Health Care Reform Roundtable Discussion at White House Focuses on Primary Care Solutions

Advanced models of primary care were the focus of an Aug. 10 roundtable discussion convened by Nancy-Ann DeParle, director of the White House Office of Health Reform. "We need to focus on improving the quality of outcomes, making sure that we're providing preventive care, and better coordinating care for patients with chronic diseases, and all of those are things that primary care has a critical role to play in doing," DeParle told roundtable participants.

"This is going to require changing the way that we deliver health care," she added, noting that many of the participants in the roundtable were already engaged in testing primary care models that have improved quality and care coordination and reduced costs.

"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.

According to Kocher, primary care practices and health care systems that achieve improved health care quality, enhanced health care access and reduced health care costs share four common modalities:

Roundtable participant and family physician Allen Dobson, M.D., of Concord, N.C., described the benefits his state has reaped from the Community Care of North Carolina, or CCNC, project.

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:

Michael Soman, M.D., president of Group Health Physicians, a Seattle-based corporation with more than 900 physicians, told the roundtable that his organization has made a "strategic, long-term commitment to effective primary care that applies to all of its clinics."

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.

Although all of the health care systems described during the roundtable shared common functionalities and visions and could be replicated, said Robert Phillips, M.D., M.S.P.H., director of the AAFP's Robert Graham Center, the transformation process likely would take many years without key elements, such as payment reform.

"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."