1. 2012-13 Welcome to the Family Medicine Clerkship

3. Why have a FM rotation? Ecology of Medical Care 1000

4. Why have a FM rotation? Ecology of Medical Care 1000 750

5. Why have a FM rotation? Ecology of Medical Care 1000 750 250

6. Why have a FM rotation? Ecology of Medical Care 1000 750 250 10

7. Why have a FM rotation? Ecology of Medical Care 1000 750 250 10 1

8. Why have a FM rotation? Ecology of Medical Care 1000 750 250 10 1

9. Why have a FM rotation? Ecology of Medical Care 1000 750 250 10 1

10. Care is the most expensive in the world Source: Centers for Medicare and Medicaid Services 2008

11. Mortality amenable to health care (per 100,000 population*) * Countries’ age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections. See report Appendix B for list of all conditions considered amenable to health care in the analysis. Data: E. Nolte and C. M. McKee, London School of Hygiene and Tropical Medicine analysis of World Health Organization mortality files (Nolte and McKee 2008). Care does not result in good outcomes & has not improved much Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 11

12. Care is not well communicated 75% of patients do not know what doctor did in the ED 50% of patients do not recall what the doctor told them 40% of patients say their doctors rush JGIM 2009

13. Care is complicated Sources: R. Berenson and J. Horvath, “The Clinical Characteristics of Medicare Beneficiaries and Implications for Medicare Reform,” prepared for the Partnership for Solutions, March, 2002; Medicare SAF 1999.

14. Care neglects prevention & is uneven * Recommended care includes seven key screening and preventive services: blood pressure, cholesterol, Pap, mammogram, fecal occult blood test or sigmoidoscopy/colonoscopy, and flu shot.. Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008

15. Primary Care Well Done: The Patient Centered Medical Home Ensure Access to Care Comprehensive Care Coordinated Care Systems Based Approach to Quality and Safety Patient Centered Care

16. The Promise of Primary Care Graham Center 2011. Recent ACO/PCMH experiments Geisinger and others 7%+ reduction in total costs (entire cost of primary care for Medicare!!) 16%-24% reduction in hospital admissions 30-40% reduction in emergency department CCNC $1 billion saved in 6 years

17. The Promise of Primary Care % of primary care providers in system U.S.

18. The Promise of Primary Care % of primary care providers in system U.S.