1. Session 8 – May 18, 2011 Organization, Integration and New Strategies for Improving the System Group presentation #5: Race Against Time Health System Organization 1

2. Designing a Primary Health Care System Builds on principles of: Equity Universal Access Community Participation Intersectoral Collaboration Encompasses broad population health issues, including public health functions. Creates conditions responsive to the needs of vulnerable/underserved groups. Coordinates care across the continuum – links prevention, acute care & chronic care. Fosters continuous evaluation and improvement. 2

3. Challenges to System Re-design Workforce Size, composition, distribution, training, remuneration, migration Information Systems Clinical and administrative Financing Mechanisms Source, sufficiency, sustainability and stewardship Political Will Role of/tools available to local, state & national governments, and international bodies 3

4. Impact of Managed Care on Primary Care Improve cost effectiveness by increasing reliance on primary care/decreasing specialty care. MCOs employ more PCPs and fewer specialists per capita. Increase employment opportunities and earnings for PCPs relative to specialists. This was all in a 1997 article… 4

5. Primary Care & Managed Care 5 Percentage of Physician Time Spent in Primary Care in Metropolitan Areas, by Involvement with Managed Care, 1995. Simon, et al (1997) Analysis of AMA Socioeconomic Monitoring System Survey. (HlthAff, 16(6): 89.)

6. Implications for Primary Care Managed care influences practice style of PCPs and specialists. Pros and Cons for quality of care. Physician workforce – sufficiency and composition. 6

7. Managed Care Backlash Reversal of integrated delivery progress. Abandon capitation as a payment mechanism, and along with it alignment of hospital and physician incentives. Reversal of primary care and specialist fortunes. Increased bargaining leverage for hospitals, decreased leverage for physicians. Increased concentration in insurance markets due to merger and/or exit. 7

8. What About Now: Managed Care, or Managing Care? Definition of “Managed Care” vs. definition of “Patient- Centered Medical Home” Integration of health service delivery functions. Key concept around ‘gatekeeping’ and utilization. Relationship between managing/integrating care and cost/quality/access. Other strategies healthcare delivery systems use to integrate care. Other issues regarding organization, financing and managing health services delivery. 8

9. Break When You Return: Group 5 Presentation 9