Primary Care, PCMH Key to Improving Health Care Quality, Saving Billions, Says Report

The U.S. health care system could reduce health care expenditures by more than $2 trillion and save U.S. households $537 billion during the next 10 years by adopting a series of polices that include greater use of primary care and the patient-centered medical home (PCMH). That's the conclusion of a recent study (42-page PDF; About PDFs) issued by the Commonwealth Fund Commission on a High Performance Health System.

The report looks at ways of stabilizing U.S. health care spending, while at the same time boosting the health care system's performance, by moving from a volume-based to a value-based health care system. The aim is to improve overall patient care and save billions in health care costs. To achieve that goal, the commission has identified three overarching strategies:

The report includes a series of policies to support and implement these core strategies. The policies rely heavily on primary care and range from a revision of Medicare physician fees and payment updates that would reward value to medical malpractice reforms that provide fair compensation for injury while promoting patient safety and adoption of best practices. Enactment of the core strategies and polices could reduce projected health care spending by more than $2 trillion during the next 10 years, thus generating enough savings to pay for a repeal of the sustainable growth rate formula, which has called for steep reductions in the Medicare physician payment rate for the past decade.

"By instituting broader Medicare payment reforms and ensuring these spread to Medicaid, as well, the pace of delivery system reform would be accelerated without resorting to across-the-board reductions in provider payments and would produce substantial net savings for federal programs," the report states.

"The commission is saying that primary care is really central to the health care system," said Stuart Gutterman, vice president and executive director of the Commission on a High Performance Health System, in an interview with AAFP News Now. "Primary care is usually the first point of contact for the health care system. Increasingly, we are seeing (payers) adopt what is known as the patient-centered medical home approach."

The report describes U.S. households as the "major winners" of a more strategic approach. According to the report's authors, the policies they recommend have the potential to provide better care and health outcomes, as well as producing an estimated $537 billion in savings for households during the next 10 years. The savings would result from lower insurance premiums and out-of-pocket costs, more efficient insurance markets serving Medicare beneficiaries, and slower overall growth.

"In the end, reduced health spending by federal, state and local governments, and private employers also would accrue to households, which ultimately bear the burden of health spending through higher taxes, reduced wages and direct out-of-pocket costs," says the report.

Even with the savings, the health care sector would continue to grow, the report notes. But this growth would provide resources to innovate while also meeting the needs of an aging population.

"We are trying to focus on policies that would improve the health care system and make it more satisfying for people who work in the health care system and interact with the health care system instead of the alternative, which would mean taking payments from providers or benefits from people who access the health care system," said Gutterman.

AAFP President Jeff Cain, M.D., of Denver, praised the overall intent of the report in an interview with AAFP News Now, saying that it reflects many of the Academy's priorities.

"The AAFP consistently has called for comprehensive health care system reform based on primary care, which would improve quality, increase access and bend the cost curve," said Cain. "This report takes a similar approach."

Cain noted that the report underscores the ability of primary care to achieve the goals of higher quality, enhanced patient access and better controlled costs.

For example, the report cites evidence from the United States and abroad that attests "to the potential of redesigned primary care and care teams to improve care and patient experiences -- and to lower costs over time by preventing complications and reducing avoidable use of hospitals and more specialized care."