Primary Care Costs & Payment

The Robert Graham Center strives to inform policy decisions affecting issues surrounding primary care by providing evidence derived from rigorous economic research. The Graham Center is interested in producing economic research that generates new evidence and ideas to enable primary care to attain the “triple aim” of increased quality, improved outcomes, and reduced costs while informing effective policy decision-making.

Primary Care Forum

The March 2014 Primary Care Forum, titled “Thinking Differently about Payment for Primary Care: Considering Alternative Payments Promoting Value, Complexity and Comprehensiveness” presented research conducted by Dr. David Katerndahl comparing the complexity of ambulatory care visits across various practice specialties.

View Forum Presentations »

Blended Payment Models

Graham Center staff produced a systematic review of the published literature on services covered by care management fees in documented blended payment models and their associated per member per month fee. The goal of this work is to help inform primary care physicians of the aspects of care management fees including the range of ‘typical’ fees, the usual services and products covered under such fees, and issues other physicians have encountered in negotiating such fees. This document was releases as supporting evidence for the AAFP’s new policy on care management fees.

Collaborative Work

Collaboration with the AAFP and outside partners including other research groups, practice-based research networks, state and local agencies and university departments continues to be essential. Center staff will continue to pursue research that provides new evidence regarding the costs of primary care practice transformation, the economic impact of primary care, and new methods of paying for primary care functions.

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Narrow Results:

  • Accountable Care Organizations Serving Deprived Communities Are Less Likely to Share in Savings

    Articles | Nov 15, 2019 | Alex R. Webb, MD; Winston Liaw, MD, MPH; YoonKyung Chung, PhD; Stephen Petterson, PhD; and Andrew Bazemore, MPH, MD

    Primary care physicians are increasingly participating in ACOs. While prior studies have identified ACO and patient characteristics associated with savings, none have examined characteristics of the communities served by ACOs. Our objective was to assess the relationship between an ACO's service area characteristics and its savings rate.

  • Investing in Primary Care: A State-level Analysis40 page PDF

    Reports | Jul 24, 2019 | Yalda Jabbarpour, MD; Ann Greiner, MCP; Anuradha Jetty, MPH; Megan Coffman, MS; Charles Jose, MD; Stephen Petterson, PhD; Karen Pivaral; Robert Phillips, MD, MSPH; Andrew Bazemore, MD, MPH; and Alyssa Neumann Kane

    In a first-of-its-kind study, the 2019 Patient-Centered Primary Care Collaborative (PCPCC) Evidence Report examines states’ primary care spending patterns, including spending across payer types, and considers the implications of these results for select patient outcomes.

  • How Evolving United States Payment Models Influence Primary Care and Its Impact on the Quadruple Aim

    Articles | Aug 27, 2018 | Brian Park, MD, MPH; Stephanie B. Gold, MD; Andrew Bazemore, MD, MPH; and Winston Liaw, MD, MPH

    This narrative review proposes a taxonomy of the major health care payment models, reviewing their ability to uphold the functions of primary care, and their impacts across the Quadruple Aim.

  • Advancing Primary Care Through Alternative Payment Models: Lessons from the United States & Canada

    Articles | May 09, 2018 | Andrew W. Bazemore, MD, MPH

    The United States and Canada share high costs, poor health system performance, and challenges to the transformation of primary care, in part due to the limitations of their fee-for-service payment models.

  • Methods Conference 2017: Primary Care Spending Summary6 page PDF

    Content Type, Reports | Apr 24, 2018 | The Robert Graham Center

    As global spending on health care (especially in the United States) continues to increase, there is a push to characterize the expenditures and inform policy interventions. Evidence suggests that increased attention to primary care results in improved health outcomes at a lower cost. However, there is no single established method for defining or measuring primary care expenditures in the US or internationally. On December 6 and 7, 2017, the 34 people representing several international and US health organizations came together to discuss primary care spending.

  • Aggregation to Promote Health in an Era of Data and Value Based Payment

    Articles | Sep 19, 2017 | Winston Liaw, MD, MPH; Andrew Bazemore, MD, MPH; and Robert Phillips, MD, MSPH

    A description of aggregation- an emerging strategy in an era of value based payment and big data- and proposes a model for categorizing aggregators, calling for greater investigation into their benefits and costs.

  • Navigating Payer Heterogeneity in the United States: Lessons for Primary Care4 page PDF

    Articles | Aug 18, 2017 | Andrew Bazemore, MD, MPH; Winston Liaw, MD, MPH; Daniel McCorry, MD

    The US exemplifies hybridization which results in both systemic benefits and harms. While this practice stimulates innovation, encourages practices to be efficient, and increases choice, it has also been linked to gaps in patient safety and overtreatment. We propose three lessons from the US for navigating a public and private system: hybridization allows for innovation; hybridization leads to administrative complexity; and if the costs of participation outweigh the benefits, practices may undergo dehybridization.

  • Bright Spots in Care Management84 page PDF

    Reports | Jun 12, 2017 | Tyler Barreto, MD; Andrew Bazemore, MD, MPH; Megan Coffman, MS; Yalda Jabbarpour, MD; and Winston Liaw, MD, MPH

  • Executive Summary: Bright Spots in Care Management12 page PDF

    Reports | Jun 12, 2017 | Tyler Barreto, MD; Andrew Bazemore, MD, MPH; Megan Coffman, MS; Yalda Jabbarpour, MD; and Winston Liaw, MD, MPH

  • Impact of Gaps in Merit-Based Incentive Payment System Measures on Marginalized Populations

    Articles | May 09, 2017 | Kyle Eggleton, MBChB, MMedSci, MPH; Winston Liaw, MD, MPH; and Andrew Bazemore, MD, MPH2

    As the United States enters a new era of value-based payment heavy in emphasis on primary care measurement, careful examination of selected measures and their potential impact on outcomes and vulnerable populations is essential.

  • Effective Payment for Primary Care: An Annotated Bibliography32 page PDF

    Reports | Mar 30, 2017 | Stephanie B. Gold, MD and Brian J. Park, MD, MPH

  • The Effects of Training Institution Practice Costs, Quality, and Other Characteristics on Future Practice

    Articles | Mar 15, 2017 | Robert L. Phillips Jr, MD, MSpH; Stephen M. Petterson, PhD; Andrew W. Bazemore, MD, MPH;, Peter Wingrove, BS; and James C. Puffer, MD

    This study assesses whether cost and quality imprinting can be detected within the 3,436 Hospital Service Areas (HSAs).

  • Among Low-Income Respondents With Diabetes, High-Deductible Versus No-Deductible Insurance Sharply Reduces Medical Service Use

    Articles | Dec 15, 2016 | David L. Rabin, MD, MPH; Anuradha Jetty, MPH; Stephen Petterson, PhD; Ziad Saqr, MD; Allison Froehlich, MD

    Private insurance with a deductible substantially and problematically reduces medical service use for lower-income insured respondents with diabetes

  • What Now for Obamacare?

    Commentaries & Editorials | Nov 11, 2016 | Douglas Kamerow, MD

    With Trump headed for the White House and Republicans still in control of both houses of Congress, we are told that Obamacare’s demise is just a matter of time.

  • High-Deductible Plans May Reduce Ambulatory Care Use

    One Pagers | Nov 01, 2016 | Anuradha Jetty, MpH; David Rabin, MD, Mph; Stephen Petterson, PhD; Allison Froehlich, BA

    Many patients with high-deductible insurance plans delay or avoid necessary treatment, including ambulatory and preventive care.

  • Summary: Understanding the Impact of Medicare Advantage on Hopitalization Rates2 page PDF

    Reports | Mar 15, 2016 | The Robert Graham Center

  • Understanding the Impact of Medicare Advantage on Hospitalization Rates: A 12-State Study34 page PDF

    Reports | Mar 15, 2016 | Stephen Petterson, PhD; Andrew Bazemore, MD, MPH; Yalda Jabbarpour, MD; and Peter Wingrove, BS

  • Complexity of Ambulatory Care Visits of Patients with Diabetes as Reflected by Diagnoses per Visit

    Articles | Jan 12, 2016 | Miranda Moore, PhD; Claire Gibbons, PhD; Newton Cheng, MS; Megan Coffman, MS; Stephen Petterson, PhD; and Andrew Bazemore, MD, MpH

    To explore complexity, we looked at diabetes as a case study to determine whether and how the complexity of office-based visits varies by physician specialty type, as measured by the number of diagnoses reported per visits.

  • What's Happening to Cheap Generic Drugs?

    Commentaries & Editorials | Oct 05, 2015 | Douglas Kamerow, MD

    Prices for certain generic drugs have skyrocketed recently. Sometimes this is due to standard market circumstances, but increasingly it is caused by aggressive pricing strategies by pharmaceutical companies.

  • U.S. Medicare, Medicaid, and Nurse Practitioners all Turn 50

    Commentaries & Editorials | Jul 20, 2015 | Douglas Kamerow, MD

  • More Comprehensive Care Among Family Physicians is Associated with Lower Costs and Fewer Hospitalizations

    Articles | May 11, 2015 | Andrew Bazemore, MD, MPH; Stephen Petterson, PhD; Lars Peterson, MD, PhD; and Robert Phillips, MD, MSPH

    Comprehensiveness is lauded as 1 of the 5 core virtues of primary care, but its relationship with outcomes is unclear. We measured associations between variations in comprehensiveness of practice among family physicians and healthcare utilization and costs for their Medicare beneficiaries.

  • Only One Third of Family Physicians Can Estimate Their Patient Panel Size

    Articles | Mar 16, 2015 | Lars Peterson, MD, PhD; Anneli Cochrane, MPH; Andrew Bazemore, MD, MPH; Elizabeth Baxley, MD; and Robert Phillips, MD, MSPH

    In addition to payments for services rendered to individual patients, primary care physicians will increasingly be paid for their ability to achieve goals across the body of patients most closely associated with them: their “panel.” In a 2013 survey, however, only one third of family physicians could estimate their panel size, raising concern about their ability to perform more advanced primary care functions.

  • Opting Out of Medicaid Expansion May Cost States Additional Primary Care Physicians

    One Pagers | Jan 01, 2015 | Mark W. Lin, MD; Stephen Petterson, Phd; Claire Gibbons, Phd; Sean Finnegan, MS; Andrew Bazemore, MD, MpH

    States currently electing not to expand Medicaid possibly forego the opportunity to expand their primary care workforces by a total of 1,525 physicians. Increased demand from expansion states and a limited primary care physician pool may provide a pull across state lines to the disadvantage of nonexpansion states.

  • Spending Patterns in Region of Residency Training and Subsequent Expenditures for Care Provided by Practicing Physicians for Medicare Beneficiaries

    Articles | Dec 15, 2014 | Candice Chen, MD; Stephen Petterson, PhD; Robert Phillips, MD, MSHP; Andrew Bazemore, MD, MPH; and Fitzhugh Mullan, MD

    Graduate medical education training may imprint young physicians with skills and experiences, but few studies have evaluated imprinting on physician spending patterns.

  • Cost, Utilization, and Quality of Care: An Evaluation of Illinois’ Medicaid Primary Care Case Management Program

    Articles | Sep 15, 2014 | Robert L. Phillips Jr, MD, MSPH Meiying Han, PhD Stephen M. Petterson, PhD Laura Makaroff, DO Winston R. Liaw, MD, MPH

    In 2006, Illinois established Illinois Health Connect (IHC), a primary care case management program for Medicaid that offered enhanced fee-for-service, capitation payments, performance incentives, and practice support.

  • Winnable Battles: Family Physicians Play an Essential Role in Addressing Tobacco Use and Obesity

    One Pagers | Jun 05, 2014 | Joseph Nichols MD, MPH and Andrew Bazemore, MD, MPH

    Tobacco use and obesity are linked to most deaths and significant disability in the United States, and family physicians are uniquely positioned to address these issues. This highlights a need for transforming primary care practices and teams to systematize the recognition and management of unhealthy behaviors, and for alternative payment models that support these efforts.

  • Proximity of Providers: Colocating Behavioral Health and Primary Care and the Prospects for an Integrated Workforce

    Articles | May 16, 2014 | Benjamin Miller, PsyD; Stephen Petterson, PhD; Bridget Teevan Burke, MPH; Robert Phillips, MD, MSPH; Larry Green, MD

    Integrated behavioral health and primary care is emerging as a superior means by which to address the needs of the whole person, but we know neither the extent nor the distribution of integration. Using the Centers for Medicare and Medicaid Services’ National Plan and Provider Enumeration System (NPPES) Downloadable File, this study reports where colocation exists for (a) primary care providers and any behavioral health provider and (b) primary care providers and psychologists specifically

  • Making the Case: Family Medicine for America's Health53 page PDF

    Presentations | Apr 15, 2014 | Andrew Bazemore, MD, MPH

    Making the Case: Family Medicine for America’s Health

  • Blended Payment Models and Associated Care Management Fees21 page PDF

    Presentations | Nov 07, 2013 | The Robert Graham Center

  • Effectiveness Over Efficiency: Underestimating the Primary Care Physicians Shortage

    Articles | Feb 01, 2013 | Robert Phillips, MD, MSPH; Andrew Bazemore, MD, MPH; and Lars Peterson, MD, PhD

    Interest in improving health care outcomes requires increasing the effectiveness of primary care. Focus on effectiveness is leading many innovative health systems to shrink primary care patient panels to strengthen relationships, and to enhance primary care teams to increase comprehensiveness. Such strategies would make primary care shortages worse than predicted, and are compounded by substantial declines in clinicians of all types choosing primary care careers.

  • A Large Retrospective Multivariate Analysis of the Relationship Between Medical Student Debt and Primary Care Practice in the United States22 page PDF

    Presentations | Dec 12, 2012 | Julie Phillips, MD, MPH; Stephen Petterson, PhD; Andrew Bazemore, MD, MPH; Robert Phillips, MD, MSPH.

  • Integrating Public Health and Primary Care12 page PDF

    Presentations | May 15, 2012 | Paul Wallace, MD and Sean P. David, MD

    Primary Care and Public Health: Exploring Integration to Improve Population Health

  • Integrating Public Health & Primary Care through Communities of Solution32 page PDF

    Presentations | May 08, 2012 | Sean P. David, M.D., S.M., D.Phil., Andrew Bazemore, M.D., M.P.H., Marguerite R. Duane, M.D., M.H.A., Sarah Lesko, M.D., M.P.H. , Kim S. Griswold, M.D., M.P.H., Thomas M. Morgan, M.D. , John M. Westfall, M.D., M.P.H. , James C. Puffer, M.D. , Larry Green, M.D.

    Integrating Public Health & Primary Care through Communities of Solution

  • Increasing Graduate Medical Education (GME) in Critical Access Hospitals (CAH) could enhance physician recruitment and retention in rural America

    Articles | Jan 15, 2012 | mam M. Xierali; Sarah A. Sweeney; Robert L. Phillips, Jr.; Andrew W. Bazemore; and Stephen M. Petterson, PhD

    Critical Access Hospitals (CAHs) are essential to a functioning health care safety net and are a potential partner of rural Graduate Medical Education (GME) which is associated with greater likelihood of service in rural and underserved areas. Currently, very little Medicare funding supports GME in the CAH setting, highlighting a missed opportunity to improve access to care in rural America.

  • Rewarding Family Medicine While Penalizing Comprehensiveness? Primary Care Payment Incentives and Health Reform: The Patient Protection and Affordable Care Act (PPACA)

    Articles | Nov 15, 2011 | Stephen Petterson; Andrew W. Bazemore; Robert L. Phillips, Jr.; Imam M. Xierali; Jason Rinaldo; Larry A. Green; and James C. Puffer.

    Family physicians’ scope of work is exceptionally broad, particularly with increasing rurality. Provisions for Medicare bonus payment specified in the health care reform bill (the Patient Protection and Affordable Care Act) used a narrow definition of primary care that inadvertently offers family physicians disincentives to delivering comprehensive primary care.

  • Using Maps to Strengthen Your Case: A Robert Graham Center Deep Dive19 page PDF

    Presentations | Jul 17, 2011 | Sean Finnegan, MS; Sarah Lesesne, MSPH; Mark Carrozza, MA; Michael Topmiller, MS et al

  • The Importance of Time in Treating Mental Health in Primary Care

    Articles | Jun 15, 2011 | Benjamin F. Miller; Bridget Teevan; Robert L. Phillips, Jr.; Stephen M. Petterson; and Andrew W. Bazemore.

    Primary care plays a critical role in treating mental health conditions, but caring for patients with comorbid mental health and medical conditions increases visit length. Lack of appropriate reimbursement mechanisms and competing priorities make it difficult to integrate mental health into primary care. Caring for patients with mental health comorbidities requires time not now affordable in the primary care setting and demands a new payment policy to promote team-based, integrated care for mental and physical illness in a patient-centered medical home.

  • Evidence About Your Value (and the Return on Investment)43 page PDF

    Presentations | May 15, 2011 | Robert L. Phillips, Jr., MD, MSPH

    Evidence About Your Value (and the return on investment)

  • FPs Lower Hospital Readmission Rates and Costs

    One Pagers | May 01, 2011 | Veerappa K. Chetty, PhD; Larry Culpepper, MD, MPH; Robert L. Phillips, Jr., MD, MSPH; Jennifer Rankin, PhD, MPH, MS, MHA; Imam Xierali, PhD; Sean Finnegan, BS; and Brian Jack, MD

    Hospital readmission after discharge is often a costly failing of the U.S. health care system to adequately manage patients who are ill. Increasing the number of family physicians (FPs) is associated with significant reductions in hospital readmissions and substantial cost savings.

  • I LIVE PC: International Learning on Increasing the Value and Effectiveness of Primary Care253 page PDF

    Monographs & Books | Apr 15, 2011 | Robert Graham Center

    View the conference packet from the 2011 International Learning on Increasing the Value and Effectiveness of Primary Care (I LIVE PC) conference, held April 4-5 in Washington, D.C.

  • Income Disparities Shape Medical Student Specialty Choice

    One Pagers | Sep 15, 2010 | Venis Wilder, MD; Martey S. Dodoo, PhD; Robert L. Phillips, Jr., MD, MSPH; Bridget Teevan, MS; Andrew W. Bazemore, MD, MPH; Stephen M. Petterson, PhD; and Imam Xierali, PhD

    Currently, a gap of more than $135,000 separates the median annual subspecialist income from that of a primary care physician, yielding a $3.5 million difference in expected income over a lifetime. These income disparities dissuade medical students from selecting primary care and should be addressed to ensure sufficient patient access to primary care.

  • Primary Care and Health Care Reform43 page PDF

    Presentations | Sep 15, 2010 | Kevin Burke and Andrew Bazemore, MD, MPH

    Primary Care and Health Reform

  • Illinois Health Connect and Your Healthcare Plus Case Statement18 page PDF

    Monographs & Books | Aug 15, 2010 | Robert Graham Center

    This case statement serves as a primer on Illinois Health Connect and Your Healthcare Plus. It describes these programs, their early achievements and the current state environment in which they exist. It then compares them to several model projects occurring in other states.

  • Primary Care and Why It Matters for U.S. Health System Reform

    Articles | May 15, 2010 | Robert L. Phillips, Jr, MD, MSPH and Andrew Bazemore, MD, MPH

    The term primary care is widely used as if it were consistently defined or well understood. In fact, neither is the case. This paper offers a definition of primary care derived from historical perspectives—from both the United States and abroad. We discuss the evidence for primary care’s important functions and international experiences with primary care. We also describe how and why the United States has deviated from this fuller realization of primary care, as well as the steps needed to achieve primary care and health outcomes on a par with those of other developed countries. These include doubling primary care financing to 10–12 percent of total health care spending—a step that would be likely to pay for itself via resulting reductions in overall health spending.

  • Title VII's Decline: Shrinking Investment in the Primary Care Training Pipeline

    One Pagers | Oct 15, 2009 | Bridget Harrison, MD MPH; Andrew Bazemore, MD MPH; Martey S. Dodoo, PhD; Bridget Teevan, MS; Hope R. Wittenberg, MA; and Robert L. Phillips, Jr. MD MSPH

    Title VII, Section 747 is a source of federal funding intended to strengthen the primary care workforce. Despite evidence that Title VII has been successful, its funding has declined over the past three decades, threatening the production of primary care physicians.

  • Estimated Effects of "America's Affordable Health Choices Act of 2009"10 page PDF

    Monographs & Books | Sep 15, 2009 | Robert Graham Center

    House draft bill H.R. 3200 was introduced in the House on July 13, 2009. Since then it has undergone committee consideration and a mark-up session. Section 1721 of HR 3200 relates to payments to primary care physicians and “requires that State Medicaid programs reimburse for primary care services furnished by physicians and other practitioners at no less than 80% of Medicare rates in 2010, 90% in 2011, and 100% in 2012 and after.” It further “maintains the Medicare payment differentials between physicians and other practitioners. The federal government would pay 100% of the incremental costs attributable to this requirement.” This white paper reports on analyses to assess and estimate the effects of Section 1721 of draft bill HR 3200 on the total gross revenue of the average physician nationally and the total gross revenue of the average family physician in each state. It shows the widely variable but important impact.

  • A Comparison of Chronic Illness Care Quality in US and UK Family Medicine Practices Prior to Pay-for-Performance Initiatives

    Articles | Sep 11, 2009 | Jesse Crosson, PhD ; Pamela Ohman-Strickland, PhD; Stephen Campbell, MD; Robert L Phillips, MD, MSPH; Martin O Roland, PhD; Evangelos Kontopantelis, PhD; Andrew Bazemore, MD, MPH; Bijal Balasubramanian, MBBS, PhD; and Benjamin Crabtree, PhD

    The Quality and Outcomes Framework (QOF) has contributed to modest improvements in chronic illness care in the UK. US policymakers have proposed similar pay-for-performance (P4P) approaches to improve care.

  • Decreasing Self-Perceived Health Status Despite Rising health expenditures

    One Pagers | Sep 01, 2009 | David Rabin, MD MPH; Stephen M. Petterson, PhD; Andrew W. Bazemore, MD MPH; Bridget Teevan, MS; Robert L. Phillips Jr., MD MSPH; Martey S. Dodoo, PhD; and Imam Xierali, PhD

    Despite steady increases in U.S. health care spending, the population's self-perceived health status has been in a long-term decline. Increased support for public health, prevention, and primary care could reduce growth in spending and improve actual and perceived health.

  • Are Medicare GME Policies Adequate to Meet the Rising Need for Primary Care Physicians?22 page PDF

    Presentations | Aug 15, 2009 | Bob Phillips, MD, MSPH

    Are Medicare GME policies adequate to meet the rising need for primary care physicians?

  • How States Will Solve the Healthcare Workforce Crisis: What to Ask For from the Feds50 page PDF

    Presentations | Jun 15, 2009 | Bob Phillips, MD, MSPH

    How states will solve the healthcare workforce crisis: What to ask for from the Feds

  • Health Care Reform Depends on Family Medicine: Walk Softly Keep the Stick Close44 page PDF

    Presentations | Jun 15, 2009 | Bob Phillips, MD, MSPH

    Health care reform depends on family medicine: Walk softly but keep the stick close

  • Effects of proposed primary care incentive payments on average physician Medicare revenue and total Medicare allowed charges14 page PDF

    Monographs & Books | May 15, 2009 | Robert Graham Center

    The US Senate Finance Committee and the Medicare Payment Advisory commission have both proposed incentive payments for primary care physicians who meet certain thresholds of "primary care-ness." With the support of the AAFP Foundation, the Graham Center analyzed how many physicians would meet proposed thresholds, and the potential impact on both physician revenue and Medicare costs. A 60% threshold (60% of claims dollars are for home, nursing home, or office visits) will capture about 60% of family physicians but only 40% of general internists. This suggests that a substantial bonus may influence more primary care physicians to deliver more primary care. But because it excludes more rural physicians than urban, these threshold codes may also be excluding physicians doing a broader scope of appropriate primary care. We do not yet suggest additional codes to be considered but suggest that Congress and the Administration need to re-evaluate their choices to avoid the unintended consequence of overly restricting the range of services needed for the Patient Centered Medical Home.

  • Is Colorado Ready for a Primary Care-based Health Care System?72 page PDF

    Presentations | Apr 15, 2009 | Bob Phillips, MD MSPH and Andrew Bazemore, MD MPH

    Is Colorado ready for a primary care-based health care system?

  • What Influences Medical Student and Resident Choices?41 page PDF

    Presentations | Apr 15, 2009 | Bridget Teevan, MS

    What influences medical student and resident choices?

  • Universal Primary Care34 page PDF

    Presentations | Mar 26, 2009 | Michael Fine, MD, and Shannon Brownlee, MS

    Universal Primary Care - Health Care. Reform. Shovel Ready Now

  • The Robert Graham Center Update: A Primary Care Perspective on Health Care Workforce and Expenditures50 page PDF

    Presentations | Mar 15, 2009 | Robert Graham Center

    A compendium of slides for public use that includes original and adapted analyses, commentary, and annotation from the staff of the Robert Graham Center.

  • Health Care: The Next Mortgage Crisis32 page PDF

    Presentations | Mar 15, 2009 | ichael Fine, MD, and Shannon Brownlee, MS

    Health Care: The Next Mortgage Crisis

  • Having a Usual Source of Care reduces ED Visits

    One Pagers | Jan 15, 2009 | Stephen Petterson, PhD; David Rabin, MD, MPH; Robert L. Phillips, Jr., MD, MSPH; Andrew Bazemore, MD, MPH; and Martey S. Dodoo, PhD

    The recent growth in the use of emergency departments (EDs) is costly, undesirable, and unnecessary. This trend is partly due to a growing proportion of persons who lack a usual source of care. This group is increasingly likely to rely on EDs for their health care needs compared with those who have a usual source of care.

  • What the Federal Government Should Do to Revitalize the Primary Care Practice Infrastructure & Quality in the United States37 page PDF

    Presentations | Jan 15, 2009 | Kevin Grumbach, MD

  • Start-up and Incremental Practice Expenses for Behavior Change Intervention in Primary Care

    Articles | Nov 15, 2008 | Martey Dodoo, PhD; Alex Krist, MD, MPH; Maribel Cifuentes ,RN, BSN; and Larry Green, MD

    If behavior-change services are to be offered routinely in primary care practices, providers must be appropriately compensated. Estimating what is spent by practices in providing such services is a critical component of establishing appropriate payment and was the objective of this study

  • Primary Care in the ACO: The Role of Primary Care in the Future Healthcare System1 page PDF

    Presentations | Nov 14, 2008 | Erica Brode, MD MPH; Andrew Bazemore, MD, MPH; Kevin Grumbach, MD

  • Primary Care's Eroding Earnings: Is Congress Concerned

    Articles | Sep 15, 2008 | Yoshi Laing, Thomas Bodenheimer, Bob Phillips, and Andrew Bazemore

    PURPOSE: Despite increasing data demonstrating the positive impact primary care has on quality of care and costs, our specialty faces uncertainty. Its popularity among medical students is declining, and the income gap is growing between primary care and other specialties. Congress has the power to intervene in this impending crisis. If we want to influence lawmakers' actions, we need to know how they are thinking about these issues. METHODS: Using a set of questions covering several physician payment topics, we interviewed 14 congressional staff aides (5 aides on Medicare-oversight committees, 9 general staff aides) and one representative from each of 3 governmental agencies: the Medicare Payment Advisory Commission, Congressional Budget Office, and Government Accountability Office. RESULTS: Interviewees revealed that issues in primary care are not high on the congressional agenda, and that Medicare's Sustainable Growth Rate (SGR) is the physician-payment issue on the minds of congressional staff members. CONCLUSION: Attempts to solve primary care's reimbursement difficulties should be tied to SGR reform.

  • Access Transformed: Building a Primary Care Workforce in the 21st Century40 page PDF

    Monographs & Books | Aug 15, 2008 | Robert Graham Center

    Access transformed: Building a primary care workforce for the 21st century

  • The Robert Graham Center Update 200847 page PDF

    Presentations | Jul 15, 2008 | Robert Graham Center

    A compendium of slides for public use that includes original and adapted analyses and commentary from the staff of the Robert Graham Center.

  • A Perfect Storm: Changes Impacting Medicare Threaten Primary Care Access in Underserved Areas

    One Pagers | Jun 15, 2008 | Imam Xierali, PhD; Andrew Bazemore, MD MPH; Bob Phillips, MD MSPH; Stephen Petterson, PhD; Martey Dodoo, PhD and Bridget Teevan, MIS

    A convergence of three policies could reduce physician Medicare payments by 14.9 to 22.3 percent in 2008, which could jeopardize access for Medicare beneficiaries in underserved areas. Congress and the Executive Branch should coordinate their roles in setting Medicare payment policy, because their overlapping decisions can have additive impact.

  • Medicare’s (Un)sustainable Growth Rate

    Commentaries & Editorials | May 01, 2008 | Steven Wilk, MD and Robert Phillips, MD, MSPH

    A review of Medicare financing, the sustainable growth rate, and legislative “fixes” enacted prior to MACRA are reviewed here.

  • Primary Care Value Propositions31 page PDF

    Presentations | Jun 15, 2007 | Robert Phillips, MD, MSPH

    Primary care value proposition

  • Impact of Title VII Funding on Community Health Center Staffing and the National Health Service Corps12 page PDF

    Presentations | Apr 15, 2007 | Bob Phillips, MD, MSPH, and Diane R. Rittenhouse, MD, MPH

    Impact of Title VII funding on community health center staffing and the National Health Service Corps

  • Prometheus: Igniting Payment Reform2 page PDF

    Presentations | Jun 15, 2006 | Francois DeBrantes National Coordinator Bridges to Excellence

    Prometheus: Igniting payment reform

  • Family Medicine Training: Time to be Counterculture Again7 page PDF

    Presentations | Apr 15, 2006 | Bob Phillips, MD, MSPH

    Family medicine training: Time to be counterculture, again

  • Healthstat: Making America's Health Care More Affordable43 page PDF

    Presentations | Feb 15, 2006 | R. Eric Hart, MD

    HealthSTAT: Making America's health care more affordable

  • Medicare Part D: Who Wins, Who Loses?

    One Pagers | Feb 01, 2006 | G Mallya, MD; Andrew Bazemore, MD, MPH; Robert Phillips, MD, MSPH; Larry Green, MD; Lawrence Klein, PhD; Martey Dodoo, PhD

    The Medicare Part D prescription drug benefit aims to relieve the burden of out-of-pocket prescription drug costs for persons older than 65 years, but its effects will vary. Persons with low income and those without prior prescription coverage are projected to save the most, whereas those who lose employer-based coverage are predicted to pay more for their existing regimens.

  • Out-of-Pocket Prescription Costs a Continuing Burden Under Medicare Part D

    One Pagers | Feb 01, 2006 | G Mallya, MD; Andrew Bazemore, MD, MPH; Robert Phillips, MD, PSPH; Larry Green, MD; Lawrence Klein, PhD; Martey Dodoo, PhD

    Of 29 million expected Part D beneficiaries, 6.9 million are projected to have annual out-of-pocket medication expenses greater than $750. Accounting for one fourth of all Part D enrollees, these beneficiaries also are most likely to have high aggregate health care costs, putting them at continued financial risk unless additional policy options are considered.

  • Mind the Gap: Medicare Part D's Coverage Gaps May Affect Patient Adherence

    One Pagers | Feb 01, 2006 | G Mallya, MD; Andrew Bazemore, MD, MPH; Robert Phillips, MD, MSPH; Larry Green, MD; Lawrence Klein, PhD; Martey Dodoo, PhD

    Medicare Part D will lower medication expenditures for many older patients. However, its complex design incorporates a staggered series of cost-sharing mechanisms that create gaps in coverage and may have a negative impact on medication adherence.

  • Primary Care in the United States: Problems and Possibilities

    Commentaries & Editorials | Dec 15, 2005 | Robert L. Phillips, Jr., MD, MSPH

    The United States has never had a more robust primary care workforce, but dysfunctional financing schemes and inability to compete for the hearts and minds of the next generation of young doctors threaten its future. Many of the problems are a direct result of the market approach to health care. Innovation is needed in how primary care functions are financed, protected, organised, and taught in order to identify options for a stable and robust health system built on primary care.

  • Who Will Have Health Insurance in the Year 2025?

    One Pagers | Nov 15, 2005 | Jennifer DeVoe, MD, DPhil; Marty Dodoo, PhD; Robert Phillips, MD, MSPH; Larry Green, MD

    If current trends continue, U.S. health insurance costs will consume the average household's annual income by 2025. As health care becomes unaffordable for most people in the United States, it will be necessary to implement innovative models to move the system in a more equitable and sustainable direction.

  • Physician Workforce: Legal Immigrants will Extend Baby Boom Demands

    One Pagers | Oct 15, 2005 | Martey Dodoo, PhD; Robert Phillips, MD, MSPH; Larry Green, MD; Ginger Ruddy, MD; Jessica McCann, MD; Lawrence Klein, PhD

    The baby boom generation will place large demands on the Medicare program and the U.S. health care system. These demands may be extended by a large legal immigrant population that will become Medicare-eligible soon after the baby boom generation does. The U.S. health care system should be prepared for sustained stress from this aging population.

  • Cost-Effective Roles for Nurse Practitioners in Secondary Prevention

    Commentaries & Editorials | Jun 15, 2005 | Phillips RL, McCann J

    Who pays and who saves may stymie implementation in the US

  • Report to the Task Force on the Care of Children by Family Physicians79 page PDF

    Monographs & Books | Jan 15, 2005 | Robert L. Phillips, Jr., MD, MSPH; Martey S. Dodoo, PhD; Jessica L. McCann, MA; Andrew Bazemore, MD; George E. Fryer, PhD; Lisa S. Klein; Michael Weitzman, MD; Larry A. Green, MD

    Report to the Task Force on the care of children by family physicians

  • Splitting the Difference: Patient Preference vs Conservation of Resources

    Commentaries & Editorials | Jun 15, 2004 | Robert Phillips, Jr., MD, MSPH

    Splitting the difference: Patient preference vs conservation of resources

  • The U.S. Primary Care Physician Workforce: Undervalued Service

    One Pagers | Oct 15, 2003 | Holly Biola, MD; Larry Green, MD; Robert Phillips, MD MSPH; Janelle Guirguis-Blake, MD; Ed Fryer, PhD

    Primary care physicians work hard, but their compensation is not correlated to their work effort when compared with physicians in other specialties. This disparity contributes to student disinterest in primary care specialties.

  • Accounting for Graduate Medical Education Funding in Family Practice Training

    Articles | Sep 15, 2002 | Chen FM, Phillips RL, Schneeweiss R, Andrilla, CHA, Hart G, Fryer GE, Casey S, Rosenblatt RA

    BACKGROUND AND OBJECTIVES: Medicare provides the majority of funding to support graduate medical education (GME). Following the flow of these funds from hospitals to training programs is an important step in accounting for GME funding. METHODS: Using a national survey of 453 family practice residency programs and Medicare hospital cost reports, we assessed residency programs' knowledge of their federal GME funding and compared their responses with the actual amounts paid to the sponsoring hospitals by Medicare. RESULTS: A total of 328 (72%) programs responded; 168 programs (51%) reported that they did not know how much federal GME funding they received. Programs that were the only residency in the hospital (61% versus 36%) and those that were community hospital-based programs (53% versus 22%) were more likely to know their GME allocation. Programs in hospitals with other residencies received less of their designated direct medical education payment than programs that were the only residency in the sponsoring hospital (-45% versus +19%). CONCLUSIONS: More than half of family practice training programs do not know how much GME funding they receive. These findings call for improved accountability in the use of Medicare payments that are designated for medical education.

  • GME Financing Reform: The Saga Continues

    Commentaries & Editorials | Aug 15, 2002 | Robert L. Phillips, Jr., MD, MSPH; George E. Fryer, Jr. PhD; and Larry A. Green, MD

    GME financing reform: The saga continues

  • Putting Practice into Research: A 20-Year Perspective

    Articles | Jun 01, 2000 | Larry Green, MD

    Since the 1982 article in Family Medicine focused on sentinel practices as an aspiration, practice based research networks (PBRNs) have become a fixture in the world of primary care. This perspectives piece reviews the origins and development of practice based research networks, their contribution to healthcare advancement, and their evolving role into the future.