National Implications for Rhode Island’s Focus on Primary Care Physicians

Thursday, May 27, 2010


It seems like the odds of actually getting your doctor on the phone these days are on par with winning a phone in radio contest.   With administrative headaches taking up to 30% of doctors’ time, it's no wonder that patient-doctor relationships have changed so dramatically over the past 20 years.  With the current system leaving doctors very little time to focus on patient wellness, some forward-thinking states are reexamining the role primary care physicians play in patients care.

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Rhode Island is at the epicenter of a powerful new concept in patient care garnering attention from Washington D.C. and across the country.

This innovation in primary care -- the patient-centered medical home -- is paying off in better health care, lower costs and happier doctors and patients. The approach is simple in that it centers on a patient's total care, starting with wellness - the prevention of illness - through a single caregiver -- a primary care physician.   These primary care physicians then help manage all their patient's health needs and coordinate care with other health professionals using a team approach.

Just last week, we saw Blue Cross Blue Shield of Rhode Island join the ranks of payers advocating wellness via their new contract with the 168 doctors who are part of the Rhode Island Primary Care Physicians Corp. This focus on paying doctors for providing "good care" versus the number of patients they see is a critical step in promoting wellness across the country.  Studies show that when a person has a primary care doctor as their usual source of care, their healthcare costs 1/3 less and they have a 19 percent lower mortality rate. This special patient-doctor relationship is particularly effective when dealing with patients with chronic illness such as diabetes, heart problems and depression which account for some 80 percent of our nation’s healthcare expenditures.

In communities across the nation, employers, health insurance companies and primary care doctors are coming together to improve how primary care is delivered. A Washington state pilot saw a 20 percent drop in emergency room visits. A North Carolina project experienced a 40 percent drop in hospitalizations for asthma and a 16 percent drop in emergency room visits.

A Pennsylvania health care system reported $3.7 million in net savings in its pilot. Rhode Island is on the same path with its Chronic Care Sustainability Initiative.

Rhode Island, with its compact size, is in a unique position to help the rest of the country understand how to scale this model of care to more patients. There are some important steps that need to be taken including a common model for the coordination of care among providers. Advancements in the use of electronic medical records could hold the key for easing this part of the equation. The measurement of success both for the doctors and the patients will be critical to this model. Employers will play a critical role in providing incentives for employees to work with their primary care doctors to stay well.

Lt. Governor Elizabeth H. Roberts and The Rhode Island Foundation are forging an ongoing dialogue around these issues through a public forum series on health care. Public forums like these will be critical to ensuring a transparent process that brings the best ideas to the table. IBM is participating in the forum this week and our experts are eager to share their perspectives and lessons learned from other states. This includes how to provide incentives for doctors for improvement in quality of care as well as incentives to encourage electronic visits and phone visits so primary care physicians can be reimbursed for keeping people well, not just for seeing them in their office.

Taking advantage of smarter technology in order to create networks of connected information that lead to better care with fewer mistakes, predict and prevent diseases, and help consumers navigate the increasingly complicated healthcare system is an important goal for all. The research clearly shows that primary care is good both for people’s health and their pocketbooks.

Anthony Morettini is a native Rhode Islander and serves as  IBM’s Senior Location Executive for Rhode Island as well as the Business Unit Executive, IBM ISV & Developer Relations.  A graduate of Providence College and 25-year-plus veteran at IBM, he currently lives with his wife Susan in Bristol.


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