Sunday, May 9, 2010

Reinventing Primary Care

Primary Care is in crisis mode and as a result bold changes are needed to help the U.S. deliver and pay for primary care, according to the authors published in the May issue of “Health Affairs”. The thematic May issue discusses the primary care crisis, innovative models needed for reform, expanding the role of other health professions, and information on promising healthcare provider practices.

“The horribly broken primary care system that we now have is plagued by underinvestment and misaligned incentives,” according to Health Affairs editor-in-chief Susan Dentzer. She continued to say “primary care is stuck in a bygone era but health reform offers the opportunity to reinvent primary care and rapidly move it into the 21st century.”

To bring these ideas together on reinventing primary care, a briefing was held on May 4th at the National Press Club hosted by Health Affairs, to discuss the variety of thoughts and ideas presented by a number of key experts.

Kathleen Sebelius, Secretary HHS, said “This is a historical moment in the transformation of the healthcare system as we are remaking and rebuilding the American healthcare system. Stronger steps are needed to support the need for primary care.

The Secretary discussed the strategic moves needed to address the problem. These include providing for incentives and coming up with new initiatives to increase and attract the workforce to the primary care field, find ways to expand the community health center program, develop the framework needed to address reimbursement issues, examine ways for collaborative care to work such as in medical homes, invest in health IT, and upgrade prevention and wellness programs.

To discuss how medical homes can play a part in supporting primary care, Paul Grundy, Director of Healthcare Technology and Strategic Initiatives, IBM Global Wellbeing Services and Health Benefits at IBM, pointed out that the patient centered medical home can really drive change.

Grundy has visited a few communities with ongoing medical homes and sees the profound impact that it can have on the community. For example, since using the medical home concept in Shelby County area in Iowa, there has been a 47 percent reduction in hospitalizations, 32 percent reduction in emergency room use, 43 percent reduction in cost overall, and a 20 percent reduction in costs for CMS. Also, in Calhoun County Area in Michigan there has been a 49.7 percent reduction in hospitalizations, reductions in costs, and the patients and the physicians have expressed improved satisfaction with the program.

He continued to say “In order for the medical home model to take effect, financial incentives have to change, quality and safety need to be the hallmark of the medical home, and resources have to be made available with support to drive the transformation of care.”

In addition, “Coordination is key and has to be integrated across all elements of the complex healthcare community. Coordination is enabled by registries, establishing new communication paths between patients, personal physicians, and the staff, plus information technology and health information exchanges must be in place.”

Troy Brennan, Executive Vice President and Chief Medical Officer of CVS Caremark Corporation said, “Another new concept that helps to drive primary care is the Minute Clinic Model which enables people to have on-demand access to basic primary care and at their convenience. Minute Clinics provides services and increased access, but at the same time, helps patients re-engage with traditional care and can be an asset to further support the medical home.

A paper appeared in the May issue of Health Affairs authored by Daniel Fields, a law student at Harvard, Elizabeth Leshen a biological engineering student at MIT, and Kavita Patel, a former Director of Policy for the Office of Public Engagement at the White House that discusses driving quality and cost savings through the adoption of medical homes.

The paper discusses seven medical home model pilots and summarizes the outcomes. The pilots included in the study included the Colorado Medical Homes for Children, Community Care of North Carolina, Geisinger Health System, Group Health Cooperative in the Pacific Northwest, Intermountain Health Care, North Dakota, and Vermont’s Blueprint for Health. The pilots showed significant improvements, hospitalization reductions, emergency department visits reduced, and per-patient savings.

According to Dr. Patel, speaking at the briefing, “There is much work to do. It is important to determine if all the features in the model home model are essential and which features can vary. It is important to master the complexity of scalable implementation, be able to aggregate program data to learn from mistakes and successes, consider systematic reforms, and determine exactly what is needed to develop the primary care pipeline.”

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