advocating for primary care in a budget crisis….and beyond

8/14/2019 Advocating for Primary Care in a Budget Crisis.and Beyond

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Advocating for Primary Care in aBudget Crisis.and Beyond

Presentation to the

National Association of Community Health Centers

_________________________Kate Breslin, Community Health Care Association of New York State

Dan Lowenstein, Primary Care Development Corporation

August 24, 2009

www.nyprimarycarehome.org


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Overview

Background

Opportunities Forming the Coalition

Coalition Strategies and Tactics

Challenges

Outcomes


3/25

Background Why?

Historically, New York has:

An extremely strong acute care system and an

undersized, disorganized primary care sector. High and rising health care costs (including but

not limited to Medicaid) with mediocre healthoutcomes.

Large disparities in access & outcomes. Highest Medicaid spending in the US, with

mediocre outcomes.


4/25

Background Opportunities

Recognition of inefficient and expensive

health care system

Commission on Health Care Facilities in the

21st Century (Hospital Closing Commission)

formed to address costs

Governor offers a fresh start promises

to transform New Yorks health care system


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Background Challenges

Low awareness of primary care

Organized, resourced hospital sector, but

disorganized, under-resourced primary care sector Competing agendas among primary care

stakeholders

Rapidly contracting economy groups competing

for shrinking resources Governor Spitzer resigns early questions about

whether Governor Paterson would support


6/25

Formation of the

Primary Care Coalition Primary Care Development Corporation

(founder)

Community Health Care Association of New

York State (founder)

Area Health Education Centers System

American College of Physicians

Academy of Family Physicians


7/25

Coalition Purpose

Purpose: Place primary and preventive care

at the center of the States health reform

agenda with the objective of assuring astrong, effective primary care home for

every New Yorker.

Strategy: To build the consensus, visibilityand momentum needed to do this.


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The Primary Care Agenda

Reform the payment system to encourage primary careby enhancing reimbursement for primary care services;

Preserve and expand primary care infrastructure and

workforce capacity; Transform the current model of care to a patient-

centered healthcare home;

Aggressively promote the use and adoption of health

information technology among providers of primarycare services; and

Expand and improve coverage to remove financialbarriers to care


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Aligns with/supports National Agenda

Increase capacity

through workforce,

capital, HIT

Support for primary care

capital and HIT adoption

Develop a primary care

workforce

Reform payment systems

to support primary care

Transform to PCMH &

expand capacity

Primary Care

Coalitions NY

Primary Care Agenda

Implement support

systems and TA

Augment capital

resources

Assure workforce

Expand revenue: grants

and reimbursement

Preserve, strengthen,

expand on stable base

Access for All America

NACHCs AAA Plan

Infrastructure

Capital

Workforce

Reimbursement

Capacity


10/25

Coalition Operations Core funding: organizational self-assessments,

augmented by additional funds as available.

Coalition leaders supply the policy expertise; hire:

Media specialist, given the need for a campaign

A part-time coordinator

Coalition partners commit themselves to weekly

war-room calls + periodic 1-day strategy retreats

Decision-making is collective; requires rapidresponse from all partners on media issues


11/25

Strategies and Tactics

Key Messages New Yorks health care system is inefficient and

expensive

Primary care is essential to*

Lowering health care costs

Improving health outcomes

Eliminating disparities

Investing in primary care saves money in the system

Strengthening primary care must go hand in hand withexpanding health insurance coverage

* Laying the Foundation: Health System Reform In NYS and thePrimary Care Imperative, Rosenbaum and Shin


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Strategies and Tactics - Policy

Developed 5-point agenda for Primary Care

Issued reports and studies detailing need for

primary care

Promoted third party evidence that supported

PCCs agenda

Publicly & actively supported New Yorksprimary care investments


13/25

Strategies and Tactics Key Targets

New York State: Executive, Legislature,

Hospital Closing Commission

New York City: Mayor, City Council

Focus on key decisionmakers in

government

Built primary care champions


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Strategies and Tactics Outreach Meetings with key legislators

Testimony at public hearings

Position papers on legislative/budget issues

Regular mailings/emails Sign-on petitions

Coalition listserv

Website

Media

Press conferences

Editorial board meetings

Edtiorial/Op-ed/story placements


15/25

Policy ResearchPrimary care need, capacity, cost savings:

Laying the Foundation: Health System Reform In NYS and thePrimary Care Imperative, (2006, Rosenbaum and Shin)

Analysis of potential cost savings through primary care investment (in

progress, August 2009) Primary Care Capacity Shortage in NYC and the Potential Impact of

Hospital Closures (PCDC and HHC)

A Zip Code Analysis of Primary Care Need in NYS (AHEC)

The Future of Primary Care in NYS (ACP)

Payment reform

New Yorks Primary Care Reimbursement System: A Roadmap ToBetter Outcomes (PCDC)

Commercial Insurers Reimbursement Rate to New YorksCommunity Health Centers Jeopardizes Care (CHCANYS)


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Website: nyprimarycarehome.org
http://www.nyprimarycarehome.org/


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Media Success


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Cycle of Influence

Media Strategy

Policy Implications

Research Published


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Policy outcomes 2006-2007

Hospital Closing Commission includes

primary care investment recommendations

Primary care policy included in

gubernatorial primary and election

campaigns

Assembly hearings on primary care


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Policy outcomes 2008-2009

New York makes historic shift in investments from inpatient tooutpatient

$600 million invested in primary care in 2007-2009

Reimbursement for important primary care enhancements

(weekend/evening operations, asthma/diabetes educators

Doctors-Across-NY - loan forgiveness and practice start-up assistance

physicians to practice in underserved communities

New Primary Care Quality Standards - Statewide Medical Home slated

for 2010

Positive changes in primary care safety net/uninsured funding

Dedicated $200M special grant funding to expand primary carecapacity, assist in HIT adoption


21/25

Whats Next?

Strategically grow coalition to engage other supporters

Expand media presence, including social media

Assure continued success of the 4-year reform agenda inthe face of continuing hospital opposition, State budgetcrisis.

Monitor feedback on reforms

Are they having the desired impact on quality and access? Are

they sufficient? Leverage new opportunities

Impact of federal health reform primary care

Federal HIT impact/opportunities/ARRA


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Big Challenges

Policy Challenges

Primary and preventive care are a silent needdifficult to light on fire as an issue.

Historic underfunding lack of power and visibilitycompared to other health care sectors.

Health care reform defined as insurance expansion

Coalition Challenges Consensus decision-making

Resources, organizational capacity


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Reflections: The Policy Front

The importance of campaign skills

The need for credibility

Expanded Coverage vs. Delivery SystemReform: Why you cant have one withoutthe other

The need to keep reinforcing messagse topolicymakers, partners, media


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Reflections: All Fronts

The importance of:

Building clarity, consensus on the problems

Having actionable strategies Building stakeholders/partnerships

Remembering that we are stronger together

than we are apart (even though we dontalways agree)


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Dan Lowenstein at (212) 437-3942

www.pcdcny.org

Kate Breslin at (518) 434-0767www.chcanys.org

www.nyprimarycarehome.org
http://www.pcdcny.org/http://www.chcanys.org/http://www.chcanys.org/http://www.pcdcny.org/

advocating for primary care in a budget crisis….and beyond

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