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Health Affairs Briefing: Reinventing Primary Care



April 27th, 2010

The May 2010 issue of Health Affairs examines what it will take to reinvent primary care in the United States. Operational, payment, regulatory, legal, and educational reforms will be necessary to improve care and achieve savings —and to prepare for the influx of millions of Americans who will be insured for the first time as of 2014.

On May 4, Health Affairs will host a briefing to examine what policies are needed to increase the corps of primary care providers and to improve practice. The briefing and the journal issue also explore the promising models of care that are likely to produce the best outcomes. U.S. Department of Health and Human Services Secretary Kathleen Sebelius has been invited to deliver the keynote address. Other speakers include Paul Grundy, director of healthcare transformation at IBM, Troyen Brennan, chief medical officer at CVS Caremark, and other leading experts and educators in primary care and health policy.

When: Tuesday, May 4, 2010, 8:30 a.m. – 2:30 p.m.

Where: National Press Club [Metro Center], Holeman Lounge, 529 14th St. NW, 13th Floor, Washington, DC

RSVP for this event online.

Health Affairs will offer live Twitter updates from the event at #HAprimarycare

Among the topics to be addressed:

  • How can we solve the primary care workforce shortage?
  • Which evolving models of primary care practice show the greatest promise? What opportunities exist for innovation?
  • How can we produce the most successful primary care teams?
  • How should we expand the roles of physician assistants and nurse practitioners?

Background

The primary care system in the United States is in crisis. Sixty-five million Americans live in primary care shortage areas. Partly due to a considerable pay gap between primary care physicians and other practitioners, U.S. medical school graduates are increasingly avoiding careers in primary care, and a major shortage of all types of primary care providers looms. A system that is already strained will face an influx of patients in 2014, when 32 million Americans will have health insurance for the first time. A larger primary care workforce is essential, but new strategies and models are also needed to address the country’s imminent primary care access problem.

Restructuring primary care practice teams can help meet this challenge. For example, barriers to practice that face nurse practitioners and physician assistants in many states must be removed. Updating and modernizing the primary care system is also essential. For example, implementation of the medical home model—a delivery model that is patient-centered and focuses on integrated care—has been proven to improve quality and reduce costs.

This issue of Health Affairs, and the briefing, are supported by the United Healthcare Foundation, California HealthCare Foundation, CVS Caremark, the ABIM Foundation and the American Academy of Physician Assistants.

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1 Trackback for “Health Affairs Briefing: Reinventing Primary Care”

  1. Can Health Plans Explain Why They Aren’t Re-Empowering Primary Care? | Care And Cost
    April 29th, 2011 at 12:07 am

1 Response to “Health Affairs Briefing: Reinventing Primary Care”

  1. fredericjones Says:

    What about Retired Physicians and other health care Professionals?
    If the Association of American Medical Colleges’ prediction comes true— that the nation’s physician shortage will grow from about 25,000 today to about 150,000 in 15 years—who will treat the millions more people who will have health coverage for the first time under health reform?
    As Congress and the President move toward health care reform, there seems to be no mention of America’s free clinics that provide care to more than 4 million Americans by utilizing thousands of volunteers with little or no state or federal support. Many of these clinics are faith-based in their origins and utilize the services of thousands of retired health care professionals to provide acute, chronic and specialty care. All of the suggestions to improve primary care are medium to long term and perhaps successful strategies. A more immediate solution is to utilize the large numbers of “retired” physicians and other health care professionals.
    Many stand currently competent and willing to provide excellent medical care to our underserved populations. Moreover, many have actually chosen to retire into the areas of physician shortage. Nonetheless many barriers are placed in their utilization, not the least of which are state medical boards reluctant to grant any type of license. This barrier seems to apply to many practitioners, trained and licensed in another state, who has expressed a willingness to care for the underserved patients of their new state of residence.
    Fortunately, a number have overcome these barriers and in the settings of free clinics provide top notch care. These experienced clinicians are quite prudent and efficient in their ordering and practice patterns further preserving expensive resources.
    These doctors, nurses, dentists and other healthcare professionals could be mobilized into a structured organization that could add dramatically and immediately to meet the health care needs of the uninsured and others in our population without ready access.
    These professionals could be recruited into existing practices, community health centers, and free clinics or into the rapidly increasing numbers of retail Clinics. Presently, many of these activities are funded by faith based and charitable donations and the “sweat equity’ of thousands of participating “retired” Health Care Professionals.’
    Some of the greatest impact could be for the management of patients with chronic medical conditions. The future benefits of such care have a predicable benefit for the health and costs. These and other chronic medical conditions are managed quite well in the free clinic settings with very selective specialty referral. In other words, provide care now or pay many $ in the future for the neglect. For that population, evidence-based protocols are available that could assure best practices.
    I am in my 26th year of serving the indigent in a free clinic setting. Along with a superb nurse practitioner (certified diabetes educator), 3 retired RNs, and a pharmacist, we strive to provide evidence-based medical care. In my instance, this is in a metabolic clinic, serving adults with diabetes, and its associated conditions-hypertension, obesity and dyslipidemia. According to the latest guidelines, we attempt to optimize blood sugar and A1C.
    However, lifestyle management is particularly difficult in this patient population, with limited economic options.
    None-the-less, we strive to control the other risk factors and are quite successful in controlling BP and Lipids and tobacco usage.
    Newer studies suggest that this approach may improve outcomes as well as intensive treatment to optimize blood sugars.
    Moreover, it can often be attained in patients with 3 generic medications, costing $ 12 per patient per month, plus low dose aspirin. We have a community pharmacy that can provide some of these medications, and then some can turn to Wal-Mart, Walgreens, and others. In some 40% of type 2 diabetes cases, the patient will require insulin. We should consider adding insulin to Metformin for a modest additional cost… There are excellent algorithms for insulin management permitting the clinician to provide comprehensive care in a single setting. Insulin may confer benefits in addition to glucose lowering that promote remission and prevention of complications.
    Many of us are committed to the concept of prevention of disease and I believe our participation would be well served by this approach…
    In this era of incentivizing participants, many of the retired health care professionals would welcome a tax credit based on volunteer hours provided. Furthermore, this would encourage them to comply with the various obstacles often placed by state licensing boards.
    Why do we continue to waste this opportunity and enormous resource for our nation’s patients in need???

    I am an AMA and ACC member, retired from active cardiology practice in the fee-for-service arena.
    However, I continue to care about the heath care of our nation’s population!

    Frederic G Jones Sr. MD, FACPE, FACC
    Consultative Cardiology (retired)
    140 The Pinnacle Sapphire NC 28774
    twitty@citcom.net 828-883-2668

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