Primary Care Spending in Maine
Explore the importance of investing in primary care as the foundation of the healthcare system in Maine. Learn about initiatives to reallocate medical care expenditures to primary care, aiming for better quality, population health, and cost-effectiveness. Discover insights on primary care spending calculations and the impact on healthcare delivery in Maine.
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Spending on Primary Care Ellen Schneiter Maine Health Management Coalition 1 Maine Health Management Coalition | 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Spending on Primary Care in Maine Why do we care? Primary care is the backbone of our health care delivery system Systems of care built on a strong foundation of primary care have better quality of care, good population health and lower costs As compared to other nations, the US has lagged behind in these system attributes This is likely due in part to a lack of investment in primary care 2 Maine Health Management Coalition | 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
So, how much do we spend in Maine? First pass quick & dirty adaptation of Rhode Island approach RI Affordability Standards Designed to reallocate medical care expenditures to primary care w/o increasing overall spend Applicable to commercial market OHIC has established a detailed approach to calculating spend, using data provided in annual filings by commercial payers RI does not yet have an APCD 3 Maine Health Management Coalition | 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
RI Approach OHIC defines primary care spending* as medical expenses paid to Family Practice, Internal Medicine, Pediatrics and providers with credentials = MD, DO, NP and PA Excludes dual providers who provide both primary and specialty care except in those situations where the specialist is paid on a PC provider fee schedule * RI Annual Health Statement Supplement Instructions 4 Maine Health Management Coalition | 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Our calculation We used claims data from the APCD CY2013 Excluded claims associated with supplemental coverage plans Only included members with a full year of eligibility (N=587k less 140k w/o continuous elig) ID d primary care providers using NPI taxonomy Included NP/PA providers if NPI ID d them as PC Only FFS claims are included 5 Maine Health Management Coalition | 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Our calculation, cont Total spend (denominator) includes NPIs that ID provider as other than PC as well as claims with provider unknown a considerable number There are claims that we were unable to classify as primary care (e.g. integrated practices billing out under a single TIN) or that were missing servicing provider 5% Rx, all pd claims other than PC 6 Maine Health Management Coalition | 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Our calculation, cont Total spend used in denominator $1.02 billion (inc $290m Rx) Of that total, primary care spend $53 million 5.2% primary care spend Remember, though, there is some slack in this calculation! Limitations of data; no non-claims spend 7 Maine Health Management Coalition | 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Considerations Is this the best way to define primary care? Definition driven by provider type v. codes Data limitations And once you figure out the spend, then what? What is the right amount to spend? 8 Maine Health Management Coalition | 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
