Kristof Stremikis

How the Affordable Care Act Will Strengthen the Nation's Primary Care Foundation

As the country turns toward implementation of the Patient Protection and Affordable Care Act, realizing the potential of reform will require significant transformation of the American system of health care delivery. To that end, the new law seeks to strengthen the nation’s primary care foundation through enhanced reimbursement rates for providers and the use of innovative delivery models such as patient-centered medical homes. Evidence suggests that these strategies can return substantial benefits to both patients and providers by increasing access to primary care services, reducing administrative hassles and burdens, and facilitating coordination across the continuum of care. If successfully implemented, the Affordable Care Act has the potential to realign incentives within the health system and create opportunities for providers to be rewarded for delivering high value, patient-centered primary care. Such a transformation could lead to better outcomes for patients, increase job satisfaction among physicians and encourage more sustainable levels of health spending for the nation.

Health information technology and physician perceptions of quality of care and satisfaction

OBJECTIVE To examine across seven countries the relationship between physician office information system capacity and the quality of care. DESIGN Multivariate analysis of a cross-sectional 2006 random survey of primary care physicians in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, United Kingdom, and United States. MAIN OUTCOME MEASURES coordination and safety of care, care for chronically ill patients, and satisfaction with practice of medicine. RESULTS The study finds significant disparities in the quality of health care between practices with low information system capacity and those with high technical capacity after controlling for within country differences and practice size. There were significant physician satisfaction differences with the overall experience of practicing medicine by information system level. CONCLUSIONS For policy leaders, the seven-nation survey suggests that health systems that promote information system infrastructure are better able to address coordination and safety issues, particularly for patients with multiple chronic conditions, as well as to maintain primary care physician workforce satisfaction.

Innovation In Medicare And Medicaid Will Be Central To Health Reform’s Success

The health reform legislation signed into law by President Barack Obama contains numerous payment reform provisions designed to fundamentally transform the nations health care system. Perhaps the most noteworthy of these is the establishment of a Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services. This paper presents recommendations that would maximize the new centers effectiveness in promoting reforms that can improve the quality and value of care in Medicare, Medicaid, and the Childrens Health Insurance Program, while helping achieve health reforms goals of more efficient, coordinated, and effective care.

Health care spending--a giant slain or sleeping?

This report reviews the history of U.S. health care spending and discusses potential explanations for the slowing in the rate of increase in health care expenditures in recent years. Strategies to control future health care costs are also discussed.

Medicare Beneficiaries Less Likely to Experience Cost- and Access-Related Problems than Adults with Private Coverage

The experiences of people covered by Medicare and those with private employer insurance can help inform policy debates over the federal budget deficit, Medicares affordability, and the expansion of private health insurance under the Affordable Care Act. This article provides evidence that people with employer-sponsored coverage were more likely than Medicare beneficiaries to forgo needed care, experience access problems due to cost, encounter medical bill problems, and be less satisfied with their coverage. Within the subset of beneficiaries who are age sixty-five or older, those enrolled in the private Medicare Advantage program were less likely than those in traditional Medicare to have premiums and out-of-pocket costs exceed 10 percent of their income. But they were also more likely than those in traditional Medicare to rate their insurance poorly and to report cost-related access problems. These results suggest that policy options to shift Medicare beneficiaries into private insurance would need to be attentive to potentially negative insurance experiences, problems obtaining needed care, and difficulties paying medical bills.

Family Medicine: Preparing for a High-Performance Health Care System

As policy leaders seek to lower costs, increase access, and improve quality in the American health care system, strengthening primary care has become a key strategy for achieving high performance. Health reform proposals under consideration in Congress include provisions that increase Medicare and Medicaid payment rates for prevention and primary care services, spread the patientcentered medical home (PCMH) model in the Medicare program, and create a payment innovation center to test and share savings with innovative primary care practices. 1 There is wide consensus that primary care is at the center of a high-performing health care system. The health professional community is leading change. The Future of Family Medicine report in 2004 set forth a new model of family medicine that is the foundation of a high-performance health system. 2 In 2007, 4 primary care professional associations endorsed joint principles for the PCMH. 3 Policy leaders have responded to the argument for the benefits to patients and the nation from a new model of care, and they are increasingly willing to commit resources to primary care with the expectation that such investment will yield returns not only in better care for patients, but also in greater value for the resources dedicated to health care. Primary care will need to undergo fundamental change in the design and delivery of care to meet these high expectations. The National Demonstration Project, launched by the American Academy of Family Physicians in 2006, is already gaining valuable experience with transforming care delivery and yielding important lessons. 4 Despite the leadership of the health professional community, change is difficult and resistance can be expected. Perhaps the greatest barrier to change is a belief that physicians are already delivering patient-centered care. A review of the performance of the health system along key dimensions is, therefore, instructive in identifying gaps in performance that can be addressed by a new model of care. In 2005, my colleagues and I 5 set forth a “2020 Vision of Patient-Centered Primary Care,” with 7 attributes of patient-centered primary care that are likely to yield cost and quality outcomes valued by patients and sought by policy leaders. These include:

Meeting enrollees' needs: how do Medicare and employer coverage stack up?

One key issue in health reform concerns the relative roles of coverage offered through private insurance and public programs. This paper compares the experiences of aged Medicare beneficiaries with those of people under age sixty-five who have private employer coverage. Compared with the employer-coverage group, people in the Medicare group report fewer problems obtaining medical care, less financial hardship due to medical bills, and higher overall satisfaction with their coverage. Although access and bill payment problems increased across the board from 2001 to 2007, the gap between Medicare and private employer coverage widened.