Reform will be built on primary care base

Building a strong foundation in primary care-based medical homes is vital to furthering delivery and payment reforms, health policy experts said here Friday.

"If you have strong primary care, you can improve health outcomes, you can lower per capita costs, and you can increase equity," said Melinda Abrams, MS, vice president of the Commonwealth Fund in New York City and director of its Patient-Centered Coordinated Care program.

However, primary care isn't where it needs to be, with a majority of patients reporting poor access to care as well as uncoordinated care, she said. Also, providers express frustration with working longer hours to receive lower wages compared to their specialist counterparts.

Developing patient-centered medical homes (PCMHs) "is the core strategy right now to strengthen primary care," Abrams said, speaking on a panel at a briefing on PCMHs hosted by the Alliance for Health Reform, a bipartisan organization that seeks to educate the media and congressional staff members on healthcare reform issues.

The model relies on paying doctors extra money -- often a per-member-per-month bonus, shared savings, or other incentives -- to provide better care to sicker patients, trying to keep them healthier and out of emergency departments and hospitals.

The Patient-Centered Primary Care Collaborative, a Washington-based advocate of PCMHs, estimates that nearly 10,000 medical home practices exist in the U.S.

Nearly every major private insurance company boasts expansive PCMH programs, and Medicare is working on a similar Comprehensive Primary Care Initiative. In Medicaid, 29 states make medical home payments, and 19 are involved in multipayer pilots, according to the National Academy for State Health Policy here.

PCMHs go a long way to recognizing primary care's importance and providing practices with the resources needed to improve patient care, experts here said. For example, many practices have used their bonuses from payers to hire care coordinators to better communicate with patients or to draft better care plans.

But in addition to just providing better care, a stronger primary care -- "accessible, coordinated, team-based, proactive medical care" -- will be essential to success for other reform efforts, including accountable-care organizations and bundled payments, Abrams told MedPage TodayFriday.

"It's both the foundation and the glue to strengthen the system," Abrams said of primary care.

As payments move away from fee-for-service and toward rewarding more coordinated, efficient care, providers of all sorts need primary care providers to help lower costs. "The way you really get cost reduction is you keep people out of the hospital," said Robert Graham, MD, chair of the board of directors for the Alliance for Health Reform. "That's where primary care can make a real difference."