State-Wide Primary Care Access Authority

On Wednesday, CHC Sr. Vice President and Clinical Director Margaret Flinter and CHC Chief Quality Officer Daren Anderson attended the final meeting of the State-Wide Primary Care Access Authority (watch the CT-N Video).  Here are Margaret’s reflections on the final meeting.

Very early Wednesday morning, I walked into Room 1c of the Legislative Office Building to prepare to lead the last meeting of the Statewide Primary Care Access Authority, a group convened by Senator Williams and other legislative leaders in 2007 to study primary care capacity, access and quality in Connecticut and recommend strategies for change and improvement.  The room was empty when I got there, and I indulged in a few moments of remembering the many and talented people who had sat around the table as members of the Authority, the legislature, state officials, and very talented guests. People like Dr. Mitch Katz, who came from San Francisco to share how that city had achieved universal access to primary care, Dr. Steve Kempner, who described the North Carolina strategy, and Ellen Andrews from right here in Connecticut who worked so hard to bring the Primary Care Case Management system to Connecticut.

As the room filled and the meeting began, I welcome Senator Williams to this final meeting of the Authority by saying that if ever it were true that the world has changed while we did our work, it is certainly true of these last four years in health care.  Who knew in 2007 that Barack Obama would be elected in 2009, propose major health reform for the first time since the Clinton administration, and that the Affordable Care Act would become the lay of the land?  Or that the adoption of electronic health records would get a massive investment by the federal government that would spur adoption in practices at a dizzying rate compared to a few years ago?  Or that the concept of truly patient-centered care—something primary care providers always aspired to but rarely had the disciplined systems of access, care coordination, and quality to reliably deliver on—would become part of the “norm” for practices to pursue.

Yet here we are in 2011.  Over 1,000 primary care providers are enrolled with the “Regional Extension Center” to get direct technical assistance in implementing electronic health records.  More than 300 providers across the state are recognized by NCQA as patient centered medical homes.  Three new FQHCs have opened, fifteen new FQHC sites have opened and three more are in progress;  in 2010, community health centers in Connecticut saw 100,000 more patients than they did in 2007. School based health centers and health services have also expanded.

As we presented our final recommendations to Senator Williams, perhaps the main point we were making is this:  when it comes to primary care, yes, we have got to have universal coverage (or as close as we can get to it), through expansion of Medicaid, the exchanges, the elimination of denials for pre-existing conditions.   We have got to have help with supporting the education and training of primary care workforce, not just primary care providers but the behavioralists, assistants, nurses, dentists and all the others that make up a high performance primary care team.  The true transformation of primary care to care that reliably, efficiently, expertly and compassionately delivers clinically excellent care in the domains of prevention, health promotion, chronic disease management, and treatment of acute illness must come from within primary care.  Practices need help. They need data, and coaching, and systems, and technology to achieve these transformations.  First and foremost they need the commitment to transformation itself.

Sitting at the legislative table, knowing I was speaking not just to the members of the Authority but to people across Connecticut who watch CT-N (who knew just how many people watch their broadcasts?).   I was incredibly proud of the vast distance CHC has come in its commitment to building a world class, transformational, primary care system for special populations in Connecticut.  Dr. Daren Anderson, our Chief Quality Officer, sat to my right during the meeting, speaking eloquently to the urgent need to transform and to use a combination of the patient centered home model and a dedication to data-driven continuous improvement to improve the outcomes of care.

Martin Luther King once said he had climbed to the mountain top and seen the Promised Land.   We think we too have seen the promised land of health care as right, universal coverage, transformational care, and better health for all.  Now to get there.