PRIMARY CARE - CORNERSTONE OF TOMORROW S HEALTH SYSTEM

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Ruth Tyler
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1 KNOWLEDGE ~ WISDOM ~ EXCELLENCE ~ SERVICE PRIMARY CARE - CORNERSTONE OF TOMORROW S HEALTH SYSTEM Prepared By: John E. Maupin, DDS, MBA President December 4, 2012

2 MOREHOUSE SCHOOL OF MEDICINE: A COMMUNITY-BASED MEDICAL SCHOOL Ø One of the Nation s 18 Community-based Medical Schools Distinctive Emphasis on Primary Care and Generalist Training. Ranked Number One School in the Country for its Contribution to the Social Mission of Medical Education. (Annals of Internal Medicine, June 2010) Renowned for its Emphasis on Population Health, Innovative Partnerships, and Model Community Empowered Science-based Health Promotion and Disease Prevention Programs. Ø Perfectly Aligned With National Healthcare Priorities To: Expand the Number of Primary Care Physicians and Critical Specialist Working in Underserved Communities; Reduce Preventable Deaths and Promote Healthier Lifestyles for all Americans Increase the Racial and Ethnic Diversity in the Health Professions; and Eliminate Racial and Ethnic Health Disparities.

3 HEALTH SYSTEM : UNSUSTAINABLE MARKET CONDITIONS Ø Unaffordable levels of healthcare expenditures at a 6me of unprecedented economic stress. Ø Inefficient care delivery. Ø Unwarranted varia6ons in healthcare delivery. Ø Popula6on health management short comings, i.e. system failure to sufficiently curtailed preventable illness and chronic condi6ons. 3

4 TRANSFORMATION FRAMEWORK Quality Access Value Cost 4

5 SYSTEM WIDE TRANSFORMATION Clinical Quality TRANSFORMATION Payment System Popula6on Health 5 Source: Marlin Priest, MD Execu8ve Vice President Bon Secure Health System

6 HEALTHCARE TRANSFORMATION Ø Create Medical Home Capabilities: Deliver primary care Manage population outcomes Optimize chronic disease care Coordinate care across the spectrum of care Ø Create High-Value Care Networks Establish high value integrated networks Specialists/ancillaries Inpatient care Outpatient facility care Drive continuous improvement Ø Enhance IT and Data Management Infrastructure Enable population management Connect system participants via real-time interactivity Link EMR with population management systems 6

7 PRIMARY CARE AN ESSENTIAL COMPONENT OF HEALTH CARE DELIVERY SYSTEM Medical care given by a health care provider to a patient, either as a first contact regarding a specific illness, condition or health concern or as a part of regular, ambulatory care, and sometimes followed by referral to other health service providers. Ø Primary care practices provide ready access to a personal physician. Ø Practices provide health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment. Ø Facilitate referrals to specialty care. Ø Structure of practice may include a team of physicians and other health professionals.

8 LOOMING SHORTAGE OF PRIMARY CARE PHYSICIANS Ø The Associa6on of American Medical Colleges es6mated in 2008 a shortage of approximately 21,000 primary care physicians in 2015 and approximately 63,000 physicians overall. Ø The Primary Care shortage is among the worst in Georgia. According to one study, unless we focus aoen6on and dedicate resources to primary care training, Georgia will rank last in the na6on for physicians per capita by Ø Experts project a con6nued primary care shorsall due to the needs of an aging popula6on, and a decline in the number of medical students choosing primary care.

9 HEALTH REFORM EFFORTS TO INCREASE PRIMARY CARE DOCTORS Ø Primary Care Training and Enhancement The Affordable Care Act (ACA) authorizes grants and contracts to hospitals, schools or training programs to plan, develop or operate professional training programs in family medicine, general internal medicine or general pediatrics. Ø National Health Service Corps The ACA reauthorized $1.5 billion in funding for the National Health Service Corps - 15,000 primary care providers in provider shortage communities. Ø Medicare Reimbursement Increased Medicare reimbursement for primary care physicians Ø Medicaid Reimbursement Increased Medicaid Funding for the next two years to bring Medicaid primary care service fees in line with those paid by Medicare.

10 HEALTHCARE TRANSFORMATION COORDINATION OF CARE IN THE COMMUNITY A majority of stakeholders say care is, at best, only somewhat coordinated in their communities. Physicians are most critical of coordination in their communities, with only one in four saying it is coordinated. 22% 3% 5% 35% 9% 30% Key Highly coordinated Coordinated Somewhat coordinated Not coordinated Not sure 56% 36% 51% 15% 8% 3% 15% 10% Physicians Consumers Hospital Executives Source: Optum Ins8tute for Sustainable Health

11 COMMUNITY ORIENTED PRIMARY CARE (COPC) Research/Innova6on COPC Clinical Prac6ce Public Health 11

12 COMMUNITY ORIENTED PRIMARY CARE (COPC) Community Oriented Primary Care: A comprehensive approach to care of a defined population: Ø Integrating preventive and curative care with significant community involvement. Ø Taking into account the socioeconomic, environmental, structural and cultural determinants of health. Ø Assessing a defined population's health needs. Ø Organizing effective intervention strategies. Ø Evaluating the success of the interventions. 12 Source: Community Oriented Primary Care Am J Public Health, 2005 Mat: 95(5):757 Jamie Gofin, MD, MPH and Rosa Gofin MD, MPH

13 PRIMARY HEALTH SERVICES FOR TRADITIONALLY UNDERSERVED COMMUNITIES Ø Federally Qualified Community Health Center (FQHC): FQHCs are specifically located in an area that is designated as a Medically Underserved Area/Population (MUA or MUP). Provide services regardless of ability to pay, and charge for services on a sliding-fee scale that is based on patients' family income and size. Provide comprehensive primary health, oral, and mental health/ substance abuse services to persons in all stages of the life cycle.

Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases

Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases Epidemiology Over 145 million people ( nearly half the population) - suffer from asthma, depression and other chronic