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Innovations in Primary Care: What's in the Affordable Care Act?

On Monday, an audience of more than 300 congressional and administration staff, press, and other key stakeholders gathered for a briefing on how the Affordable Care Act supports and strengthens primary care and how innovation in primary care can serve as a foundation to improve health system performance and control costs.

Melinda Abrams, director of the Commonwealth Fund's Patient-Centered Coordinated Care Program, explained that—while provisions related to primary care can be found throughout the sweeping reform legislation—they should be thought of as a comprehensive set of policies intended to position primary care as a stable base on which the rest of the reform efforts can build. The primary care provisions fall into three categories: payment reforms and financial incentives, efforts to expand and train the primary care workforce, and support for primary care practices as they work to adopt innovative ways to deliver high-quality care. A forthcoming Commonwealth Fund policy brief, "Realizing Health Reform's Potential: How the Affordable Care Act will Strengthen Primary Care in the U.S. and Benefit Patients, Providers, and Payers," will explore how the provisions, if taken together and implemented effectively, could put the health care system on a path to high performance.

Kevin Grumbach, M.D., chair of the Department of Family and Community Medicine at the University of California, San Francisco, presented highlights of more than 20 years of research demonstrating that systems that focus on primary care produce better health outcomes and deliver higher-quality care at a lower cost. Results from recent medical home demonstrations are consistent with this research: medical homes lead to cost-savings for payers and better care for patients. Notably, these findings hold true across a variety of different settings—from integrated health systems such as Geisinger Health System or Group Health Cooperative to initiatives sponsored by private health plans or state Medicaid programs. With a strong primary care foundation, quality of care and patient experience improve, while emergency department use and hospitalizations are reduced—resulting in net savings per patient in a relatively short amount of time.

States that have sought to strengthen primary care delivery offer lessons for national reform implementation. In Minnesota, the state legislature has called for all residents to have a health home—a patient- and family-centered primary care setting that works to ensure that care is accessible, high-quality, and coordinated among various providers. Jeff Schiff, medical director of the Minnesota Department of Human Services, said that the state is investing 2 percent of its annual health care budget into the effort, with the expectation that it will be cost-neutral over two years.

Vermont has been a leader in supporting primary care providers. One way it has done this is through the creation of Community Health Teams throughout the state. The teams include nurse coordinators, social workers, community health workers, and others that serve as shared resources for all primary care providers to facilitate care coordination. Craig Jones, executive director of the Vermont Blueprint for Health, explained that such teams are funded by all insurers in the state. Vermont is also expending considerable effort on multi-payer insurance reforms that encourage primary care practices to serve as health homes.

Finally, Paul Grundy, M.D., director of healthcare transformation at IBM, shared the perspective of a large employer that has been at the forefront of championing patient-centered primary care as a way to enhance value and lower costs for purchasers. Grundy argued that reforming primary care is essential to increase the value of health care and that purchasers not only play an essential role in making this happen but also stand to gain significantly by way of healthier and more productive employees.

The briefing concluded with a lively dialogue between panelists and the audience. A webcast of the briefing and speaker presentations are available here.

Publication Details

Publication Date: December 17, 2010
Author: Rachel Nuzum
Citation: R. Nuzum, Innovations in Primary Care: What's in the Affordable Care Act?, The Commonwealth Fund, December 2010.


Rachel Nuzum
Vice President, Federal and State Health Policy, The Commonwealth Fund