7667 Blyn Med Grp - Primary Care Journey Rk
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Transcript of 7667 Blyn Med Grp - Primary Care Journey Rk
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The Primary Care JourneyWhere Have We Been?
Where Are We Now?
Where Do We Go From Here?
By Ronda Kotelchuck
Executive DirectorPrimary Care Development Corporation
April 4, 2008
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A Couple of Reminders
The Dual Agenda
Universal coverage
Health system reform
Who Delivers Primary Care to the Underserved?
5. Hospital outpatient departments (50%)
6. Private practitioners (35%)
7. Community health centers (15%)
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A Look-Back: Late 1980s, Early 1990s
Community epidemics; overcrowded hospitals
Growing consensus on critical lack of primary care
Community Service Society Report
Foundation Initiatives NYS Department of Health, NYC Health Planning Agency
Advocates
HHC Strategic Plan, the Mayors Initiative
Creation of PCDC
To expand primary care capacity by making available capital for new andexpanded facilities
To assist providers in achieving new levels of excellence in access,quality
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The Mid-1990s to 2005
Major shift in NYS health policy
Deregulation; competition; belief in the market
Managed care; the growth of primary care capacity Rate freezes for ambulatory care
Deepening problems:
The growth of chronic illness Rising costs with little evidence of impact
Appalling disparities in health and health care
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The PrecursorsNational:
Growing evidence base for primary care and its impact on:
Rising costs
Health outcomes Health disparities
Emergence of the Patient-Centered Medical Home(PCMH)
Consensus of employers, payors, consumers, professional
associations; establishment of the National PCMH Collaborative
Agreement on standards and measures
Recognition program by NCQA
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Precursors (Continued)
New York State
The Concern with Cost:
The Senate Task Force on Medicaid Costs
The Governors Task Force on Medicaid
The Berger Commission
Formation of the Primary Care Coalition
A new governor with a primary care agenda
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Establishing the Primary Care Agenda
Primary care capacity:
Urban and rural communities still in need
2. A new model of primary care:
Most primary care still reactive, episodic, lacks continuity, coordination
Performing far below best practices Information technology (especially EHRs):
Essential to providing quality care
Expensive to acquire and operate, especially for safety net primary care providers
Workforce:
Young people ceasing to enter primary care
Physicians fleeing NYs underserved communities Primary care reimbursement (The most important)
Historic underpayment
Lack of financial resources, incentives for improvement
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What Happened and Where Do We
Stand Today?The significance of:
The 2008-09 NYS health care budget, use of
HEAL-NY monies
The consensus that produced it
The overview: Shift from inpatient to outpatient: $170M
Primary care enhancements: $170M
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The Score Card1. Primary care reimbursement:
Higher rates, new payment method for hospitals, DTCs (APGs)
Increase in private practice rates (75% of Medicare)
Primary care capacity:
HEAL 6: $105M for primary care expansion Enhanced reimbursement for evening, weekend hours
3. Primary care workforce:
Doctors Across NY:
Physician Loan Repayment: $2M/year for recruits to underserved communities($150,000 over 5 years)
Physician Practice Support: $5M for physicians opening or joining practices inunderserved communities
Community-Based Ambulatory Care Training: $5M for resident/medical studenttraining in community sites
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The Score Card (Continued)
1. New model of primary care:
Diabetes and asthma educators for patient self-management
Mental health:
Reimbursement for services by CSWs for children, adolescents,pregnant women, in DTC settings
Integration of primary care and mental health
New quality standards for hospital outpatient departments
2. Health information technology: HEAL 5: $105M for health information exchange among
community-based providers
Supplemental Payments for DTCs serving Medicaid, uninsured
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Where Do We Go From Here?
Sea change, yet tentative, first steps
Continued need for support, momentum,
vigilance
The vision: the Patient-Centered Medical
Home
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For More Information, Contact:
The Primary Care Development
Corporation
Website: www.pcdcny.org
Phone: (212) 437-3917
E-Mail: [email protected]
The Primary Care Coalition
Website: www.nyprimarycarehome.org
Listserv: e-mail to rkotelchuck@ cdcn or
http://www.pcdcny.org/mailto:[email protected]://www.nyprimarycarehome.org/mailto:[email protected]:[email protected]://www.nyprimarycarehome.org/mailto:[email protected]://www.pcdcny.org/
