the value of primary care
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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.
Page 2 © Copyright IBM Corporation 2007
Global Well-being Service & Health Benefits
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.
Page 3 © Copyright IBM Corporation 2007
Global Well-being Service & Health Benefits
“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?
Page 4 © Copyright IBM Corporation 2007
Global Well-being Service & Health Benefits
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?
Page 5 © Copyright IBM Corporation 2007
Global Well-being Service & Health Benefits
0
0.5
1
1.5
2
1000 1500 2000 2500 3000 3500 4000
Per Capita Health Care Expenditures
Pri
ma
ry C
are
Sco
rePrimary Care Score vs. Total Expenditures, 1997
Starfield 10/0000-133
US
NTH
CANAUS
SWE JAP
BEL FRGER
SP
DK
FIN
UK
Starfield 10/00IC 1731
Page 6 © Copyright IBM Corporation 2007
Global Well-being Service & Health Benefits
Primary care score vs rank in outcomes
UnitedStates
AUS
BELGER
CANFIN
SP SWE
UK
0
1
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0 1 2 3 4 5 6 7 8 9 10 11 12
better------Primary care score ranking-------worse
Hea
lthc
are
Out
com
es
Ran
k*
NTH/DK
*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
Page 7 © Copyright IBM Corporation 2007
Global Well-being Service & Health Benefits
Page 8 © Copyright IBM Corporation 2007
Global Well-being Service & Health Benefits
Total cost of healthcare vs availability of Primary Care
Page 9 © Copyright IBM Corporation 2007
Global Well-being Service & Health Benefits
Total cost of healthcare vs availability of Specialists
Page 10 © Copyright IBM Corporation 2007
Global Well-being Service & Health Benefits
Quality Rank vs availability of Primary Care
Page 11 © Copyright IBM Corporation 2007
Global Well-being Service & Health Benefits
Quality Rank vs availability of Specialists
Page 12 © Copyright IBM Corporation 2007
Global Well-being Service & Health Benefits
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
Page 13 © Copyright IBM Corporation 2007
Global Well-being Service & Health Benefits
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
Page 14 © Copyright IBM Corporation 2007
Global Well-being Service & Health Benefits
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
Page 15 © Copyright IBM Corporation 2007
Global Well-being Service & Health Benefits
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
Page 16 © Copyright IBM Corporation 2007
Global Well-being Service & Health Benefits
“ …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
Page 17 © Copyright IBM Corporation 2007
Global Well-being Service & Health Benefits
“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
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