Component 1: Introduction to Health Care and Public Health in the U.S. Unit 5: Financing Health Care (Part 2) Lecture 4 This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

Healthcare IT Workforce Curriculum Version 2.0/Spring 2011 Objectives Review some potential methods of controlling rising costs in medicine Examine the role of health information technology in reducing and limiting costs Use of electronic health records and evidence based medicine Clinical decision support Clinical practice guidelines Component 1/Unit 5-4 Healthcare IT Workforce Curriculum Version 2.0/Spring 2011

Healthcare IT Workforce Curriculum Version 2.0/Spring 2011 Section 5-4:Objectives Examine briefly the Patient Centered Medical Home model for reducing healthcare expenditures Explore direct primary care or concierge medicine Component 1/Unit 5-4 Healthcare IT Workforce Curriculum Version 2.0/Spring 2011

Healthcare IT Workforce Curriculum Version 2.0/Spring 2011 Cost Drivers Technology 50 % total annual expenditures Devices advance diagnosis and care Imaging - CT, MRI Surgery - da Vinci robot Artificial devices – hips, knees, pacemakers Procedures treat the untreatable, minimize risk, improve outcomes Minimally invasive surgery Angioplasty New treatments Component 1/Unit 5-4 Healthcare IT Workforce Curriculum Version 2.0/Spring 2011

Healthcare IT Workforce Curriculum Version 2.0/Spring 2011 Cost Drivers Physician and hospital utilization Aging Increasing number >65 y.o. Increasing cost >65 y.o. Chronic disease Diagnostic tests Management of disease Component 1/Unit 5-4 Healthcare IT Workforce Curriculum Version 2.0/Spring 2011

Additional Cost drivers Administration Reimbursement methods Fee-for-service encourage utilization Disparities within and among insurance plans Billing Rules Process Other Direct to consumer advertizing Defensive medicine Tort reform Component 1/Unit 5-4 Healthcare IT Workforce Curriculum Version 2.0/Spring 2011

Healthcare IT Workforce Curriculum Version 2.0/Spring 2011 Fixing a Broken System? Limit available resources Rationing Incentives to change utilization Increase patient cost Wellness and prevention Increase in efficiency Health Information Technology (HIT) Evidence-based medicine (EBM) Clinical Practice Guidelines Adapted from: Nelson AR, 2005, Costs of Health Care: New Solutions for an Old Problem. The Commonwealth Fund 2005. Available from: http://www.commonwealthfund.org/Content/Publications/Commentaries/2005/May/Costs-of-Health-Care--New-Solutions-for-an-Old-Problem.aspx Component 1/Unit 5-4 Healthcare IT Workforce Curriculum Version 2.0/Spring 2011

Health Information Technology Health information technology (HIT) Best chance to lower costs HITECH Reward ($$$) for meaningful use of EHR Facilitates coordination of care Supports provider Clinical decision support (CDS) Clinical practice guidelines/EBM Shared information (health information exchange) Error avoidance Component 1/Unit 5-4 Healthcare IT Workforce Curriculum Version 2.0/Spring 2011

Evidence-based medicine Evidence-based medicine (EBM) Systematic review of published research Clinical practice guidelines Standard of care Lower costs Defensive medicine Cook book medicine? Evaluating technology Component 1/Unit 5-4 Healthcare IT Workforce Curriculum Version 2.0/Spring 2011

Healthcare IT Workforce Curriculum Version 2.0/Spring 2011 The Medical Home Provides comprehensive medical care Personal physician = director Practice team Collective responsibility Enhanced access Same day appointments Component 1/Unit 5-4 Healthcare IT Workforce Curriculum Version 2.0/Spring 2011

Healthcare IT Workforce Curriculum Version 2.0/Spring 2011 The Medical Home Coordinated care Specialists, hospitals Other organizations Active patient participation in decision making Improves quality and safety Planned coordinated care EBM, CDS HIT measure quality performance Research: 5.6% lower costs Component 1/Unit 5-4 Healthcare IT Workforce Curriculum Version 2.0/Spring 2011

Healthcare IT Workforce Curriculum Version 2.0/Spring 2011 Concierge Medicine Also known as direct primary care Patient pays fee or retainer Monthly or annual Receives special service Enhanced access Multiple models Practice size limited Limited or no insurance billing Requires patient maintain health insurance for services not covered in the practice Component 1/Unit 5-4 Healthcare IT Workforce Curriculum Version 2.0/Spring 2011

Healthcare IT Workforce Curriculum Version 2.0/Spring 2011 Concierge Medicine Typical features Same day urgent care appointments and next day non-urgent care appointments 24-hour telephone access Extended office visits Preventive care physicals/screenings E-mail and mobile phone access Component 1/Unit 5-4 Healthcare IT Workforce Curriculum Version 2.0/Spring 2011

Healthcare IT Workforce Curriculum Version 2.0/Spring 2011 Concierge Medicine Typical features Wellness and nutrition planning Coordination of medical needs during travel Patient’s home or workplace consultations Smoking cessation support Stress reduction counseling Mental health counseling Component 1/Unit 5-4 Healthcare IT Workforce Curriculum Version 2.0/Spring 2011

Healthcare IT Workforce Curriculum Version 2.0/Spring 2011 Concierge Medicine Practice costs lower Lower staff costs Fewer patients/fewer administration/fewer nursing Lower overhead costs Rent smaller office Lower utility costs Perception of improved quality No difference from traditional primary care Component 1/Unit 5-4 Healthcare IT Workforce Curriculum Version 2.0/Spring 2011

Healthcare IT Workforce Curriculum Version 2.0/Spring 2011 Concierge Medicine Challenges Health insurance for specialty services, high-cost procedures, emergency treatments, and hospitalization. No data on how model affects overall health care costs Employers evaluating model for savings Could exacerbate the shortage of primary care providers Component 1/Unit 5-4 Healthcare IT Workforce Curriculum Version 2.0/Spring 2011

Healthcare IT Workforce Curriculum Version 2.0/Spring 2011 Summary Improved efficiency – prospective savings Health information technology Evidence-based medicine Medical home model Lower costs 5.6% Comprehensive care Concierge medicine Retainer based model of the medical home Direct primary care Enhanced services No research to support cost containment Component 1/Unit 5-4 Healthcare IT Workforce Curriculum Version 2.0/Spring 2011