New York’s Primary Care Coalition

Presentation to the

Florida Association of Community Health Centers

_________________________Ronda Kotelchuck, Primary Care Development Corporation

Kate Breslin, Community Health Care Association of New York State

July 29, 2008

www.nyprimarycarehome.org

Overview• Backdrop

• The Opportunity

• The Response: Coalition

• The Purpose

• Coalition Arguments

• The Primary Care Agenda

• Coalition Tactics

• Outcomes

• Challenges and Reflections

The Backdrop

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 health outcomes.

• Large disparities in access & outcomes.

• Highest Medicaid spending in the US, with mediocre outcomes.

The Opportunity

• State attention to growing costs.

• State efforts to address cost concerns: task forces, reports, Commission on Health Care Facilities in the 21st Century (Hospital Closing Commission)

• A new Governor bringing a new Administration

The Response: Formation of the Primary Care Coalition

• Primary Care Development Corporation

• Community Health Care Association of New York State

• Area Health Education Centers System

• American College of Physicians

• Academy of Family Physicians

Coalition Leaders: Primary Care Development Corporation

(PCDC)

• 15-year old nonprofit dedicated to making available strong, effective primary and preventive care to underserved communities.

• Operates as a public-private partnership, with close relationships with the City, State, business and private foundations.

• Strategies: Providing programs and services to primary care centers– Capital financing: $221 million of investment in over 70 capital

healthcare projects, creating capacity for 450,000 patients.

– Performance Improvement: Assisted 350 health center teams reduce patient waiting times, provide same-day appointments, improve emergency preparedness, increase revenues, and implement electronic health records

Coalition Leaders: Community Health Care Association of NYS

(CHCANYS)• New York’s Primary Care Association.

• Statewide association of community health centers -- 50 CHCs with more than 425 sites, providing care for more than 1.1 million people across New York State

• Strong policy department working on behalf of CHCs and strengthening & expanding community based primary care.

Coalition Purpose

Purpose: To place primary and preventive care at the center of New York State’s health reform agenda with the objective of assuring a strong, effective primary care home for every New Yorker.

Strategy: To build the consensus, visibility and momentum needed to do this.

Coalition Arguments• A strong, effective primary care sector is essential to

solving three key problems facing the health system*:– Rising costs

– Improved health outcomes

– Eliminating disparities

• Especially true with prevalence of chronic illness as a driver of health status and health care cost.

• Health care reform has two inextricable agendas: universal coverage and delivery system reform

* “Laying the Foundation: Health System Reform In NYS and the Primary Care Imperative,” Rosenbaum and Shin

The Primary Care Agenda

• Reform the payment system to encourage primary care by 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 primary care services; and

• Expand and improve coverage to remove financial barriers to care

Coalition TacticsTargets:

• State: Executive, Legislature, Hospital Closing Commission

• New York City: Mayor, City Council

Tactics:

• Credible justification – Rosenbaum/Shin Report

• Statewide testimony, meetings

• Getting support sign-on, broad outreach

• Press conferences

• Media Strategy including hiring of media specialist; use of press conferences, editorial board meetings, placement of articles, editorials, op-eds

• Coalition Listserv, Website (www.nyprimarycarehome.org)

Website: nyprimarycarehome.org

Press Releases, Press Conferences

CONTACT: FOR IMMEDIATE RELEASE

Stefan Friedman (212) 561-8730 June 8, 2006

GOTTFRIED, QUINN, STATEWIDE HEALTHCARE LEADERS CALL FOR

INCREASED PRIMARY AND PREVENTIVE CARE

Broad coalition from business, labor, and political communities join healthcare

advocates in urging statewide taskforce to include primary and preventive care

on agenda of New York’s healthcare future Healthcare experts release New York-

based study documenting benefits of Primary Care

(NEW YORK) – As the Commission on Healthcare Facilities in the 21st Century met

today to discuss the future of healthcare in New York State, a coalition spearheaded by

Assembly Health Committee Chair Richard Gottfried, New York City Council Speaker

Christine Quinn, the Community Health Care Association of New York State, the Primary

Care Development Corporation, the New York State . . . .

Policy Research

Primary care need and capacity:

• A 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 York’s Primary Care Reimbursement System: A Roadmap To Better Outcomes (PCDC)

• Commercial Insurers’ Reimbursement Rate to New York’s Community Health Centers Jeopardizes Care (CHCANYS)

Cycle of Influence

Media Strategy

Policy Implications

Research Published

Outcomes• Influenced Hospital Closing Commission to include primary care

recommendations

• Inserted primary care policy into the gubernatorial primary and election campaigns

• Sponsored, broadly distributed and publicized signature study: “Laying the Foundation: Health System Reform in NYS and the Primary Care Imperative”

• Established a website (www.nyprimarycarehome.org) and a listserv

• Brief key officials; testify at state and local hearings, consult and advise local officials

• Obtain regular statewide press coverage, including feature articles, editorials, op-eds and letters to the editor.

• Obtained upstate and downstate Assembly hearings on primary care

OutcomesNew York State

• FY 2008-09 budget includes $340M in annual increases to primary care, including:– Groundbreaking increases in primary care payment rates as part of a four-

year plan to shift resources from inpatient to primary care

– Reimbursement for important primary care enhancements (weekend/evening operations, asthma/diabetes educators)

– New Doctors-Across-NY program to attract physicians to underserved communities (physician loan forgiveness and practice start-up assistance)

• Dedicated $200M special grant funding to expand primary care capacity, assist in HIT adoption.

New York City

• $27M Mayoral initiative to implement electronic medical records;

• $27M City Council initiative to expand primary care; $6.2M appropriation for IT infrastructure

What’s Next?

• Assure continued success of the 4-year reform agenda in the face of growing hospital opposition, State budget crisis.

• Strategy: – Ally with behavioral health, consumer

advocacy forces

– Bring the next circle of support to the table (business, labor, county governments)

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 rapid response from all partners on media issues

The Fit With A National Agenda

Access for All America

NACHC’s AAA Plan

The Primary Care Imperative

aka the Rosenbaum report

New York’s Primary Care Campaign

Capacity Preserve, strengthen, expand on stable base

Primary care home, stem the erosion of primary care capacity

Transform to PCMH & expand capacity

Reimbursement Expand revenue: grants and reimbursement

Reimbursement reform Reform payment systems to support primary care

Workforce Assure workforce Invest in development of primary care workforce

Develop a primary care workforce

Capital Augment capital resources

Stimulate capital investment in primary care

Support for primary care capital and HIT adoption

Infrastructure Implement support systems and TA

Pay for quality and HIT adoption

Increase capacity through workforce, capital, HIT

Big Challenges

• Policy Challenges– Primary and preventive care are a silent need

difficult to “light on fire” as an issue.

– Historic underfunding lack of power and visibility compared to other health care sectors.

– Health care reform defined as insurance expansion

• Coalition Challenges– Consensus decision-making

– Resources, organizational capacity

Reflections: The Policy Front

• The importance of campaign skills

• The need for credibility

• Expanded Coverage vs. Delivery System Reform: Why “you can’t have one without the other”

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

For More Information:

PCDC

Ronda Kotelchuck at (212) 437-3917

www.pcdcny.org

CHCANYS

Kate Breslin at (518) 434-0767

www.chcanys.org

The NYS Primary Care Coalition

www.nyprimarycarehome.org