Closing the Gaps: Primary Care Transformation Part I
By Sarianne Gruber
Twitter: @subtleimpact
Laurel Pickering, President and CEO of the Northeast Business Group on Health, introduced a “bold and audacious” initiative to close the gaps in health care, and it starts with a primary care transformation plan for New York State. “When you look at the statistics increasing one primary care physician per 10,000 people gives us 5.5% fewer hospital visits, 11% fewer ED visits and 7% fewer surgeries. 55% of visits are for primary care, but we spend only 5%. A lot of Americans don’t have a primary care doctor,” emphasized Ms. Pickering at the New York Business Leaders monthly forum. The evening’s theme on Closing the Gaps: Benefits of HIE for Care Coordination began with a very informative and timely initiative to advance primary care in New York State. Ms. Pickering spoke on motivating health plans and self-insured payers to embrace a larger financial stake on prevention, care coordination and the management of complex conditions on the road to reducing healthcare costs and improving health of population. The Northeast Business Group on Health (NEBGH) thinks transforming Primary Care equals transforming health care. NEBGH is a business coalition comprised of approximately 70 self-insured organizations, mostly national and global, from New York, New Jersey, Connecticut and Massachusetts, representing about 2 million plus covered lives. Even though NEBGH is employer led and purchaser focused, they are also a multi-stakeholder organization, comprised of health plans, providers, pharmaceutical companies and consultants. NEBGH works to solve tough issues in healthcare, and ideally “we are better together than we are alone.” Their mission is to empower its members to drive excellence in health and achieve the highest value health care delivery and the consumer experience.
NEBGH is working now with the State of New York on a great opportunity –to improve the health of the population, improve consumer experience and improve cost – the “Triple Aim.” Ms. Pickering pointed out that the timing is really right since the nation is moving in the direction of value based care both in the private and public sector. Spurred on by government funding, New York State received a $100M SIM grant to implement a state innovation plan over the next four years. Two-thirds of the funds will go towards practice transformation–going to essentially consultants that can help primary practices change the way they practice medicine to do population health. The overarching goal after four years is to have 80% of New York State’s population receive primary care in an advanced primary care setting. Advanced primary care programs will integrate both population health and behavioral health. In addition, New York State wants to achieve top quartile performance among all states in prevention and public health by 2020. It is anticipated that 80% of care needs will be paid for under value-based financial arrangements. “Our role is to engage input from health plans and self-insured employers, which is critical is because ultimately they will buy in and pay for this,”shared Ms. Pickering. The plan is to move towards a multi-payer approach and grow in the same direction is very important especially when it comes to working with providers. “If providers have ten health plans, they can’t do something different for every payer. This is about getting payers to align so providers can deliver the best care possible and be incentivized to do it. And provide feedback to New York State,” asserted Ms. Pickering.
Instituting an Advanced Primary Care program still has its challenges. First, physicians need to be paid differently in order to retool and transform their medical practice. Securing financial resources means having the health plans and self-insured employers pay more. NEBGH has started asking health plans and other payers to pay an additional PMPM per month for care management. Practices are also going to need one time support to transform a practice with EHR and HIE technology as well as ongoing financial support, a sustainable investment built into our current payment system. Second, a set of core measures for benchmark performance. Proposed measures for chronic disease, behavioral health, patient experience, appropriate use and cost are being proposed and awaiting agreement from the health plans. And thirdly, primary care adoption of patient-centered care begins with engaging patients to become actively informed consumers, organizing work flows around the patient and actively promoting the health of the patient.
Ms. Pickering closed her discussion with how this is going to create benefits for all of us. Consumers will have improved health outcomes, coordinated care and a better patience experience. Employers will have more manageable costs, healthier employees thus more productivity and higher employee satisfaction; even fewer vendors to fill healthcare gaps. Primary care physicians can spend more time with their patients, have more resources and aligned measures to report. And Health plans will have a greater impact on the primary care initiatives to improve health.
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