Written by Adele Allison, National Director of Government Affairs, SuccessEHS. The shape of the U.S. health care industry is changing every day, and this presentation sheds light on some interesting statistics including Primary Care Providers, The American Patient, Health Care and the U.S. Economy and more.

1. Health Care By the Numbers Primary Care Providers Community Health Centers Health Care & the U.S. Economy The American Patient Eligible Professionals & Meaningful Use Patient-Centered Medical Home Sources Brought to you by: www.successehs.com Written by: Adele Allison National Director of Government Affairs, SuccessEHS

2. Primary Care Providers The role of the primary care provider in overall quality is now and always has been a fundamental building block for a hearty health care delivery system. As the country seeks to convert from episodic care or reactive medicine to delivery of long-term wellness and care management throughout the patient life, the PCP is the proverbial glue that binds. That value is becoming increasingly recognized. Nevertheless, 21% of Americans live in rural locales and only 10% of physicians practice there; and, it is increasingly rare for physicians to enter primary care medicine out of medical school. The U.S. is looking to mid-level providers more and more to fill the gap.

3. Primary Care Providers Office visits in the U.S. that are Primary Care Providers 62% Physicians that currently practice Primary Care Medicine 43% Medical school graduates entering Primary Care Residencies in Internal Medicine (2%), Family Medicine (4.9%), and Pediatrics (11.7%) 18.6% 49.1% Office-based physicians that use nurse practitioners (NPs), nurse midwives (CNMs) or physician assistants (PAs) Primary care physicians utilizing NPs, CNMs or PAs as compared to 45.9% of surgical specialists and 45.9% of medical specialists 55.6%

4. Primary Care Providers Number of PCPs the U.S. will be short by 2025 with our current trends 64,800 Average yearly salary difference between Primary Care Providers and Specialists $135,000

5. Community Health Centers Borne out of President Johnson’s “War on Poverty and Civil Right” in 1965, Neighborhood Health Centers were started with the first two being opened in a Boston public housing project and Mound Bayou, MS. In the 45 years since, Community Health Centers have played a critical role in providing care to underserved communities, regardless of the patient’s ability to pay. CHCs have long held bipartisan support to expand these critical services. With the passage of the Patient Protection and Affordable Care Act in March, 2010, CHCs have been identified as ideal in providing care to the additional 32 million Americans that will have coverage.

6. Community Health Centers Physicians serving CHCs 9,600 Mid-level providers serving CHCs 6,400 CHC patients served in 2010 19,469,467 CHC patient visits in 2010 77,000,000 Community Health Centers 1,124 CHC clinic sites 8,100 Dollars spent on CHC services in 2010 $11,000,000,000 CHC visits with any Chronic Condition. Compare this to the 49% of Chronic Care patients for private MDs. 56%

7. Health Care & the U.S. Economy As health care expenditures in the U.S. near 18% of the Gross Domestic Product (GDP) – meaning almost 18 cents on every dollar spent in the U.S. is for something health care related – and rising, the course must be changed. Without a change in care delivery and reimbursement, the current path will saddle Americans with a health care system that consumes 31% of GDP by 2035. Incredible! According to the Congressional Budget Office (CBO), health care is out-pacing inflation, driven by new technologies / services, costly new drugs, increased demand for care, rampant chronic disease, lack of patient accountability for lifestyle choices, and aging demographics with Baby Boomers, who account for 56% of the projected growth in spending on entitlements under Medicare, Medicaid and Social Security.

8. Health Care & the U.S. Economy Projected annual growth in Medicare between 2013 and 2021 31% GDP percentage predicted to be attributed to health care spending if no changes are made to the U.S. System by 2025 Dollars estimated by the CBO for Medicare expenditures by 2025 $966,000,000,000 Dollars estimated by CBO for Medicare expenditures with the advent of the Baby Boomer generation entering retirement $555,000,000,000 6.3%

9. Health Care & the U.S. Economy GDP percentage representing health care spending in 1965 5.8% GDP percentage representing health care spending in 2011 17.6%

10. The American Patient In a report by the World Economic Forum delivered to the United Nations Summit on Non-Communicable Diseases in September 2011, the world was given a glimpse of global trends in non-infectious diseases. The top 5 “biggest killers,” which are: cancer, diabetes, heart disease, lung disease and mental health. According to this report, non-communicable disease represents 87% of all U.S. deaths, compounded by the American lifestyle of inactivity (43% are sedentary), smoking, and markedly rising rates in blood pressure and glucose. According to Kaiser Health, prevention is the answer to bringing the cost of chronic disease into check, and health IT can provide the tools to do so.

11. The American Patient 48% 74% 19.6% 26.9% Americans using at least one prescription in the last month U.S. physician office visits involving drug therapy Americans age 65+ with Diabetes from 2005-2008 Americans age 65+ with Diabetes from 1988-1994

12. The American Patient Adults age 18+ who met the federal physical activity guidelines for aerobic activity Increase in obesity among children age 6-11 from 1988-94 to 2007-08 47% 55% Number of drugs ordered or provided in 2008 2,300,000,000 Americans without insurance in 2010 49,900,000 U.S. life expectancy as compared with 86.4 in Japan and 76.1 in Turkey 80.6

13. The American Patient Ambulatory care visits with mental disorders as primary diagnosis 58,200,000 Adults age 18+ who currently smoke 19% Cancers that are preventable with proper exercise, diet and avoiding tobacco 40% Heart disease and Type 2 diabetes that are preventable with proper exercise, diet and avoiding tobacco 80% Dollars spent on health care needs related to diabetes 1 out of every 10 Cents of every health care dollar spent in the U.S. is chronic disease related 75 Cents of every health care dollar is spent in the U.S. is spent on prevention 5

14. Eligible Providers & Meaningful Use The enacting of the American Recovery and Reinvestment Act of 2009 (ARRA) essentially has legislated the adoption of certified, interoperable electronic health records (EHRs). According to the CBO, health information technology (HIT) plays a critical role in reforming health care, reigning in costs and delivering value for the health care dollar. Not only can providers realize individual return on investments through reduced / eliminated transcription costs, labor for paper manual workflows and missed charges, adoption of interoperable EHRs can create industry-wide savings and improved patient quality and safety through evidence-based clinical decision support, coordinated patient care, and elimination of duplication in diagnostics. HIT also delivers a public good through access to relevant medical information when needed, where needed. The CBO estimated a reduction in Medicare spending by $4.4B and $7.3B in Medicaid from 2011-2019 from accelerated adoption of HIT. Additionally, the CBO estimates implementation of HITECH would reduce costs in the health care system by 0.3% overall from 2011-2019, or $289.7B in savings.

15. Eligible Providers & Meaningful Use Eligible Professionals registered with CMS for the Medicare EHR Incentive Program 71,378 Specialty professionals achieving Stage 1 Medicare Meaningful Use 813 Internists and Family Practice professionals achieving Stage 1 Medicare Meaningful Use 898 Eligible Professionals registered with CMS for the Medicaid EHR Incentive Program 17,181 Physicians receiving year 1 Medicaid EHR Incentives 3,372 Nurse Practitioners, Certified Nurse Mid-wives and Physician Assistants receiving year 1 Medicaid EHR Incentives 948

16. Eligible Providers & Meaningful Use Dentists receiving year 1 Medicaid EHR Incentives 143 Dollars paid to Eligible Professionals for the Medicaid EHR Incentive Programs YTD $93,925,043 Dollars paid to Eligible Professionals for the Medicare EHR Incentive Programs YTD $38,322,000

17. Patient-Centered Medical Home Inspired in the mid-1960s through the American Academy of Pediatrics (AAP), the idea arose that whenever a patient is cared for, the question, “where is their medical home?,” should be asked. Subsequently, the largest U.S. gathering of primary care organizations – including AAFP, AAP, ACP and AOA – came together in 2007 and defined the “Joint Principles of the Patient-Centered Medical Home” (PCMH). Since that time, the patient-centered medical home has received a firestorm of attention. “Medical Homes” and “Patient-Centered” care is heralded throughout the Patient Protection and Affordable Care Act of 2010 (PPACA). Anticipated Accountable Care Organizations being put into place effective January 1, 2011, as required under PPACA, advocate a PCMH at the hub. HRSA and the National Association of CHCs (NACHC) are striving to have every CHC in the nation PCMH recognized by 2015. As the U.S. seeks to address health care spending, value is being placed on primary care that embraces the PCMH model in the form of reimbursement differentials. The call to action is at hand.

18. Patient-Centered Medical Home Laws have been passed in 44 states and D.C. relating to the Medical Home 300 Bills introduced in 27 states reference the Medical Home 81 FQHCs that have been recognized as Level 1, 2 or 3 NCQA-PCMHs 6% Physician organizations that support the PCMH care model 23 Year initiative announced by CMS in late September 2011 to foster collaboration between public-private health care payers building upon PCMH 4 FQHCs planning to apply for NCQA-PCMH recognition in the next 18 months 42%

19. Patient-Centered Medical Home 62.5% CHCs participating in public/state PCMH pilot or demonstrations, in comparison to 24.1% of MD-owned and 58.3% Hospital-owned practices FQHCs considering or having received medical home recognition from another national organization 11% Federal Agencies with PCMH activities underway (AHRQ, CMS, DOD, HRSA, HIS, SAMHSA, VA, and NIH) 8 Physicians surveyed by MGMA with PCMH transformation underway or expressed interest in becoming PCMH recognized 5,259 Number of practices that have received NCQA recognition as PCMHs 2,314

20. Patient-Centered Medical Home Hospital-owned practices participating in public/federal PCMH pilot or demonstration projects, compared to 37.5% of CHCs and 55.2% of MD-owned practices 58.3% 72.4% MD-owned practices participating in Commercial Health Plan or Multi-Payer PCMH program 68.5% Practices expressing a preference for NCQA’s PCMH program of recognition 11.3% Practices expressing a preference for The Joint Commission’s PCMH program of recognition Practices expressing a preference for AAAHC’s PCMH program of recognition 10.4%

21. Sources Primary Care Providers -Hing and Uddin, NCHS Data Brief, No. 47, “Visits to Primary Care Delivery Sites: United States, 2008,” October, 2010. -Physician Characteristics and Distribution in the U.S., 2008 AMA Table 4.1, (Note: PCP is defined herein as Family Practice, General Practice, Internal Medicine, OB-GYN, and Pediatrics). -Hauer KE, Durning SJ, Kernan WN, Fagan MJ, Mintz M, O’Sullivan PS, et al., “Factors associated with medical students’ career choices regarding internal medicine,” JAMA, 2008; 300(10): 1154-1164. -Assn. of American Medical Colleges, “Physician Shortages to Worsen Without Increases in Residency Training,” June, 2010. -Robert Phillips et al., “Specialty and Geographic Distribution of the Physician Workforce: What Influences Medical Student & Resident Choices” 43, March, 2009. -Park, Cherry, and Decker, NCHS Data Brief, No. 69, “Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants in Physician Offices,” August, 2011. -Ibid. Community Health Centers -HRSA Data Warehouse, http://datawarehouse.hrsa.gov/PrimaryHealthCare.aspx, October, 2011. -Ibid. -Ibid. -Ibid. -Ibid. -Ibid. -Ibid. -Hing and Uddin, Ibid.

22. Sources Health Care & the US Economy -Centers for Medicare and Medicaid, National Health Expenditures Data Tables, http://www.cms.gov/NationalHealthExpendData/downloads/tables.pdf -CMS, NHE Data Tables, Ibid. -Congressional Budget Office, Long-Term Budget Outlook, “The Long-Term Outlook for Medicare, Medicaid, and Total Health Care Spending,” Chapter 2, June, 2009. -Congressional Budget Office, “The Budget and Economic Outlook: An Update,” August, 2011. -Ibid. -Ibid. The American Patient - Centers for Disease Control and Prevention, “Fast Facts: Therapeutic Drug Use,” 2005-2008. -Ibid. -Ibid. -U.S. Dept. of Health and Human Services, CDC, National Center for Health Statistics, “Health, United States, 2010,” DHHS Pub. No. 2011-1232, February, 2011, 77. -Ibid. -Ibid, Table 66 -U.S. Census Bureau 2010 Highlights Report, http://www.census.gov/hhes/www/hlthins/data/incpovhlth/2010/highlights.html. -Centers for Disease Control and Prevention, “Fast Facts: Mental Health – Ambulatory Care,” Average Annual 2006-2007. -Centers for Disease Control and Prevention, “Fast Facts: How Healthy Are We – Health Risk Factors,” 2008. -Ibid. -K. Thorpe and J. Lever, Kaiser Health News, “Prevention: The Answer to Curbing Chronically High Health Care Costs,” May, 2011. -Ibid. -Ibid. -Ibid. -Ibid.

23. Sources Eligible Professionals & Meaningful Use -R. Sunshine, Congressional Budget Office, U.S. Congress, Letter to Hon. Charles Rangel, U.S. House of Representatives, Chairman on the Ways and Means Committee, January, 2009. -CMS, Regulations and Guidance, EHR Incentive Programs, Spotlight and Upcoming Events, “Provider Registration and Payments,” August, 2011. -Ibid. -Ibid. -Ibid. -Ibid. -Ibid. -Ibid. -Ibid. -Ibid. -Ibid. Patient-Centered Medical Home -Patient-Centered Primary Care Collaborative, Federal & State Government, http://www.pcpcc.net/federal-and-state-government -American Academy of Family Practice, Government Relations Division, “2011 State Legislation: Medical Homes,” March, 2011. -Center for Medicare & Medicaid Innovation, CMS, “Comprehensive Primary Care Initiative,” September 28, 2011. -American College of Physicians, ‘Who Supports the PCMH Care Model,” http://www.acponline.org/running_practice/pcmh/understanding/who.htm -Michael McBride, Modern Medicine, “The Patient-Centered House that Technology Built,” July, 2011. -L. Ku, P. Shin, E .Jones, B. Bruen, George Washington University Department of Health Policy, “Transforming Community Health Centers into Patient-Centered Medical Homes: The Role of Payment Reform,” September, 2011. -Ibid. -Ibid. -Agency for Healthcare Research and Quality, PCMH Resource Center, “Cross-Agency Summary Table,” March, 2011. -Medical Group Management Association, “The Patient-Centered Medical Home: 2011 Status and Needs Study,” July, 2011. -Ibid.