1. The Future of Primary Healthcare Presented by Barbara Marx Brocato Barbara Marx Brocato& Associates 18 Pinkney Street Annapolis, MD 21401 Phone: 410-269-1503 Fax: 410-269-5021 E-mail: Barbara@bmbassoc.com Web Site: www.bmbassoc.com

2. The Health Care Debate • Increased insurance coverage and increased eligibility DOES NOT equal increased access to care • You need an ample provider workforce • Maryland physician workforce is threatened

3. Governor’s Task Force on Health Care Access and Reimbursement 2007-2008

4. Governor’s Task Force on Health Care Access and Reimbursement 2007-2008

5. The Health Care Environment • Commercial reimbursement in Maryland is in the lowest 25% of the country • Medicare and Medicaid provide very low reimbursement • Maryland is a high cost of living state • Physician recruitment happens in a National market • States with more favorable systems have an advantage over Maryland

6. The Health Care Environment • Increasingly those “going down the road” to medicine are not going into primary care • Results in a shortage of primary care physicians • Leads to increased utilization of emergency departments and long wait times to be treated • Providers not accepting Medicare • Establishing concierge practices – patient pays an annual or monthly fee for physician to provide services. This is not a substitute for insurance, some concierge practices do not accept insurance.

7. Health Care Reform • Where will the solutions come from(?) • Federal? • State? • Combination of both? • What are some possible approaches? • Fairer provider reimbursement • Incentives to attract primary care physicians • Loan forgiveness • Tort Reform • Bundled Payments • Medical Homes • Case management systems

8. Barbara Marx Brocato &Associates For a copy of this presentation contact us at: 18 Pinkney Street Annapolis, MD 21401 Phone: 410-269-1503 Fax: 410-269-5021 E-mail: Barbara@bmbassoc.com Web Site: www.bmbassoc.com