Primary Care Challenges: Data, Teams and Primary … Care Challenges: Data, Teams and Primary Care....
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Primary Care Challenges: Data, Teams and Primary Care Andrew Bazemore MD MPH National Health Policy Forum November 2013
Transcript of Primary Care Challenges: Data, Teams and Primary … Care Challenges: Data, Teams and Primary Care....
Primary Care Challenges:
Data, Teams and Primary Care
Andrew Bazemore MD MPH
National Health Policy Forum November 2013
U.S. Primary Care Workforce by Provider Type, 2010
Primary care provider Number
Physicians 208,807
Nurse practitioners 55,625
Physician assistants 30,402
Total 294,834
2010 AMA Masterfile, 2010 National Provider Identifier File
U.S. Primary Care Workforce by Provider Type, 2010
Primary care provider Number
Physicians 208,807
Nurse practitioners 55,625
Physician assistants 30,402
Total 294,834
2010 AMA Masterfile, 2010 National Provider Identifier File
Primary Care Providers & ‘Scope of Practice’ debates
War of words over:
Substitution, Length of training
Access, Cost benefits debated
Primary Care Providers & ‘Scope of Practice’ debates
War of words over:
Substitution, Length of training
Access, Cost benefits debated
Primary Care Providers & ‘Scope of Practice’ debates
War of words over:
Substitution, Length of training
Access, Cost benefits debated
Fighting for crumbs
Much ado about nothing?
Spending on Primary Care: Mai Pham, CMS: PC = 4% of Medicare 6-7% of health care dollar
McKinsey Report, 2008: Runaway growth concentrates in same day hospital costs ($186 billion more than expected over 3 yr period, nearly 10% annual growth, driven by more procedures, expensive diagnostics)
Spending & Primary Care
UNITED STATES
AUSBEL
GERCAN
DKFINNTH
SPASWE UK
FRA
JAP
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2worse Primary Care Score better
Per
Cap
ita H
ealth
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pend
iture
s 20
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Spending & Primary Care
UNITED STATES
AUSBEL
GERCAN
DKFINNTH
SPASWE UK
FRA
JAP
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2worse Primary Care Score better
Per
Cap
ita H
ealth
Car
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pend
iture
s 20
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UnitedStates
AUS
BEL GER
CANFIN
SP SWE
UK
0
1
2
3
4
5
6
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8
9
10
0 1 2 3 4 5 6 7 8 9 10 11 12
better------Primary care score ranking-------worse
Heal
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re O
utco
mes
Ra
nk* NTH/DK
$0
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
$450,000
Ann
ual I
ncom
e
Year
Specialty to Primary CarePhysician Payment Gap
Diagnostic
Orthopedic Surgery
Primary Care
Family Medicine
10
Do provider/population ratios matter?
Between 1500:1 and 2000:1 (FP + NP+PA; 1000:1 with other PCPs) if costs and avoidable hospitalizations matter
Difficulty demonstrating for General Internal Medicine
Primary Care’s Aspirations: Declaration of Alma Ata
“Primary care is essential health care based on practical, scientifically sound and socially acceptable methods and
technology made universally accessible to individual and families in the community through their full participation and at a
cost that the community and country can afford… It forms an integral part of both the country’s health system, of
which it is the central function and main focus, and overall social economic development of the community”
Institute of Medicine Report: Primary Care and Public Health Exploring Integration to Improve Population Health
March 28, 2012
Folsom
Community
Public Health Community
Medical Community
Primary Care Must Pursue Health as a ‘Community Affair’:
Moving the Primary Care discussion towards self-actualization
Moving the Primary Care discussion towards self-actualization
Alma Ata: Integrated, Team Based,
Community Oriented, Patient-Centered
Primary Health Care
U.S. Health Care System: FFS driven towards
Competition/Substitution, Provider & Hospital centric
Future of Primary Care?: Spending tied to Population Health means
More Interdisciplinary teams
Geriatric Interdisciplinary Teams (GIT-P) Bodenheimer et al: Lower burnout, Higher pt
satisfxn, better clinical outcomes Requires: Clear goals & roles/division of labor,
effective communication, training together
Overcoming the ‘overwhelming barriers of disciplinary territoriality and systems inertia’
Baldwin DC. DHHS 1994
Future of Primary Care?: Spending tied to Population Health means
PC driven redxn in hospital bed-days Geisinger, Wellmed
A Stronger Training Pipeline More Decentralized, Interdisciplinary training?
More Patient & Community engagement
Questions?
