Healthcare Reform: the Value of Primary Care

1. Healthcare Reform: the Value of Primary Care Jennifer Aloff MD, FAAFP

2. Family physicians provide comprehensive primary health care for millions of Michigan citizens • Nearly 3,000 family physicians including some 400 residents in 18 training programs throughout the state students • Family physicians practice an average of 48+ hours per week and average 110 office/patient visits / week

3. Family Physicians Care For The Community • Continuous Health Relationships: - Care for patients in each stage in the life cycle, from birth through old age -Know a patient’s family health history and understand health issues in the context of the person’s culture and lifestyle

4. Family Physicians Care For The Community • Provide personal medical homes to rural and urban areas in Michigan that otherwise would be underserved • Offer care for people who don’t have regular access to healthcare • MAFP members: 24.5% serve rural areas, 23.3% volunteer in local health clinics on top of their practice

7. Cost-Effective Care • Studies have shown an increase in primary care physicians within a population results in a reduction of healthcare costs - Michigan had 240 active primary care physicians per 100,000 population in 2004; 27th among states • Sub-specialty care is more costly than primary care - Studies show sub-specialists tend to order more tests and administer more medications SOURCE: U.S. Census Bureau,
See Table 154, Statistical Abstract of the United States, 2007. SOURCE: Greenfield S, Nelson EC, Zubkoff M, Manning W, Rogers W, Kravits RL, et al. Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study. JAMA 1992;267:1624-30.

8. Utilization of Services • Studies have shown that when people have access to family physicians/primary care: 1. More preventive services are delivered; 2. Intervention occurs before health issues develop into more serious problems and costly conditions, and 3. Emergency room utilization rates decline SOURCE: L. Green, G. Fryer, “The Ecology of Medical Care,” New England Journal of Medicine 344. 2021-5 (2001) SOURCE: M.A. Schuster, et al., “How Good is the Quality of Health Care in the U.S.?” Milbank Quarterly 76 no. 4 (1998)

9. Benefits of Access to Primary Care • For each 1 percent increase in primary care physicians, average-sized metropolitan areas experienced a decrease of 503 hospital admissions2,968 emergency room visits 512 surgeries.1 • Hospitalization rates and expenditures for ambulatory care-sensitive conditions like diabetes and congestive heart failure are higher in areas where there are fewer primary care physicians and where access to primary care is limited.2 1Kravet, Steven J, et al. “Health Care Utilization and the Proportion of Primary Care Physicians.” Amer J Med 121.2 (2008): 142-148. 2Bodenheimer, Tomas and Fernandez, Alicia. “High and Rising Health Care Costs. Part 4: Can Costs Be Controlled While Preserving Quality?” Ann Intern Med 143.1 (2005): 23-31.

10. Primary Care and Chronic Diseases SOURCE: 2002 National Health Interview Survey • Percentage of MI Adults with Asthma – 13.4% • Percentage of MI Adults with Diabetes – 7.6% • Percentage of MI Adults with Obesity – 25.4% • Percentage of MI Adults with Hypertension – 26.8%

11. Cost Comparison $51.15 Cost of average visit to a family physician $116.41 Cost of average visit to a sub-specialist $340 Average per-month cost for patients using primary care physicians as usual source of care $506 Average per-month cost for patients using sub-specialist physicians as usual source of care SOURCE: Centers for Medicare and Medicaid Services, National Fee Schedule, 2003 SOURCE: Lewin Group estimates, as reported in “Report on Financing the New Model of Family Medicine,” Annals of Family Medicine, Vol. 2, Supp. 3, Nov-Dec 2004. Based on 1998 National Medical Expenditure Panel Survey, adjusted to 2004 dollars.

12. Patient-Centered Medical Home (PCMH) A patient-centered medical home integrates patients as active participants in their own health and well-being. Patients are cared for by a personal physician who leads the medical team that coordinates all aspects of preventive, acute and chronic needs of patients using the best available evidence and appropriate technology. These relationships offer patients comfort, convenience and optimal health throughout their lifetimes.

13. 2007 Joint Principles of PCMHAAFP, AAP, ACP & AOA • Personal physician • Physician directed medical practice • Whole person orientation • Care is coordinated and/or integrated-facilitated by registries, IT, Health-IT exchanges • Quality and safety -evidence-based medicine and clinical decision-support tools-quality improvement activities • Enhanced Access • Payment recognizes added value

14. Benefits of PCMH • AAFP/ TransforMed demonstration projects (32 sites across the Nation) • showed 7% cost reduction • improved patient outcomes • 20% fewer hospitalizations • lower all-cause mortality • North Carolina (Medicaid) Community Care Model showed $231 - $255 Million/ year cost savings in 2005 & 2006 (Source: Steiner, Beat D, et al. “Community Care of North Carolina:Improving Care Through Community Health Networks.” Ann Fam Med6.4 (2008): 361-367.)

15. PCMH

16. Additional Resources • Michigan Academy of Family Physicians(517) 347-0098www.mafp.commy email: president@mafp.com • American Academy of Family Physicianswww.aafp.orgwww.familydoctor.org • www.medicalhomeforall.com