Primary Care Collaborative Adds More Muscle

Seven of the nation's largest insurance companies have joined the Patient-Centered Primary Care Collaborative, or PCPCC, a group of medical associations -- including the AAFP -- employers, advocacy groups and academic centers that is working to transform the U.S. health care system by making primary care and the patient-centered medical home an integral part of public and private health care plans.

Aetna, BlueCross BlueShield Association, CIGNA, Humana, MVP Health Care, UnitedHealthcare, and WellPoint Inc. joined the PCPCC in September, putting the collaborative in a stronger position to drive major changes in the nation's health care system.

"These are the largest insurers in the country," said Paul Grundy, M.D., PCPCC chair and IBM's director of health care, technology and strategic planning. "They are all of the national health benefits plans, meaning they are plans engaged across the United States."

The PCPCC was founded earlier this year and has experienced dramatic growth, now encompassing dozens of disparate organizations representing a cross-section of society. With the addition of the seven insurance carriers, the PCPCC represents more than 50 million covered lives, making it a major player in the debate about national health care reform.

By joining the collaborative, all seven insurance companies have agreed to work toward the development and implementation of a series of multi-payer, patient-centered medical home demonstration projects. They also have agreed to contribute to the mounting evidence that patients treated under a medical home model generally are healthier and experience a higher quality of care provided in a more cost-effective manner.

The insurance companies have joined the PCPCC just as it prepares to hold a "Call-To-Action Summit on Restructuring and Reintegrating Health Care Around the Patient," which is scheduled in Washington on Nov. 7.

Grundy described the work of the PCPCC as "historic," saying that the collaborative will be remembered as a "breakthrough" and a "transitional point" in reforming the nation's health care system. The rapid growth of the collaborative is a result of a "broken" health care system that does not allow large purchasers of health care, such as IBM, to buy comprehensive, integrated care for their employees, according to Grundy. That's a situation that the PCPCC is now poised to change, he added.

"We are dissatisfied with buying episodic noncomprehensive care -- the human loss, the waste, the price we pay for that," explained Grundy.

The collaborative, he said, represents "us seeing the light and saying, 'We really want to buy comprehensive care through national or regional health benefits companies.'"

Within the next five years, IBM and other large employers in the collaborative would like to be able to "buy meaningful comprehensive and patient-centered primary care with a meaningful doctor/patient relationship for our employees anywhere in the United States," Grundy said. This will require a shift in the treatment paradigm from an acute-care model to a preventive model that places an emphasis on primary care and the patient-centered medical home. For this to happen, insurance providers will have to restructure physician payment systems to recognize and reward physicians for providing primary care and patient-centered medical homes, according to Grundy.

"We are not buying wisely under the current system," he said. "We are not valuing comprehensive care, and we are not paying for it in a way that allows good comprehensive care to be really self-sustaining."

Grundy credited the AAFP and three other physician-led primary care organizations with spearheading and sustaining the PCPCC, including the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association.

"When we approached them, they stepped up to this and said, 'We agree this is important,'" said Grundy. "They have committed resources and have tirelessly supported this (collaborative)."