Wednesday Jun 13, 2012

It's Simple: Primary Care Equals Better Care Overall

"A strong primary care foundation is critical to improv­ing care for vulnerable populations and to achiev­ing high performance in the U.S. health care system overall. … Access to primary care is associated with improved quality of care, better health outcomes, and lower health care costs."

Sounds good, right? Maybe even familiar. Those sentences echo what the AAFP has been telling Congress, HHS and private payers for years. But that paragraph isn't copied from testimony the Academy provided to Congress or comments we provided to HHS.

Those statements are from the findings of a recent report by The Commonwealth Fund, a private foundation that supports independent research on health care issues.

A previous Commonwealth Fund study found that access to a medical home reduces health disparities for racial and ethnic minorities. This new report builds on that by looking at how health care improves when patients have both health insurance and a medical home.

The results in the most recent report weren't surprising. We already knew access to primary care improves management of chronic illness and averts more complicated problems through better wellness and prevention care. One of the advantages of the medical home model is practices don't wait for patients to show up with a problem. Instead, they take responsibility for keeping patients up to date and notify them when they are due for preventive services or chronic illness care.

According to the Commonwealth Fund report researchers, who surveyed more than 4,000 adult patients, four characteristics were identified as part of a medical home:

  • patients had a regular physician or place of care;
  • patients experienced no difficulty contacting their physician by phone;
  • patients believed their physician knew their medical history; and
  • patients said their physicians coordinate care with other doc­tors.

      By that definition, fewer than half of U.S. adults have medical homes. So how much of a difference do insurance and a medical home actually make? According to the Commonwealth Fund report:

  • 95 percent of insured adults reported having a primary care physician, compared to fewer than 75 percent of uninsured adults;
  • more than half of insured adults had a medical home, compared to 27 percent of uninsured adults;
  • more than half of insured, nonelderly adults were up to date on recommended preventive screenings, compared to a little more than one-third of those without health insurance;
  • more than half of low-income adults with health insurance and a medical home reported receiving all recommended preventive screen­ings, compared with 44 percent of respondents without a medical home;
  • among low-income adults with health insurance, only 35 percent of respondents with a medi­cal home reported having cost-related access problems, compared with half of respondents without a medical home; and
  • nearly two-thirds of adults without health insurance said they had failed to seek medical care because of costs, compared with one-third of insured adults.

The report stressed that its findings affirm the importance of the Patient Protection and Affordable Care Act, which is expected to expand insurance coverage to more than 30 million adults by 2020. The ACA also promotes the adoption of the medical home and other innovative health care delivery models.

A Supreme Court ruling on the health care reform law is expected before the court adjourns at the end of the month

A recent report about Medicare and Medicaid in Health Affairs found that increases in both the availability of acute care beds in a community and the number of physicians per thousand residents were associated with increased health care spending. Conversely, increases in the percentage of physicians working in primary care were associated with reduced spending.

And that brings us back to where we started. Improving access to primary care improves care and outcomes and lowers costs. It's that simple.

Glen Stream, M.D., M.B.I.is president of the AAFP.

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