Introduction to Health Care and Public Health in the U.S.

1. Introduction to Health Care and Public Health in the U.S. Introduction to and History of Modern Health Care in the U.S. Lecture c This material (Comp 1 Unit 1) 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 90WT0001. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

2. Introduction to and History of Modern Health Care in the U.S.Learning Objectives - 1 • Define key terms in health care and public health (Lectures a, b, c, d) • Describe components of health care delivery and health care systems (Lecture a) • Discuss examples of improvements in public health (Lecture b)

3. Introduction to and History of Modern Health Care in the U.S.Learning Objectives - 2 • Define core values and paradigm shifts in U.S. health care (Lecture c) • Describe the technology used in the delivery and administration of health care (Lecture d)

4. Core Values in U.S. Health Care • Patient centricity • Individual choice • Interdisciplinary care • Technology and innovation drive health care • Technology drives health care spending

5. Cost of Health Care • Options for financing health care • Taxation or general revenue • Social health insurance • Voluntary or private health insurance • Out-of-pocket payments • Internal donations • Health care expenditure • 1980: $253 billion • 1990: $714 billion • 2015: $3.2 trillion

6. Paradigm Shifts in Medicine:Physician-Centric to Patient-Centric Care - 1 • Old model • Patient care options were determined by the provided • Patients were offered few opportunities to make decisions • New model • Cultural shift towards giving patients greater responsibility in their care • Shift from paternalism to patient autonomy

7. Paradigm Shifts in Medicine:Physician-Centric to Patient-Centric Care - 2 • Patient Self-Determination Act,1990 • Requires organizations to give individuals information about their rights • Participate in and direct their own health care decisions • Accept or refuse medical or surgical treatment • Prepare an advance directive • Information on the provider’s policies that govern the utilization of these rights • Providers, organizations and health care systems have become more responsive to patient needs

8. Paradigm Shifts in Medicine:Individual to Team-Based Care - 1 • Patient care was provided by an individual clinician • Increasing complexity caused an evolution towards collaboration between clinicians • Interdisciplinary team • “…group of individuals with diverse training and backgrounds who work together as an identified unit or system” (Drinka, 2000) • Intensive care units, hospice care, primary care outpatient settings

9. Paradigm Shifts in Medicine:Individual to Team-Based Care - 2 • Patient Centered Medical Home • Introduced by the American Academy of Pediatrics in 1967 • Endorsed by numerous organizations • Features include • Personal physician • Physician-directed medical care • Care is coordinated • Emphasis on quality and safety • Enhanced access to care

10. Paradigm Shifts in Medicine:Team-Based Care to Accountable Care • Accountable Care Organizations (ACOs) • Groups of physicians, hospitals, and other health care providers who provide coordinated, high-quality care • Goal is to ensure that patients get the right care at the right time, avoid having unnecessary duplication of services, and aim to prevent medical errors • Some ACOs may share in the savings achieved

11. Paradigm Shifts in Medicine:Physician-Kept Records to Personal Health Records • First medical records were maintained by physicians as notes • 1907 – first individual records developed and centrally located in Mayo Clinic • Advances in technology led to the electronic medical records • Current trend is towards the personal health record, which is created and maintained by the patient

12. Paradigm Shifts in Medicine: Dominance of Technology in Health Care Delivery • Health information technology (HIT) • Allows comprehensive management of information • Secure exchange between patients and providers • HIT can • Improve quality and prevent medical errors • Increase efficiency of care • Reduce unnecessary health care costs • Increase administrative efficiencies • Expand access to affordable care • Improve population health

13. Introduction to and History of Modern Health Care in the U.S. Summary – Lecture c • The core values in U.S. Health Care • Paradigm shifts in Medicine • Physician-centric to patient-centric care • Individual to team-based to accountable care • Physician-kept to personal health records • Paper-based to electronic-based management of medical records

14. Introduction to and History of Modern Health Care in the U.S. References – 1 – Lecture c References Accountable Care Organizations. Retrieved January 19, 2017, from Center for Medicare and Medicaid Services, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/ Drinka, T.J.K. and Clark, P.G. (2000) Health Care Teamwork. Interdisciplinary Practice and Teaching. London: Auburn House. JAMA Special Communication – Uninsured Adults Presenting to US Emergency Departments. Assumptions vs. Data. (2008). Journal of the American Medical Association, 300(16), 1914-1924. Retrieved from http://jamanetwork.com/journals/jama/fullarticle/182794.

15. Introduction to and History of Modern Health Care in the U.S. References – 2 – Lecture c References Joint Principles of the Patient Centered Medical Home. (2007). Retrieved January 19, 2017, from Patient-centered Primary Care Collaborative - American Academy of Family Physicians (AAFP),http://www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PCMHJoint.pdf. Wilson, KB (2016). Health Care Costs 101. Oakland, CA, California Health Care Foundation. http://www.chcf.org/publications/2016/12/health-care-costs-101

16. Introduction to Health Care and Public Health in the U.S.Introduction to and History of Modern Health Care in the U.S.Lecture c 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 90WT0001.