The Primary Care Journey: Where Have We Been? Where Are We Now? Where Do We Go From Here?

  • Uploaded by: pcdc1993
  • 0
  • 0
  • May 2020
  • PDF

This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA


Overview

Download & View The Primary Care Journey: Where Have We Been? Where Are We Now? Where Do We Go From Here? as PDF for free.

More details

  • Words: 669
  • Pages: 12
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



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]

Related Documents


More Documents from ""