Delivery System Change: Improving Quality and Controlling Costs

1. Delivery System Change: Improving Quality and Controlling Costs

2. The Health System Value of Primary Care • Only 5 - 6% of total expenditures in the current U.S. health care system are for primary care. • Adults with an established relationship with a primary care physician had 33% lower costs of care, and were 19% less likely to die. (Starfield) More primary care physicians lower cost and higher quality

3. Primary Care Access Why are only 4.28% of all doctors in Illinois primary care doctors? Courtesy of the Robert Graham Center

4. Rebalancing Primary Care and Specialist CareWhat does Health Care Reform do? • Establishes a workforce commission to make recommendations about how to support additional training for primary care • Loan forgiveness provisions for primary care providers who work in underserved areas • Provides a new graduate medical education funding stream for teaching health centers • Reauthorization of the Title VII Health Professions Programs • A redistribution of residency slots with priority for primary care and general surgery, states with low physician-to-resident ratios, and rural areas • Increased funding for the National Health Service Corps

5. Percentage of Medical Students Who Chose a Career in Primary Care United States Canada Canada: Payment and Med Ed Reform Goal 50% FPs 35 30 25 20 COGME: Market Forces Rule No Goal for FPs 15 2004 2009 1998

6. Reimbursement Reform • Beginning January 1, 2011 and ending January 1, 2016, primary care physicians will get a 10% bonus for Medicare services. • To qualify for the bonus, 60 percent of their Medicare charges must be for primary care services as defined by evaluation and management (E/M) codes for office visits, nursing home visits and home visits. • Only 59 percent of family physicians would qualify for this bonus. • In 2013 and 2014, Medicaid payments for primary care services increase to be at least equal to Medicare payments • An Independent Payment Advisory Board starting in 2014 will recommend Medicare spending reductions to Congress • Pilot programs with emphasis on quality measurement and paying for value instead of volume • For 2010, Medicare will increase payment for psychotherapy services by 5 percent.

7. Primary Care Redesign • Legislation establishes a new Medicaid demonstration program that attempts to prove the Patient Centered Medical Home (PCMH) model • Flexibility for Centers for Medicare & Medicaid Services to experiment with the PCMH model based on early results Great Outcomes

8. Best kept secret now revealed! Illinois Medicaid Medical Home Project saves ½ billion dollars over two years Primary Care Case Management (Illinois Health Connect) and Disease Management (Your Healthcare Plus) projects led by primary care physicians and built in primary care practices

9. The Beginning Fall 2005, then-governor announces All Kids program, Illinois is first state to provide universal access for all children Spring 2006, state Medicaid program lets RFPs for PCCM and DM projects Summer 2006, Automated Health Systems and McKesson Health Solutions are successful bidders for PCCM and DM, respectively

10. The Launch Fall 2006: 5,100 medical homes recruited. Practices decide how many Medicaid patients they will take 5.1 million slots identified for 1.5 million patients January-November 2007, all eligible patients enrolled in medical homes

11. Guided by Primary Care Steering committee started meeting monthly for first two years, moved to every six weeks in third year, and met quarterly starting in fourth year. Illinois Medicaid program engaged providers in strategic planning and decision-making

12. Results Roll In • FY 2008 PCCM and DM at full implementation for last six months of FY = $180 million in savings • FY 2009 First full year of operations = $320 million in savings

13. Where were the savings? Decreased hospital admissions Shortened hospital stays Decreased emergency room use

14. Provider and Patient Satisfaction • Annual provider survey results rank programs at 97% satisfaction rate, a significant improvement over provider attitudes before program creation. • Annual patient survey highlights patients’ satisfaction with program and providers.

15. Current status(June 2010) 2 million patients and 5,700 medical homes; 200,000 others in managed care FY ‘10 results will be available in March 2011 Disease Management (YHP)contract up in June 2011 Primary Care Case Management (IHC) contract up in June 2012

16. Evaluation 1 No formal evaluation to date for either PCCM or DM Republicans would rather have managed care IAFP, with funding from Community Memorial Foundation, www.cmfdn.org and Michael Reese Health Trust, www.healthtrust.net , engaged Graham Center, www.graham-center.org to write case statement and create RFP

17. Evaluation 2 • Two proposed projects 1. Fiscal analysis of Illinois Health Connect, ‘06-’09 2. Study of high-performing and low- performing practices • Hope to complete by Feb 2011 to help inform leaders and influence next steps

18. For more information Illinois PCCM - Margaret Kirkegaard, MD, medical director, Illinois Health Connect, www.illinoishealthconnect.com Illinois DM - Carrie Nelson, MD, medical director, Your Healthcare Plus, www.yourhealthcareplus.com Illinois Academy of Family Physicians, www.iafp.com Graham Center, Robert Phillips, MD, MSPH, director, www.graham-center.org

19. Health Care ReformProgress…Not Perfection!

20. Your IAFP Contact • Gordana Krkic (Ker-kitch) CAE Deputy Executive Vice President Illinois Academy of Family Physicians 4756 Main St., Lisle, IL 60532 630-427-8007 gkrkic@iafp.com