financing primary care – the best of times
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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. Agenda. The Value Proposition: health conveyed per dollar spent The Perdue Experience - PowerPoint PPT PresentationTRANSCRIPT
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
Financing Primary
Care – The Best of Times
Agenda
1. The Value Proposition: health conveyed per dollar spent
2. The Perdue Experience 3. NBGH Primary Care
Work Group product4. Caution: Do Not Enter
the Weird Zone!
Financing Primary
Care – The Best of Times
USA – Cost vs. “Product”
Cost/ Intensity of Service
Hea
lth
Sta
tus
There is a relationship between cost And health status improvement:
Financing Primary
Care – The Best of Times
The solution? Chicken!!
Financing Primary
Care – The Best of Times
The Perdue Experience
On-site primary clinics (called Wellness Centers) which serve as medical homeo Visits are on the clock, minimal
payroll-deducted co-pay, clinics operate during all production shifts.
o Goal is health improvement in a longitudinal model
Financing Primary
Care – The Best of Times
The Perdue Experience
Physician contracting in owned, direct networks.
o This allows us to have efficient networks, yet establish PCP reimbursement at the highest level vs. other payers in each geographic area.
o We want our docs to smile when a Perdue patient comes into the office.
o We ask our PCPs to be Marcus Welby, managing each case whatever the outside service requirements.
Financing Primary
Care – The Best of Times
The Perdue Experience
$4,719
$3,255
$5,427
$3,146
$6,241
$3,231
$7,177
$2,834
$8,400
$3,157
$9,400
$3,312
$0
$2,000
$4,000
$6,000
$8,000
$10,000
FY03 FY04 FY05 FY06 FY07 FY08
Cost per Associate: National Business Group on Health vs. Perdue
NBGH
Perdue
Financing Primary
Care – The Best of Times
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
Financing Primary
Care – The Best of Times
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
Financing Primary
Care – The Best of Times
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?
Financing Primary
Care – The Best of Times
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?
Financing Primary
Care – The Best of Times
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.
Financing Primary
Care – The Best of Times
Agenda
1. The Value Proposition: health conveyed per dollar spent
2. The Perdue Experience 3. NBGH Primary Care
Work Group product4. Caution: Do Not Enter
the Weird Zone!
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