Health Care Reform Roundtable Discussion at White House Focuses on Primary Care Solutions
By James Arvantes
8/19/2009
"We want to work with physicians and state health leaders who have already been engaged in some of these reforms," said DeParle.
"We have folks around this table who have done amazing things to improve the way patients receive care," said Robert Kocher, M.D., a member of the National Economic Council and special assistant for health care to the president, who moderated much of the discussion.
- care coordination,
- patient education and empowerment,
- easier patient access to providers, and
- the use of health information technology.
Primary Care Base
According to Dobson, who is chair of the project, CCNC is a public-private partnership between the state of North Carolina and 14 not-for-profit networks composed of most of the state's local providers, including physicians, hospitals, academic medical centers, public hospital systems, health departments and social services.
The partnership delivers patient-centered primary care to low-income adults and children in the state, including Medicaid recipients and beneficiaries enrolled in the State Children's Health Insurance Program.
CCNC has saved the state's Medicaid program more than $100 million a year for the past six years and, in the process, has emerged as the centerpiece of North Carolina's health care strategy, a model embraced by patients and providers alike, said Dobson.
He attributed the success of CCNC to three key elements:
- the medical home, which all patients are required to have;
- integrated health systems that are connected virtually, providing "a flexible structure that has proved adaptable in rural areas, as well as urban areas"; and
- increased payment, including a supplemental blended fee for care providers and funds for patient and primary care physician resources, such as case managers, care coordinators, pharmacists and medical directors.
Group Health Physicians comprises 250 primary care practices and 400,000 patients. The company has made a substantial investment in its primary care teams by increasing staffing for the teams by 30 percent. It also decreased the number of patients that physicians are responsible for from 2,300 to 1,800 and increased individual physician/patient visitation times from 20 to 30 minutes, said Soman.
What the organization has sought to do, he said, is put the patient/physician unit at the core of everything it does. "That means supporting that relationship with high-quality information, strong teams and great access. This allows the teams to address each patient's acute, chronic and prevention needs."
With a patient-centered, primary care focus, Group Health Physicians was able to reduce ER and urgent care visits by 29 percent during a one-year period, said Soman.
Common Visions
"Without payment reform, without facilitation, without leadership and vision ... without getting all the payers involved, this goes from a two-year process, as we've seen in some states, to a 15-year process, said Phillips. "It really takes some organization and some work to help practices get there."
Kevin Grumbach, M.D., professor and chair of the department of family and community medicine at the University of California, San Francisco, told the roundtable "everyone in this country should be getting accessible, whole-person, patient-centered care that is built on a solid foundation of primary care."
"That is not the governing ethos of this health care system right now," he said. "It is about, 'How much high tech can you pour into it?' 'How much subspecialization can you get?' 'How many new hospitals can you build?' That is where the incentives are right now."
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