Transcript Family Medicine Legislative Breakfast January 31, 2006

Jennifer Aloff MD, FAAFP
 Family physicians provide comprehensive
primary health care for millions of Michigan
citizens
 Nearly 3,000 family physicians including
some 400 residents in 18 training programs
throughout the state students
 Family physicians practice an average of
48+ hours per week and average 110
office/patient visits / week
Family Physicians Care
For The Community
• Continuous Health Relationships:
- Care for patients in each stage in the life
cycle, from birth through old age
- Know a patient’s family health history and
understand health issues in the context of the
person’s culture and lifestyle
Family Physicians Care
For The Community
• Provide personal medical homes to rural and
urban areas in Michigan that otherwise would be
underserved
• Offer care for people who don’t have regular
access to healthcare
• MAFP members: 24.5%
serve rural areas, 23.3%
volunteer in local health clinics
on top of their practice
Cost-Effective Care
 Studies have shown an increase in primary
care physicians within a population results in a
reduction of healthcare costs
- Michigan had 240 active primary care physicians
per 100,000 population in 2004; 27th among states
 Sub-specialty care is more costly than primary
care
- Studies show sub-specialists tend to order more tests and
administer more medications
SOURCE: U.S. Census Bureau, See Table 154, Statistical Abstract of the United States, 2007.
SOURCE: Greenfield S, Nelson EC, Zubkoff M, Manning W, Rogers W, Kravits RL, et al.
Variations in resource utilization among medical specialties and systems of care. Results from
the medical outcomes study. JAMA 1992;267:1624-30.
Utilization of Services
• Studies have shown that when people have
access to family physicians/primary care:
1. More preventive services are delivered;
2. Intervention occurs before health issues develop
into more serious problems and costly conditions, and
3. Emergency room utilization rates decline
SOURCE: L. Green, G. Fryer, “The Ecology of Medical Care,” New England Journal
of Medicine 344. 2021-5 (2001)
SOURCE: M.A. Schuster, et al., “How Good is the Quality of Health Care in
the U.S.?” Milbank Quarterly 76 no. 4 (1998)
Benefits of Access to Primary Care
 For each 1 percent increase in primary care physicians, average-sized
metropolitan areas experienced a decrease of
503 hospital admissions
2,968 emergency room visits
512 surgeries.1
 Hospitalization rates and expenditures for ambulatory care-
sensitive conditions like diabetes and congestive heart failure are
higher in areas where there are fewer primary care physicians and
where access to primary care is limited.2
1Kravet,
Steven J, et al. “Health Care Utilization and the Proportion of Primary Care Physicians.” Amer J Med 121.2 (2008):
142-148.
2Bodenheimer, Tomas and Fernandez, Alicia. “High and Rising Health Care Costs. Part 4: Can Costs Be Controlled While
Preserving Quality?” Ann Intern Med 143.1 (2005): 23-31.
Primary Care and Chronic Diseases
Condition
Treated by PC Physician
Asthma
80%
Congestive Heart Failure
88%
Coronary Heart Disease
88%
Depression/Anxiety
81%
Diabetes
88%
Hypertension
88%
Multiple Sclerosis
77%
Parkinson’s
90%
SOURCE: 2002 National Health Interview Survey
•
•
•
•
Percentage of MI Adults with Asthma – 13.4%
Percentage of MI Adults with Diabetes – 7.6%
Percentage of MI Adults with Obesity – 25.4%
Percentage of MI Adults with Hypertension – 26.8%
Cost Comparison
$51.15
$116.41
Cost of average visit to a
family physician
Cost of average visit to a
sub-specialist
$340
$506
Average per-month cost
for patients using
primary care physicians
as usual source of care
Average per-month cost for
patients using sub-specialist
physicians as usual source
of care
SOURCE: Centers for Medicare and Medicaid Services, National Fee Schedule, 2003
SOURCE: Lewin Group estimates, as reported in “Report on Financing the New Model of
Family Medicine,” Annals of Family Medicine, Vol. 2, Supp. 3, Nov-Dec 2004. Based on
1998 National Medical Expenditure Panel Survey, adjusted to 2004 dollars.
Patient-Centered Medical Home
(PCMH)
 A patient-centered medical home integrates
patients as active participants in their own health
and well-being.
 Patients are cared for by a personal physician who
leads the medical team that coordinates all aspects
of preventive, acute and chronic needs of patients
using the best available evidence and appropriate
technology.
 These relationships offer patients comfort,
convenience and optimal health throughout their
lifetimes.
2007 Joint Principles of PCMH
AAFP, AAP, ACP & AOA
 Personal physician
 Physician directed medical practice
 Whole person orientation
 Care is coordinated and/or integrated
-facilitated by registries, IT, Health-IT exchanges
 Quality and safety
-evidence-based medicine and clinical decision-support tools
-quality improvement activities
 Enhanced Access
 Payment recognizes added value
Benefits of PCMH
 AAFP/ TransforMed demonstration projects (32 sites across
the Nation)
 showed 7% cost reduction
 improved patient outcomes
 20% fewer hospitalizations
 lower all-cause mortality
 North Carolina (Medicaid) Community Care Model
showed $231 - $255 Million/ year cost savings in 2005 &
2006
(Source: Steiner, Beat D, et al. “Community Care of North Carolina:Improving Care
Through Community Health Networks.” Ann Fam Med6.4 (2008): 361-367.)
PCMH
Additional Resources
 Michigan Academy of Family Physicians
(517) 347-0098
www.mafp.com
my email: [email protected]
 American Academy of Family Physicians
www.aafp.org
www.familydoctor.org
 www.medicalhomeforall.com