1 THE COMMONWEALTH FUND Innovations in Primary Care

1 THE COMMONWEALTH FUND Innovations in Primary Care: What’s In the Affordable Care Act? Melinda Abrams, MS The Commonwealth Fund www. commonwealthfund. org Alliance for Health Reform Briefing December 13, 2010

2 Primary Care Foundation At Risk • Strong primary care base critical to achieve high performance • Patients not receiving timely, efficient care – Half of all adults report problems obtaining access to primary care – Two-thirds of U. S. adults report problems with coordination of care – One in five chronically ill adults say they visited the ER for care they could have received from primary care clinician • Primary care practitioners report difficult practice environment – 58 percent of primary care physicians report that their patients have difficulty paying for medications or care – Only 46 percent of physicians report using electronic health records – Almost half of U. S. primary care physicians work in small practices – Reimbursement system biased in favor of procedures – Primary care physicians earn 54 percent of specialist physicians – Only 7 percent of 4 th year medical students choosing primary care THE COMMONWEALTH FUND 2

3 Affordable Care Act: Investing in Primary Care 1. Changing Payment and Financial Incentives to Promote Primary Care – Medicare 10% primary care bonus, 2011 -2016 – Medicaid primary care reimbursement increased to Medicare levels, 2013 -134 – Incentives for patients to obtain preventive care 2. Testing and Spreading Innovative Ways to Deliver Primary Care – State option to enhance reimbursement to primary care practices for Medicaid patients with chronic conditions – Innovation Center: medical home pilots a priority – Grants/contracts to build capacity of medical homes: • Community-based collaborative care networks for low-income patients • Community Health Teams increasing access to coordinated care • Primary Care Extension Center program 3. Ensuring Adequate Supply of Primary Care Providers – Scholarships, loan repayment and training demonstration programs to invest in primary care physicians, mid-level providers and community providers – $11 billion for Federally Qualified Health Centers 2011 -2015 to serve 15 million more patients by 2015 THE COMMONWEALTH FUND

4 Objectives of This Briefing • Primary care critical to improving quality, lowering cost • Affordable Care Act of 2010 – Many provisions will improve access, coordination, efficiency, patient experience, cost-savings – Taken together, put us on a path to high performance • Many states have a started to strengthen primary care – Much to learn from their lessons, challenges • Importance of multiple payers working together – Medicare and Medicaid – Public and private THE COMMONWEALTH FUND

5 Acknowledgements Rachel Nuzum Assistant Vice President, Federal Health Policy Stephanie Mika Associate Policy Officer, Federal Health Policy Georgette Lawlor Program Associate, Patient-Centered Coordinated Care Visit the Fund at: www. commonwealthfund. org THE COMMONWEALTH FUND