The Primary Care Journey Where Have We Been? Where Are We Now? Where Do We Go From Here? By Ronda Kotelchuck Executive Director Primary Care Development Corporation April 4, 2008
A Couple of Reminders The Dual Agenda •
Universal coverage
•
Health system reform
Who Delivers Primary Care to the Underserved? 5. Hospital outpatient departments (50%) 6. Private practitioners (35%) 7. Community health centers (15%)
A LookBack: Late 1980’s, Early 1990’s • Community epidemics; overcrowded hospitals • Growing consensus on critical lack of primary care – – – – –
Community Service Society Report Foundation Initiatives NYS Department of Health, NYC Health Planning Agency Advocates HHC Strategic Plan, the Mayor’s Initiative
• Creation of PCDC – To expand primary care capacity by making available capital for new and expanded facilities – To assist providers in achieving new levels of excellence in access, quality
The Mid1990’s to 2005 • Major shift in NYS health policy – Deregulation; competition; belief in the market – Managed care; the growth of primary care capacity – Rate freezes for ambulatory care
• Deepening problems: – The growth of chronic illness – Rising costs with little evidence of impact – Appalling disparities in health and health care
The Precursors National: • Growing evidence base for primary care and its impact on: – Rising costs – Health outcomes – Health disparities
• Emergence of the PatientCentered Medical Home (PCMH) – Consensus of employers, payors, consumers, professional associations; establishment of the National PCMH Collaborative – Agreement on standards and measures – Recognition program by NCQA
Precursors (Continued) New York State • The Concern with Cost: – The Senate Task Force on Medicaid Costs – The Governor’s Task Force on Medicaid – The Berger Commission
• Formation of the Primary Care Coalition • A new governor with a primary care agenda
Establishing the Primary Care Agenda •
Primary care capacity: –
2.
A new model of primary care: – –
•
Essential to providing quality care Expensive to acquire and operate, especially for safety net primary care providers
Workforce: – –
•
Most primary care still reactive, episodic, lacks continuity, coordination Performing far below best practices
Information technology (especially EHRs): – –
•
Urban and rural communities still in need
Young people ceasing to enter primary care Physicians fleeing NY’s underserved communities
Primary care reimbursement (The most important) – –
Historic underpayment Lack of financial resources, incentives for improvement
What Happened and Where Do We Stand Today? The significance of: – The 200809 NYS health care budget, use of HEALNY monies – The consensus that produced it
The overview: – Shift from inpatient to outpatient: $170M – Primary care enhancements: $170M
The Score Card 1.
Primary care reimbursement: – –
•
Primary care capacity: – –
3.
Higher rates, new payment method for hospitals, DTCs (APGs) Increase in private practice rates (75% of Medicare) HEAL 6: $105M for primary care expansion Enhanced reimbursement for evening, weekend hours
Primary care workforce: –
Doctors Across NY: • • •
Physician Loan Repayment: $2M/year for recruits to underserved communities ($150,000 over 5 years) Physician Practice Support: $5M for physicians opening or joining practices in underserved communities CommunityBased Ambulatory Care Training: $5M for resident/medical student training in community sites
The Score Card (Continued) 1.
New model of primary care: –
Diabetes and asthma educators for patient selfmanagement
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Mental health:
–
2.
•
Reimbursement for services by CSWs for children, adolescents, pregnant women, in DTC settings
•
Integration of primary care and mental health
New quality standards for hospital outpatient departments
Health information technology: –
HEAL 5: $105M for health information exchange among communitybased providers
–
Supplemental Payments for DTCs serving Medicaid, uninsured
Where Do We Go From Here? • Sea change, yet tentative, first steps • Continued need for support, momentum, vigilance • The vision: the PatientCentered Medical Home
For More Information, Contact: • The Primary Care Development Corporation – Website: www.pcdcny.org – Phone: (212) 4373917 – EMail:
[email protected]
• The Primary Care Coalition – Website: www.nyprimarycarehome.org Listserv: email to
[email protected]