The value of primary care

Page 1 © Copyright IBM Corporation 2007

Global Well-being Service & Health Benefits

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.



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 37th 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.



“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?



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?



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Per Capita Health Care Expenditures

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Primary care score vs rank in outcomes

UnitedStates

AUS

BELGER

CANFIN

SP SWE

UK

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*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





Total cost of healthcare vs availability of Primary Care



Total cost of healthcare vs availability of Specialists



Quality Rank vs availability of Primary Care



Quality Rank vs availability of Specialists



The numbers say:primary care delivers better health outcomes

mortality

morbidity

medication use

per capita expenditures

patient satisfactionSOURCE: B. Starfield, et al, “The Effects of Specialist Supply on Populations’ Health,”

Health Affairs (March 2005); W5-97



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



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



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



“ …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



“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

Economy & Finance

The value of primary care