The Health Insurance Commissioner in Rhode Island has long advocated for increased emphasis and investment in primary care to improve outcomes and decrease costs. I must admit to being a skeptic as to whether investment in primary care was the most efficient way to achieve improved outcomes. I also wasn’t sure how you could shift dollars away from hospitals and specialists. Although the evidence that these investments will turn the tide on outcomes and quality is still mixed, I’ve become a strong believer, a convert if you will, that Christopher F. Koller was right. It makes sense that if primary care is the foundation of the system, and we strengthen the foundation, the whole system will be stronger. The Chronic Care Sustainability Initiative (CSI), which is really the Patient Centered Medical Home (PCMH) Project in RI, has now shown that patient outcomes improve and utilization can be reduced for patients receiving their care from PCMH practices. It makes sense that if primary care is the foundation of the system, and we strengthen the foundation, the whole system will be stronger.
On another note, I want to recommend that you read the statements of the Presidential candidates on healthcare reform published in the June issue of the New England Journal of Medicine and “The Conservative Case for Obamacare” in the Sunday Review Section of the New York Times.
TED ALMON said:
ReplyDeleteLou has another insightful comment with this post. I have always been positive on the value of coordinated primary care, a medical home, etc. I still believe that wellness and prevention, promoted in a meaningful way by such programs as Lou notes, are the right thing for us to do in healthcare. I believe they do indeed help us to maintain or improve the health status of the population of patients who come to us for care. The point I want to raise is that I remain doubtful that such efforts will reduce system wide costs. Oh I agree if you track individuals, effective primary care improves their health in many ways, and of course it is logical that improved health means fewer expensive medical interventions. But we have yet to track these people to the end of their lives, which also presumably (consistent with public health metrics) will be longer than they would otherwise have been. No matter how fit and well you keep people, they eventually get old and infirm, and this is when they consume the preponderance of their lifelong allocation of care. If our intention is to affect utilization through the lifelong use of more coordinated primary care, I think we are barking up the wrong tree. Only if we come to grips with end of life care, a true “third rail” issue politically, can we eventually limit the use of medical resources among those facing their relatively imminent demise.
But costs are not driven solely by utilization, true reform forces us to look at many other issues about the way providers are organized and care is coordinated. This is a most fertile opportunity. Administrative costs alone, estimated by the Commonwealth Fund at 31% of total healthcare costs, reflect a bloated and cumbersome system of financing steadily draining resources while adding no value to the provision of needed care. The real value of a reengineered primary care system might lie in helping patients to more efficiently navigate what has been a highly fragmented, and therefore inefficient and often redundant network of providers.
A new emphasis on primary care coordination, prevention and wellness is an entirely worthwhile goal and strategy. We should do it because it improves the quality of health for the population, but we can’t assume it will solve the cost puzzle. We need to work on many other areas to do that. TA
Nice insight, but I think this article from Forbes might also be of interest!
ReplyDeletehttp://www.forbes.com/sites/merrillmatthews/2012/10/02/there-is-no-conservative-case-for-obamacare/