Is This Progress?

The Health Insurance Commissioner in Rhode Island has long advocated for increased emphasis and investment in primary care to improve outcomes and decrease costs. I must admit to being a skeptic as to whether investment in primary care was the most efficient way to achieve improved outcomes. I also wasn’t sure how you could shift dollars away from hospitals and specialists. Although the evidence that these investments will turn the tide on outcomes and quality is still mixed, I’ve become a strong believer, a convert if you will, that Christopher F. Koller was right. It makes sense that if primary care is the foundation of the system, and we strengthen the foundation, the whole system will be stronger. The Chronic Care Sustainability Initiative (CSI), which is really the Patient Centered Medical Home (PCMH) Project in RI, has now shown that patient outcomes improve and utilization can be reduced for patients receiving their care from PCMH practices.

It makes sense that if primary care is the foundation of the system, and we strengthen the foundation, the whole system will be stronger.

The Health Insurance Commissioner has, with the cooperation of the insurers, mandated that the insurers increase their spending on primary care by 1% per year from 2010 to 2014. He has further required that this increased spending on primary care not be included in rate increase requests. His Office has reported that the plans have met the spending target through 2011 and in their projected spending for 2012. This is a credit to the Health Insurance Commissioner, the insurers, and the primary care physicians who have embraced the concept. It also shows that change in the healthcare system is possible if you develop a specific intervention with clear targets and create a mechanism for tracking progress. This should give us hope that larger change in the system is possible.

On another note, I want to recommend that you read the statements of the Presidential candidates on healthcare reform published in the June issue of the New England Journal of Medicine and “The Conservative Case for Obamacare” in the Sunday Review Section of the New York Times.