Talk Health Reform

Guest Post: Reforming Primary Health Care

This post was written by the Oregon Primary Care Association, a non-profit membership organization founded in 1984. OPCA represents Community Health Centers (also called Federally Qualified Health Centers or FQHCs).  The OPCA believes that every person has a right to accessible quality comprehensive health care.

The following post represents the views of the OPCA.

There is growing consensus among patients, providers, and policy makers that the delivery of primary health care is not working well in this country.  Providers are frustrated with the inability to prepare and review patient information before a visit and the financial pressures that limit their visit with each patient to 15 minutes or less.  Patients are dissatisfied with the relationships they have with their providers, and a majority of patients with chronic conditions report that they do not comply with treatment protocols in part because half of them did not understand their doctor’s advice (Bodenheimer, 2006).  Policy makers and health care purchasers are frustrated by a system that provides financial disincentives to support primary health care, despite strong evidence that investment in primary care will enhance outcomes and minimize expenditures over time.   

As Oregon looks to reform its health care system to enhance access, improve quality and reduce costs, how can we create a more efficient and higher quality delivery system for primary health care?

The Oregon Health Fund Board has been learning about national and local models to reform primary health care called the primary care medical home.  These models, supported nationally and locally by many health care organizations, aim to reform the delivery of primary health care by creating a patient-centered experience.  Important components/principles shared by these models include:

• The primary care visit is a Patient-Centered Experience, allowing adequate time for the visit, a sustained relationship with a culturally competent provider team, and patient-driven goals.
• Team Based Care is provided that is proactive, planned, and maximizes services during each visit.  Evidence-based medicine guides decision making, and team members each practice at the top of their ability/license.
• Behavioral health is fully integrated into primary health care.
• Provider Accessibility is enhanced through more timely visits, electronic (phone, email) contact with provider teams, and removal of transportation and cultural barriers.
• Care is coordinated and/or integrated throughout the entire health care process.  Community services are also coordinated, as needed, for the patient. 
• The Primary Care Medical Home is nested in a community structure that collaboratively leverages and maximizes resources.
• Payment Reform that provides appropriate compensation and incentives for these components is essential.

It is important to note that the Oregon Health Fund Board is also considering reform for the broader system termed the Integrated Health Home.  This discussion is focused on primary health care reform specifically – one of the key components of overall system reform.

Questions: 

How can providers optimize communication with patients?  What is the most effective way to manage care (where does the care manager “live”)?  What financial incentives are necessary to support such an enhanced model of primary health care?  Is a primary care home necessary for everyone, or just patients with the most complex health and social needs?  What does it mean to provide culturally competent primary health care?  How does reforming the primary care system impact reform for the broader health care system? 

Guest Post: CareOregon

This Guest Post is from CareOregon, a Medicaid managed care plan serving over 95,000 Oregon Health Plan members in 16 counties across the state.

The Oregon Health Plan (OHP), as initially envisioned in 1987, was supposed to provide access to care for all Oregonians with all segments of society sharing in the cost. However, twenty years after the development of OHP, we do not have enough state general funds allocated to either cover the intended OHP population or maximize our federal match. That means that for every dollar the state is not spending on OHP, we give up $1.57 from the federal government. Not fully funding the OHP “Standard” population means there are more uninsured Oregonians. When the uninsured get care, providers, payors and health care consumers pay for this care.

In order to get the federal dollars we are entitled to, we need to allocate additional state general fund dollars to OHP. But let’s not just keep putting money into a system without thinking about whether the system is designed to give us what we want for our population. The primary care system is a good place to start since it will improve patient care and reduce costs. Another way to improve our “bang for the buck” is to think about how we deliver and pay for care.

We know that coordination of care at a primary care level can result in better health for people and save significant money in the whole system. Paying for nurses to provide some of these services, rather than doctors, would save dollars in the system and improve outcomes. If health plans and insurers had more flexibility in how clinicians are paid, the delivery system could be transformed to provide the care people need for less cost. In addition, information that compared outcomes across programs would allow us to see if the money we are spending is well used.

Hopefully, the Health Fund Board and its committees will look for as many opportunities as possible to provide that flexibility and to maximize the state’s federal matching dollars. It’s a shame to leave that money on the table.