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Primary Care In Healthcare Reform The Innovator ’ s Opportunity United Health Care October 5, 2010 Sue Houck Houck & Associates, Inc Boulder, CO. Request Reconsider sacred cows. Less Waste, More Shared Savings
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The Innovator’s Opportunity
United Health Care
October 5, 2010
Houck & Associates, Inc
Reconsider sacred cows
“In return for a share of whatever savings they achieve, physicians and hospitals will have to reduce waste… The ACO model is set up to gradually transfer more financial risk to providers, forcing doctors to become more efficient. ”
New Payment Models: What They Could Mean to Doctors Part 1: Accountable Care Organizations. Medscape Business of Medicine
1. Resources generate value
3. Culture shift
Patients are most satisfied with medical visits in which they talk about their specific treatment, are examined, and receive health education. There was a negative relationship with time spent on history taking.
The Influence of Physician Practice Behaviors On Patient Satisfaction. Fam Med. 1993 Jan;25(1):17-20.Robbins, JA, Bertakis, KD, Helms, LJ, Azri, R, Callahan, EJ, Creten, DA
Poorly controlled diabetes
Physical1. Resources Generate ValueCould focus on 1:1 physician office visits actually limit primary care supply and innovation?
GreenField Health in Portland, OR combines e-mail care with e-visits and an interactive website. The innovative practice now does 40% of patient interactions through web messaging, 40% via telephone and only 20% via traditional office visits. Total costs of care are 20% less than national average.
Non-physician work delegated
MD:FTE clinical staff: 3.5 vs. 1.56
Same day access to own provider
Near top of 200+ physician group for NCQA's Heart Stroke Recognition Program
Patients likely to return >95%
“I got my professional life back and now do only the work that only I can do as a physician. The nurses are happier because they have a lot more responsibility”
“My patients love that I’m available when they want to be seen and am not distracted with administrative tasks or entering data into a computer.”
Beyond our social contract to avoid risk
A new kind of leadership
Patients as core resource
Director of Epidemiology, Rika Murthy at Cedars-Sinai was frustrated that after efforts to “catch and award” physician hand washing with $10 Starbucks cards, compliance rose from 65 to about 80 percent-better, but not great.
During a Chief of Staff meeting, Murthy gave each attendee a petri dish and cultured their palms. The resulting images, “were disgusting and striking, with gobs of bacteria.” One photograph was made into a screen saver and posted on every Cedars-Sinai computer. Reasons for not complying vanished in the face of vivid evidence. Overnight, hand washing compliance rose to just under 100%.
He currently averages 5 medical office visits per year and is routinely told to RTC in 3 months. His blood pressure is occasionally elevated and blood sugar well controlled. Frank has never been hospitalized. Frank is also computer savvy and has a Facebook page.
Frank’s satisfied with his primary care physician, Ben Francisco but hates the “hassle” of office visits. In the last year he has visits for: conjunctivitis, sore throat, blood pressure check, a physical and diabetes.
Blend office visits and alternatives for Frank
Beyond Incremental: Primary Care Strategy Map
Heal, Enable & Delight Patients Cost-Effectively Every Time
Non-physician tasks delegated
Accountable for value
Care happens at the office
Ratio of clinical staff:MD
Patients key team members
Memorable service experience
Clinical decisions rely on human memory