The Primary Care Crisis: Prospects for Reinvention Kavita K. Patel M.D., M.S. Daniel Fields...

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The Primary Care Crisis: Prospects for Reinvention Kavita K. Patel M.D., M.S. Daniel Fields Elizabeth Leshen The Primary Care Crisis May 4, 2010, Page 1

Transcript of The Primary Care Crisis: Prospects for Reinvention Kavita K. Patel M.D., M.S. Daniel Fields...

Page 1: The Primary Care Crisis: Prospects for Reinvention Kavita K. Patel M.D., M.S. Daniel Fields Elizabeth Leshen The Primary Care Crisis May 4, 2010, Page.

The Primary Care Crisis: Prospects for Reinvention

Kavita K. Patel M.D., M.S.Daniel FieldsElizabeth Leshen

The Primary Care Crisis May 4, 2010, Page 1

Page 2: The Primary Care Crisis: Prospects for Reinvention Kavita K. Patel M.D., M.S. Daniel Fields Elizabeth Leshen The Primary Care Crisis May 4, 2010, Page.

The Promise of Health Reform

The Primary Care Crisis, Page 2

Page 3: The Primary Care Crisis: Prospects for Reinvention Kavita K. Patel M.D., M.S. Daniel Fields Elizabeth Leshen The Primary Care Crisis May 4, 2010, Page.

Vermont Colorado Inter mountain

North Dakota

North Carolina

Group Health

Geisinger

Embedded care coordinator

Community teams*

24/7 access

Performance evaluations

Health IT

Pay for performance

PMPM payment

Shared savings

Note: characteristics as reported* With care coordinator** % reduction from baseline

Comparison of Successful Medical Homes

Dedicated Care

Coordinator

Access

Data-driven tools

Payment reform

Key common features are:

• Dedicated care coordinators• Expanded access to care givers• Data-driven analytical tools• Incentives for providers

Page 4: The Primary Care Crisis: Prospects for Reinvention Kavita K. Patel M.D., M.S. Daniel Fields Elizabeth Leshen The Primary Care Crisis May 4, 2010, Page.

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Group Health7

Vermont4

Geisinger

Intermountain

North Dakota

Colorado

North Carolina

ED visit reduction

Total savings / patient

11%

15%

18%

40%2

29%

24%

16%

$71

$215

$640

$169-5303

$5166

North Dakota 6%

1 Not all metrics reported; unless indicated otherwise, data is based on as reported outcomes, reduction from baseline2 Only for Asthma patients3 $169 for all patients; $530 for patients with chronic conditions4 Expected5 4.8% for all patients; 19.2% for patients with complex illnesses6 Based on AFDC savings from FY2007 ($135m) and ABD savings from FY2008 ($400m).7 Change relative to control group. See Reid et al, 2009 for more detail. 8 No change for overall population, 7.3% for patients with complex illnesses.

$530

HospitalizationReduction

4.8-19.2%5

11% 12%

0-7.3%8

Sources: Colorado Department of Health Care Policy and Financing, Geisinger Health Plan, Paulus et al., Group Health Cooperative, Reid et al (2009), Dorr et al (2006), Care Management Plus, Community Care of North Carolina, McCarthy et al (2008), Vermont Blueprint for Health

Overview of Outcomes

Pilots showed significant improvements:

• Hospitalization reduction

• ED visit reduction

• Per-patient savings

1 Not all metrics reported; unless indicated otherwise, data is based on as reported outcomes, reduction from baseline2 Only for Asthma patients3 $169 for all patients; $530 for patients with chronic conditions4 Expected5 4.8% for all patients; 19.2% for patients with complex illnesses6 Based on AFDC savings from FY2007 ($135m) and ABD savings from FY2008 ($400m).7 Change relative to control group. See Reid et al, 2009 for more detail. 8 No change for overall population, 7.3% for patients with complex illnesses.

Geisinger

Intermountain 4.8-19.2%5 0-7.3%8 $640

North Dakota 6% 24% $531

15%

Page 5: The Primary Care Crisis: Prospects for Reinvention Kavita K. Patel M.D., M.S. Daniel Fields Elizabeth Leshen The Primary Care Crisis May 4, 2010, Page.

Challenges for the Future

• Determining which features are essential and which can vary

• Mastering the complexity of scalable implementation

• Aggregating program data to learn from mistakes and successes

• Consideration of systemic reforms?• Primary Care Pipeline- is it what we

needed/wanted?


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