Financing Primary Care The Best of Times

1
Financing Primary Care The Best of Times

• The Patient-Centered Medical Home Summit
• Washington, D.C. October 17, 2008
• Roger C. Merrill, M.D., Chief Medical Officer

2
Agenda

• The Value Proposition health conveyed per dollar
  spent
• The Perdue Experience
• NBGH Primary Care Work Group product
• Caution Do Not Enter the Weird Zone!

3
USA Cost vs. Product
There is a relationship between cost And health
status improvement
Health Status
4

• The solution? Chicken!!

5
The Perdue Experience

• On-site primary clinics (called Wellness Centers)
  which serve as medical home
• Visits are on the clock, minimal payroll-deducted
  co-pay, clinics operate during all production
  shifts.
• Goal is health improvement in a longitudinal
  model

6
The Perdue Experience

• Physician contracting in owned, direct networks.
• This allows us to have efficient networks, yet
  establish PCP reimbursement at the highest level
  vs. other payers in each geographic area.
• We want our docs to smile when a Perdue patient
  comes into the office.
• We ask our PCPs to be Marcus Welby, managing each
  case whatever the outside service requirements.

7
The Perdue Experience
8
The NBGH Primary Care Work Group Conclusions

• Increasing PCP reimbursement is an appropriate
  goal or tool.
• 20 payment increase for primary care 1 total
  increased Plan spend
• Reimbursement changes must be overall cost
  neutral

9
The NBGH Primary Care Work Group Conclusions

• This neutrality will be gained through more
  efficient use of expensive services, not via
  price concessions from facilities and
  specialists.
• There must be a quid pro quo for any increase in
  payment

10
Caution do not enter the Weird Zone!

• In a time of primary care scarcity, setting a
  performance bar too high will be
  counterproductive.
• What performance or outcome requirements do we
  set when new procedures, gadgets, or
  pharmaceuticals are introduced?

11
Caution do not enter the Weird Zone!

• Does a new stent have to demonstrate lower
  mortality?
• Does a new imaging study prove value by reducing
  overall cost of a condition?
• Does an operative intervention have to prove
  improved, measurable outcome for it to be
  covered under a medical plan?

12
Caution do not enter the Weird Zone!

• While we ideally should require such data before
  coverage is permitted, in fact we do not.
• Then it is entirely inappropriate to demand a
  much higher bar for the most ethical, valuable,
  and patient-centered members of the medical
  community in their ministrations to our patients.

13
Agenda

• The Value Proposition health conveyed per dollar
  spent
• The Perdue Experience
• NBGH Primary Care Work Group product
• Caution Do Not Enter the Weird Zone!

14
Financing Primary Care The Best of Times

• The Patient-Centered Medical Home Summit
• Washington, D.C. October 17, 2008
• Roger C. Merrill, M.D., Chief Medical Officer