1. High Value Primary Care: New Evidence on the Excellent Return on Investment in Primary Care Commonwealth Fund and Alliance for Health Reform Briefing December 13, 2010 Kevin Grumbach, MD Department of Family & Community Medicine University of California, San Francisco Center for Excellence in Primary Care

2. Abundant research evidence over the past 20 years indicates that health systems and regions with a strong foundation of primary care have: Better population health outcomes Better quality of care More preventive care Lower costs More equitable care and mitigation of health disparities

3. Source: Baicker & Chandra, Health Affairs, April 7, 2004

5. From Observational Studies to the Health System Equivalent of Clinical Trials What happens to quality, access and costs as a result of investments to enhance and improve primary care? A review of recent prospective evaluation research on the outcomes of interventions to implement advanced primary care models of Patient-Centered Medical Homes in the US

6. Review of Recent Evidence on PCMH Outcomes 14 different initiatives –>1 million patients, 1000s of medical practices –5 Integrated delivery systems Group Health, Geisinger, HealthPartners, Intermountain, VHA –3 Private health plan sponsored initiatives BCBS South Carolina, BCBS North Dakota, Metropolitan Health Networks Florida –2 Medicaid state initiatives North Carolina, Colorado –4 Other models

7. Common Elements of PCMH Models Team-based primary care Proactive care coordination (often with RN care managers) Enhanced patient access Systematic chronic care model Tracking and feedback of clinical performance data Payment reform

8. Findings Are Consistent Across These Studies Excellent return on investment: –Quality of care, patient experiences, care coordination, and access are demonstrably better. –Reductions in ED visits and hospitalizations produce net savings in total costs per patient.

9. Examples of Cost Outcomes Group Health Cooperative: 5% ↓ $PMPM Geisinger: 7% ↓ $PMPM VA: $593 ↓ cost per patient with COPD BCBS South Carolina: 6.5% ↓ $PMPM Metropolitan Health Networks: 20% ↓ $ per patient North Carolina Medicaid/SCHIP: Cumulative savings of $974.5 million over 6 years (2003-2008) Colorado Medicaid: $215 ↓ cost per child per year

10. Conclusions Primary care has an excellent ROI –Better quality –Bend the cost curve With appropriate resources, primary care practices are able to transform themselves into high performing patient centered medical homes Urgent need for all stakeholders to support reform and renewal of primary care