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Innovations in Primary Care:What’s In the Affordable Care Act?

Melinda Abrams, MS

The Commonwealth Fundwww.commonwealthfund.org

Alliance for Health Reform Briefing

December 13, 2010

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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 4th year medical students choosing primary care

THE COMMONWEALTH

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3Affordable 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

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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

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Acknowledgements

Visit the Fund at:

www.commonwealthfund.org

Georgette LawlorProgram Associate,Patient-Centered Coordinated Care

Stephanie MikaAssociate Policy Officer,Federal Health Policy

Rachel NuzumAssistant Vice President, Federal Health Policy