financialbarriers to care
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Aligns with/supports National Agenda
Increase capacity
through workforce,
capital, HIT
Support for primary care
capital and HIT adoption
Develop a primary care
workforce
Reform payment systems
to support primary care
Transform to PCMH &
expand capacity
Primary Care
Coalitions NY
Primary Care Agenda
Implement support
systems and TA
Augment capital
resources
Assure workforce
Expand revenue: grants
and reimbursement
Preserve, strengthen,
expand on stable base
Access for All America
NACHCs AAA Plan
Infrastructure
Capital
Workforce
Reimbursement
Capacity
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Coalition Operations Core funding: organizational self-assessments,
augmented by additional funds as available.
Coalition leaders supply the policy expertise; hire:
Media specialist, given the need for a campaign
A part-time coordinator
Coalition partners commit themselves to weekly
war-room calls + periodic 1-day strategy retreats
Decision-making is collective; requires rapidresponse from all partners on media issues
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Strategies and Tactics
Key Messages New Yorks health care system is inefficient and
expensive
Primary care is essential to*
Lowering health care costs
Improving health outcomes
Eliminating disparities
Investing in primary care saves money in the system
Strengthening primary care must go hand in hand withexpanding health insurance coverage
* Laying the Foundation: Health System Reform In NYS and thePrimary Care Imperative, Rosenbaum and Shin
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Strategies and Tactics - Policy
Developed 5-point agenda for Primary Care
Issued reports and studies detailing need for
primary care
Promoted third party evidence that supported
PCCs agenda
Publicly & actively supported New Yorksprimary care investments
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Strategies and Tactics Key Targets
New York State: Executive, Legislature,
Hospital Closing Commission
New York City: Mayor, City Council
Focus on key decisionmakers in
government
Built primary care champions
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Strategies and Tactics Outreach Meetings with key legislators
Testimony at public hearings
Position papers on legislative/budget issues
Regular mailings/emails Sign-on petitions
Coalition listserv
Website
Media
Press conferences
Editorial board meetings
Edtiorial/Op-ed/story placements
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Policy ResearchPrimary care need, capacity, cost savings:
Laying the Foundation: Health System Reform In NYS and thePrimary Care Imperative, (2006, Rosenbaum and Shin)
Analysis of potential cost savings through primary care investment (in
progress, August 2009) Primary Care Capacity Shortage in NYC and the Potential Impact of
Hospital Closures (PCDC and HHC)
A Zip Code Analysis of Primary Care Need in NYS (AHEC)
The Future of Primary Care in NYS (ACP)
Payment reform
New Yorks Primary Care Reimbursement System: A Roadmap ToBetter Outcomes (PCDC)
Commercial Insurers Reimbursement Rate to New YorksCommunity Health Centers Jeopardizes Care (CHCANYS)
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Website: nyprimarycarehome.org
http://www.nyprimarycarehome.org/8/14/2019 Advocating for Primary Care in a Budget Crisis.and Beyond
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Media Success
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Cycle of Influence
Media Strategy
Policy Implications
Research Published
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Policy outcomes 2006-2007
Hospital Closing Commission includes
primary care investment recommendations
Primary care policy included in
gubernatorial primary and election
campaigns
Assembly hearings on primary care
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Policy outcomes 2008-2009
New York makes historic shift in investments from inpatient tooutpatient
$600 million invested in primary care in 2007-2009
Reimbursement for important primary care enhancements
(weekend/evening operations, asthma/diabetes educators
Doctors-Across-NY - loan forgiveness and practice start-up assistance
physicians to practice in underserved communities
New Primary Care Quality Standards - Statewide Medical Home slated
for 2010
Positive changes in primary care safety net/uninsured funding
Dedicated $200M special grant funding to expand primary carecapacity, assist in HIT adoption
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Whats Next?
Strategically grow coalition to engage other supporters
Expand media presence, including social media
Assure continued success of the 4-year reform agenda inthe face of continuing hospital opposition, State budgetcrisis.
Monitor feedback on reforms
Are they having the desired impact on quality and access? Are
they sufficient? Leverage new opportunities
Impact of federal health reform primary care
Federal HIT impact/opportunities/ARRA
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Big Challenges
Policy Challenges
Primary and preventive care are a silent needdifficult to light on fire as an issue.
Historic underfunding lack of power and visibilitycompared to other health care sectors.
Health care reform defined as insurance expansion
Coalition Challenges Consensus decision-making
Resources, organizational capacity
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Reflections: The Policy Front
The importance of campaign skills
The need for credibility
Expanded Coverage vs. Delivery SystemReform: Why you cant have one withoutthe other
The need to keep reinforcing messagse topolicymakers, partners, media
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Reflections: All Fronts
The importance of:
Building clarity, consensus on the problems
Having actionable strategies Building stakeholders/partnerships
Remembering that we are stronger together
than we are apart (even though we dontalways agree)
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Dan Lowenstein at (212) 437-3942
www.pcdcny.org
Kate Breslin at (518) 434-0767www.chcanys.org
www.nyprimarycarehome.org
http://www.pcdcny.org/http://www.chcanys.org/http://www.chcanys.org/http://www.pcdcny.org/