Access to Care:

1. Access to Care: Primary Care Challenges and Recommendations July 17, 2014

2. Access to Care What is primary care? The Johns Hopkins Primary Care Policy Center defines primary care as: • Entry point into a health services system for all new needs and problems • Person-focused, not disease-oriented • Provides care for all but very uncommon/unusual conditions • Coordinates or integrates care – regardless of where, who provided • Means to assure optimized care use and health status equity

3. Challenges? Deloitte Consulting study (2012): To meet pre-ACA implementation demand, Kentucky needs – • 3,790 additional physicians (including primary care doctors and specialists) • 612 more dentists • 5,635 more registered nurses • 296 more physician assistants • 269 more optometrists Source: The Commonwealth of Kentucky Health Care Workforce Capacity Report http://healthbenefitexchange.ky.gov/Documents/KY%20Healthcare%20Workforce%20Capacity%20Report%20FINAL%205_28_13.pdf

4. Challenges? Kynect – the state health benefits exchange (as of 4/21/14) 413,410 Kentuckians enrolled in new health coverage, Medicaid and private 82,795 have purchased private insurance.

5. Challenges? UK’s Dr. Kevin Pearce, speaking to a meeting of Kentucky medical educators reported (5/13): • 1500: number of people that one full-time family physician should take care of • 163 : number of family physicians that we need to add in Kentucky each year to meet 1500:1 by 2025 • 57 : maximum number of family physicians that could be produced per year in Ky now

6. Recommendations Doing Care Differently Physician-led teams coordinated, patient-centered, cost-effective quality care. How to get there? • Expanded scope of practice for APRNs – what about PAs? • Social worker can join primary care team; MD can offer primary care at CMHC • Expanded role for dental hygienists – what about dental therapists? • Peer specialists– in behavioral health – what about community health workers in primary care? Resources: Christensen and Hwang The Innovator’s Prescription Prevention Institute, Community-Centered Health Home

7. Recommendations Doing Care Differently • Expanded use of telehealth and monitoring technology • Better care integration – primary care, behavioral health, oral health • A “health home” concept, starting with high-needs Medicaid patients/”superutilizers” • An All-Payer Claims Database, where data on health care cost, use and quality cost effective care containment and quality improvement • Kentucky Health Information Exchange (KHIE), connects providers’ electronic health records systems to state system for accessible patient clinical information

8. Infrastructure needed… IT path to care continuity: Retail clinicshealthhomeshospitalsrehab/home care Care coordination – at the patient and community level TA/Coaching for care providers (Ag Extension style) – credible resource to support/sustain care transformation: Whose role? • AHECs • Local Health Departments • Regional Extension Centers • Professional associations

9. Leverage opportunities • State Innovation Model (SIM) grant – if awarded to bring cross-sector stakeholders to the table • Aligning interests  shared community solutions, payment strategies • Hospitals’ community benefit plans • Local health departments MAPPs • United Way community needs assessments • MCO contract renewals contract terms supporting better integration, new care approaches • Large employers (e.g., Kyiana Health Collaborative)new care and payment approaches, data sharing

10. Thank You!....Questions? Learn more at: www.healthy-ky.org Contact: Susan G. Zepeda, Ph.D., President/CEO 502-326-2583 szepeda@healthy-ky.org