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1、National Health Reform: The Primary Care Imperatives and Strategies for Addressing Them Presentation to the Center for Family and Community Medicine Columbia University Medical Center,Ronda Kotelchuck, Executive Director Primary Care Development Corporation Thursday, January 21, 2010,Introduction: T
2、he Problems Health Care Reform: The Primary Care Agenda Primary Care Expansion Primary Care Transformation A. Practice Redesign B. Health Information Technology Lessons and Reflections,Overview,1. Introduction: The Problems,Rising Cost and the Role of Chronic Illness,The rising cost of health care i
3、s unsustainable Cost is driven by the rising rate of chronic illness. It: Is the single largest cause of morbidity and mortality Is the single largest driver of cost (accounts for 75% of all health expenses) Has the heaviest impact on low income communities Will grow more severe as population ages C
4、hronic illness is overwhelmingly preventable or primary care manageable. Prevention and management require a robust model of primary care.,Primary Care Today: Insufficient and Poorly Organized,Primary care capacity is insufficient: 60 million Americans lack access to primary care Half of primary car
5、e doctors plan to reduce or end their practices Only 20 percent of medical students plan to practice primary care U.S. is expected to need 46,000 primary care doctors by 2025 Most primary care is poorly organized and still practiced in an outdated mode. It is: Reactive and episodic Subject to long w
6、aits and delays Uncoordinated Inefficient,Study: US Lags Behind other Countries in Key Primary Care Indicators,Commonwealth Fund study of 11 countries (November 2009) Australia, Canada, France, Germany, Italy, Netherlands, New Zealand, Norway, Sweden, UK, US US 10th out of 11 in use of Electronic Me
7、dical Records (46% - ahead of Canada) 10th of 11 in use of care teams (ahead of France) Last in access to after-hours care Least likely to have financial incentives for clinical outcomes,2. Health Care Reform The Primary Care Agenda,Health Reform Will Drive the Need for Expanded Primary Care Capacit
8、y,Expanded insurance coverage will put millions of new customers into the healthcare market Physician shortages will increase by 25% and workload by 29% over the next 15 years. The Massachusetts experience: 97% coverage Patients wait months for appointments 40% of family physicians are not accepting
9、 new patients Record use of ER for non-emergencies,Rising Costs Will Drive the Need to Transform the Model of Primary Care,Growing evidence shows that primary care is effective in reducing costs, improving health outcomes and eliminating disparities Employers, insurers and policymakers are looking t
10、o primary care as the new paradigm. A new model of care is necessary, however, to achieve these objectives. Innovations in practice have been afoot for years (practice redesign, evidence-based clinical protocols, etc.) Now these are integrated into the concept of the Patient-Centered Medical Home (P
11、CMH),PCDC: Offering Strategies for Primary Care Expansion and Transformation,Non-profit organization founded in 1993 to address lack of primary care access in underserved communities Premier public-private partnership focused on needs of safety net providers - community health centers, hospitals, sp
12、ecial needs providers Three areas of expertise Capital Financing Performance Improvement Policy,3. PCDC: Strategies for Expanding Primary Care Expansion,PCDC Primary Care Expansion Strategy,Problem: Lack of capital constrains growth of long-standing, dedicated providers of care to the underserved; f
13、urther hampered by credit crisis Strategy: Use public funds to leverage private investment Provide favorable-term loans to catalyze construction of new, expanded and renovated sites, modernized facilities Provide: Technical assistance for facility development Provide strong oversight to ensure succe
14、ssful project completion and long-term sustainability,Results,Total investments of $245 million for 78 capital projects in New York State Created capacity for 550,000 new patients/1.7M visits annually Leverage more than 5:1 private:public investment Cornerstone of local economic development: 2,200 p
15、ermanent jobs created; 4,400 with community multipliers Facilities operating successfully, no defaults,PCDC Capital Projects (partial list),Joseph P. Addabbo Family Health Center Queens, NY,Before,After,$9.4 million for 22,000 SF new facility; increased patient visits by 40%,Callen-Lorde Community H
16、ealth Center Chelsea,Before,After,$9.3 million for relocation & expansion Increased patient visits from 8,000 to 48,000 annually,Reflections on Capital Strategy for Expansion,Partnership among stakeholders is key Creates a permanent community infrastructure Relative ease of raising capital Builds a baseline of knowledge and relationships that provide great foundation stones for other initiatives (e.g., transformation; policy) Technical assistance is critical for organizations that have lit
