Chronic Disease Partnership Promotes Primary Care as Way to Avert Health Care Meltdown

Averting an impending crisis in the nation's health care system like that now plaguing the financial markets could require the next Congress to consider reforming the Medicare physician payment system to promote the use of primary care services to improve health care quality and save costs. That is according to former HHS Secretary Tommy Thompson and Kenneth Thorpe, M.D., executive director of the Emory Institute for Advanced Policy Solutions in Atlanta, who spoke during a media telebriefing conducted by the Partnership to Fight Chronic Disease, or PFCD, on Sept. 30.

The AAFP is a founding member of the PFCD.

"I think you are going to see legislation next year, both in the House and the Senate, that more rapidly accelerates the use of primary care," said Thorpe, executive director of the PFCD and a former deputy assistant secretary of policy at HHS during the Clinton administration.

These proposals will entail the creation of integrated primary care teams and the use of technology to better track patient care across different settings, he added.

More than 95 percent of Medicare spending is a result of chronic illnesses, a statistic that "speaks volumes to the fact that we need to redesign the delivery model largely within the traditional Medicare program," Thorpe said. "You're going to see a lot of the discussion next year move toward these issues of 'How can we redesign the delivery systems quickly around primary care and integrated teams?'"

According to Thorpe, Congress should try to find ways of realigning Medicare physician payment incentives to develop and support the health care teams. "More broadly speaking, health care homes are going to see a much more rapid diffusion over the next five years," he said.

Thompson and Thorpe said the faltering economy would accelerate, rather than diminish, the demand for health care reform. The growing cost of health care is a major concern for voters. And a failure to make health care more affordable and accessible is a recipe for disaster, they warned, one that would rival and perhaps even surpass the economic crisis now rocking the financial markets.

"We have got to find ways … to slow the growth in both Medicare and Medicaid," Thorpe said. "We've got to find ways in the private sector to make health care more affordable for working families and for businesses. Otherwise, despite the talk about universal coverage, nobody will be able to afford health care in this country 10 to 15 years from now."

The nation spends 16 percent of its gross national product, or $2.4 trillion a year, on health care, according to Thompson. Between 75 percent and 80 percent of that cost is consumed by chronic illness care, making the prevention and treatment of chronic diseases a key part of controlling health care costs, as well as improving health care outcomes. The two major presidential candidates have acknowledged the importance of wellness and prevention, giving both elements prominent roles in their health care reform plans. According to Thompson, "wellness, disease management and prevention are issues that both political parties can rally around."

"We need to look at diabetes, which is a huge problem," said Thompson. "Twenty-one million Americans have type 2 diabetes today. But the more threatening and more consequential thing is 41 million more Americans are prediabetic." If that population progresses to diabetes, the costs of treating diabetes alone will jump from $145 billion a year today to $400 billion annually in five years.

"Then you've got obesity and cardiovascular problems, plus cancers," said Thompson. "All of these can be addressed by changing human behavior and making people a lot healthier."

Thompson is dismissive of anyone who says the nation's health care system has not reached a crisis stage. "You (ask) the 47 million who don't have health insurance if this is not a crisis," said Thompson. "You talk to that small employer who has 25 to 50 employees and who is trying to maintain (health care coverage for his employees despite) double-digit health insurance premium increases year after year."

General Motors spends $5.5 billion a year on health care costs, said Thompson, more than the company pays for steel for its automobiles. "It's just amazing that people can say it's not a crisis," he said.

Thompson and Thorpe agreed that the adoption of health information technology, or HIT, and electronic health records, or EHRs, would have to be a part of any major health care reform effort. Thompson, in response to a question by AAFP News Now, said the federal government should provide the funds for HIT and EHRs, while establishing interoperability standards for EHR systems. The federal government could pay for the systems by using the money it collects through its fraud and abuse activities, he said.