The Illinois Academy of Family Physicians

1. The Illinois Academy of Family Physicians 4756 Main Street Lisle, IL 60532 www.iafp.com

2. Family Medicine and Public Health • The Illinois Academy of Family Physicians (IAFP) is the specialty association representing the interests of family physicians and their patients. • IAFP works to support today’s family physicians and attract tomorrow’s family physicians to care for the growing needs of Illinois’ population.

3. Family Medicine:Why is it so effective? When we have an optimum number of generalist physicians operating in a health care system with appropriate characteristics, these priorities are effectively addressed: • Primary Care Medicine • Preventive Medicine • Public Health • Medical Homes (Well-coordinated, personal medical care)

4. Health Outcomes and the Supply of Primary Care Physicians: US Studies States with higher ratios of Primary Care Physicians to population had significantly better health outcomes, including: a. Lower rates of All-cause mortality b. Lower rates of Heart Disease mortality c. Lower rates of Cancer Disease mortality d. Lower rates of Stroke mortality e. Lower rates of Infant mortality f. Lower rates of Low Birth Weight infants g. Better Self-Reported Health h. Longer Life Span Shi. Journal of Health Services, 1994:24:431-458 Vogel, et al. International Journal of Health, 1998:28:183-196 The studies controlled for sociodemograhic factors: %elderly, urban, minority, education, income, unemployment, pollution, smoking Acknowledgement: Stephen Spann, M.D., M.B.A., Professor and Chair Family Medicine, Baylor College of Medicine

5. PCPSupply and Health Outcomes: Summary of United States Studies There is a consistent relationship between more primary care physicians and improved health outcomes, regardless of: • Year of study (1980-2000) • Lag period (Length of effect) • Level of Analysis (State, County or Local) • Type of Outcome Shi. Journal of Health Services, 1994:24:431-458 Vogel, et al. International Journal of Health, 1998:28:183-196 In summary, an increase of one primary care physician per 10,000 people (12.6% ) is associated with a 5.3% decline in all-cause mortality (34 per 100,000 per year). Ten more primary care physicians in a region of 100,000 saves 34 lives each year. If the supply of primary care physicians were increased by 40% (see the Dartmouth data that follows), then 107 lives per 100,000 people would be saved each year, a total of over 300,000 annually in the US, far more than the IOM estimates of 90,000 unnecessary deaths annually in hospitals due to medical errors

6. The Effect of Physician Workforce on Health Outcomes Johns Hopkins Bloomberg School of Public Health: Six population-based studies of US, Canada, and Europe found that optimal primary health outcomes occur when 40-50% of the physician workforce are generalist physicians Dartmouth Center for Evaluative Clinical Science: Three studies using US nation-wide Medicare data bases found that quality health indicators are better and cost of care decreases as the number of generalist physicians increases. These two sets of studies form the solid foundation for the importance of the ratio of primary care physicians to the total physician workforce (Hopkins), and the ratio of primary care physicians to the population (Dartmouth). The outcome measures for the Hopkins studies were mostly measures of primary health outcomes, defined below, and those for the Dartmouth studies were measures of quality health indicators that are strong markers for primary health outcomes

7. Johns Hopkins Studies: Summary Primary health outcome measures– e.g., life expectancy, death rate, infant mortality rate, death rates from cancer and heart disease, etc.— are optimized when 40 to 50 % of the physician workforce is made up of generalist physicians Starfield B: British Journal of General Practice, April 2001, p303 Shi L et al: Journal of Family Practice, April 1999, p275 Starfield B: Health Affairs, March 15, 2005, p97

8. Relationship of Physician Workforce and Health Outcomes This is a theoretical mathematical model derived from the empirical data of the population based studies done at Hopkins. Currently, about 32% of US physicians are generalists. In the past two match years (2005 and 2006), Only about 18% of physicians entering residency are expected to choose careers as generalists

9. Primary Care Orientation: Practice and Health System Characteristics Nations, Counties and States with stronger primary care practices (personal medical homes) and certain health system characteristics have consistently better health outcomes, including: Lower all-cause mortality Lower neonatal mortality Lower cause specific mortality (Pulmonary Disease, Heart Disease, Cancer) Starfield. JAMA, 1991;266:2268-71 Starfield. Lancet, 1994:344:1129-34 Starfield, et al. Oxford University Press, 1998 Or. Health Care Mortality Across OECD Countries, 2001 Shi, et al. Health Services Research, 2002;37:529-550 Macinko, et al. Health Services Research, 2003;38:831-865

10. Primary Care and Social Disparities Social deprivation is accurately measured by levels of income inequality (Gini Coefficient), and is associated with very poor health outcomes A high supply of PCPs eliminates the adverse health effect of income inequality A high supply of PCPs eliminates racial disparities in health outcomes in rural and suburban populations (but not urban populations) Data from multiple studies in the United States, United Kingdom, Mexico, Costa Rica, and 7 African nations. Summarized in Starfield B, et al. Contribution of Primary Care to Health Systems and Health, The Milbank Quarterly, 2005;83:457-502

11. IAFP’s Summer Externship Program • Exposes medical students to the specialty of family medicine and the lifestyle of a family physician. • We collect information on the students’ interests and preceptor’s office profile, with regards to mid-level providers, obstetrical care, patient base, etc. • We gauge the students’ interest in serving underserved communities in the applications. We match preceptors and students using this information, along with availability/preferences.

12. IAFP’s Summer Externship Program Through the Summer Externship Program we can increase the supply of family physicians in Illinois, particularly in underserved areas of the state. • We track externs into practice to gauge if the program affected their choice of specialty and practice location. • We train preceptors to provide a positive learning experience for their extern(s). • 32% of former externs are family physicians, 63% are primary care physicians.

13. Family Practice Residency Act • Grants provide access to the neediest of our population, bridging gaps in access to care. • The FPRA program has an 11 year track record of accountability. • The grants are competitive, with two to three times the number of proposals as grant money available. • The funds provide innovative ways to deliver health care to rural and urban medically underserved areas that can then be replicated in other areas.

14. Grants Provide Services • Thanks to the Family Practice Residency Act, grants are awarded to help establish new medical services in medically underserved areas of Illinois by family medicine training programs. • The proven success showcases public-private collaboration at its best. • Government funding serves as a catalyst to start medical services where they otherwise could not be offered. In three years, as the grant funds are stepped back, the medical services become self-sufficient and the people of Illinois have access to ongoing services.

15. Health Care Justice Act • The ultimate goal of the Health Care Justice Act is to solve the access to care problem in Illinois. • Every person in Illinois should have a “medical home,” with a primary care physician. • Family physicians provide a full range of care to every segment of the population and families. • We provide preventive care, acute and long-term health care services and coordination for generations of families.

16. High Quality Health Care for All System-wide changes will be needed to ensure high-quality health care for all. Such changes include: • Ensure that every American has a personal medical home (a family physician, pediatrician or internist), • Developing reimbursement models to sustain family medicine and primary care practices.

17. High Quality Health Care for All System-wide changes will be needed to ensure high-quality health care for all. Such changes include: • Promoting the use and reporting of quality measures to improve performance and service, • Advocating that every American have health care coverage for basic services and protection against extraordinary health care costs, • Advancing research that supports the clinical decision making of family physicians and other primary care clinicians.

18. Electronic Health Records Task Force • The IAFP initiated this legislation introduced by Representative Julie Hamos in 2005 • IDPH oversees the established Task Force • Electronic health records are integral to improved health care delivery system and safety. • The Academy EHRs reach full potential to improve the quality and safety of medical care and increase the efficiency of medical practice.

19. Problems with the Current System Family physicians are proactive in their approach to electronic health records to correct current problems with health information technology. These problems include: • Knowledge and information distribution/access are ineffective • Single purpose applications that prevent computers from working with each other • Paper-based clinical information is an anchor, slowing innovation for procedures • Lack of standards makes investing in technology risky for many.

20. Looking Forward Electronic health records as a core technology for the future of family medicine have to meet Four "Acid Test" Principles: 1. Affordability- office-based information technology should be affordable to family physicians and other office-based clinicians who face very challenging economic environments and decreasing reimbursement.

21. Looking Forward Electronic health records as a core technology for the future of family medicine have to meet Four "Acid Test" Principles: 2. Compatibility- physicians should not have to replace entire systems when purchasing a component, nor be locked in to vendor's products due to proprietary interfaces or predatory pricing tactics. Systems should be "plug and play" with regard to interfacing. Integration of health information across providers and sites is also necessary for success.

22. Looking Forward Electronic health records as a core technology for the future of family medicine have to meet Four "Acid Test" Principles: 3. Interoperability- data exchange schema should facilitate data transfer, import, and export among different vendor's systems, in different settings such as office to office, to hospital, to nursing home, and to patient/patient home. Continuous, real-time access to important patient health information is key.

23. Looking Forward Electronic health records as a core technology for the future of family medicine have to meet Four "Acid Test" Principles: 4. Data Stewardship - physicians reserve the right to choose the repository and guardians of their data, and how that data is used within a framework of privacy and security mandated by HIPAA. This will allow for secure aggregation of data for quality and performance reporting and analysis. It will also enable linking (coupling) of knowledge (evidence) with specific patient health information while providing secure messaging and communication with colleagues and patients.

24. IAFP and Tobacco Control Policy Issue: • Tobacco use is the #1 preventable cause of death in the U.S. and secondhand exposure smoke is #3. • Illinois is not a smoke-free state and until 2006 local communities were prohibited from making their own laws. • Some communities remain resistance to local policy. • Clean indoor air policies protect non-smokers, save lives and reduce illnesses triggered/caused by secondhand smoke. • Illinois woefully under-funds effective statewide tobacco prevention and use-reduction programs, despite the revenue from the MSA.

25. IAFP and Clean Indoor Air Policy Strategy: Unite with other like-minded organizations (as ICAT) with combined resources to- 1. Educate the public with credible sources 2. Broaden support base 3. Engage grassroots action 4. Lobby lawmakers at local at state level 5. Encourage media coverage and pressure for clean indoor air policy 6. Provide services to Illinoisans 7. Advocate for more funding from the state to reduce tobacco use rates in Illinois.

26. IAFP Contributions As an organization in statewide issues: • All IAFP members (including residents and students) were able and encouraged to participate at some level • Media contributions (quotes in press releases, letters to the editor) • Lobbying during legislative session and lobby day on state policy • IAFP grassroots action -Support in local communities -Direct contact with state legislators on HB 672

27. IAFP Contributions As individuals representing family medicine locally: • IAFP members served as spokespersons and coalition leaders in several communities (Evanston, Oak Park, Chicago, Springfield, DeKalb, Arlington Heights, Glenview, Carbondale to name a few) in successful and/or ongoing efforts. • Leadership testimony (town hall meetings, village hearings, house and senate hearings, and press conferences)

28. Successes • HB 672 passed in 2005 and enacted Jan 1, 2006 – Any municipality can enact a smoke-free law. • 22 communities have passed and/or enacted smoke-free workplaces with more on the way. • Cook County will be smoke-free March 2007. • Illinois dorms will be smoke-free with the 2006 signing of SB 2465. • Counties may enact clean indoor air ordinances to cover unincorporated areas and protect those workers thanks to SB 2400. • 44 percent of Illinois workers now have clean indoor air in the workplace.

29. IAFP: Front and Center IAFP partners with Illinois on: • public health • disease prevention • health care access • disparities • workforce issues • information technology

30. Count on IAFP As your partner in health, IAFP looks forward to working with the state of Illinois as it moves ahead with its State Health Improvement Plan. For more information, please contact IAFP: • www.iafp.com • Gordana Krkic, CAEVice President of Government Relations • gkrkic@iafp.com • 630-435-0257