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Primary Care Shortage: Solutions

Primary Care Shortage: Solutions. March 21, 2012 Senate Hearing Sacramento, CA. Population Forecast (thousands). >65 will comprise 17% CA population by 2020 additional 2 million people. California & Chronic Conditions. 70% of healthcare costs are derived from chronic conditions

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Primary Care Shortage: Solutions

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  1. Primary Care Shortage: Solutions March 21, 2012 Senate Hearing Sacramento, CA

  2. Population Forecast (thousands) >65 will comprise 17% CA population by 2020 additional 2 million people (1) Source: Prevent Blindness America

  3. California & Chronic Conditions • 70% of healthcare costs are derived from chronic conditions • 36% of California adults report at least 1: • Diabetes, HTN, Heart Disease, Cancer, Stroke • Current management failures exist due to: • Poor quality • Uncoordinated care • Insufficient access • Current management failures yield: • Increased hospital & ER use • Poorer health • Death

  4. Prevalence of Chronic Conditions • Diabetes: 7.8% • 42.3% are low income • Hypertension: 26.1% • 32% are low income • Children (fair to poor) health status: 6.8% • 25% of Adults with 1 chronic condition report barriers to care: • No health insurance • No usual care provider • Communication • Access points

  5. Growing Demand • Demographic trends and population shift will drive increase in incidence of major ophthalmic diseases. • 200,000 Americans develop advanced AMD each year; expected to double by 2020. (1) • Cataract affects 1 in 6 people over age 40 (2) ; 30.1 million Americans expected to have cataracts by 2020. (1) • Growing levels of obesity lead to increase in diabetic retinopathy; currently 4.1 million over age 40 affected, projected 7.2 million by 2020. (1) • Glaucoma accounts for over 7 million visits to MDs each year with potential increase to over 10 million by 2020. (2) (1)Source: “Vision Impairment and Eye Disease is a Major Public Health Problem,” National Alliance for Eye and Vision Research & National Eye Institute (2)Source: “Vision Problems in the U.S.,” Prevent Blindness America and National Eye Institute

  6. Incidence Rates for Americans 40+ (millions) 47% 79% 61% 50% Source: National Eye Institute, 2004 Study

  7. Cataract Surgery Trends • Cataract Surgery demand to grow 29% in next 10 years • 2005 = 2.8 million • 2010 = 3.6 million • 2015 = 3.83 million • 2020 = 4.34 million • 2011 cataract surgeries 3.7million procedures Source: Market Scope, Ophthalmic Market Perspective

  8. Physician Supply Projections • Growth and aging of US population will cause a surge in demand for physician services. • Requirements for physicians will increase 22% from 2005 to 2020. • Requirements for ophthalmologists will increase 28% - 60% from 2005 to 2020. • Non-physician clinicians (NPC) will increase 60% from 2005 to 2020. • NPCs will provide 40% of current physician work by 2020 Source: DHHS Physician Supply and Demand Projections to 2020

  9. Optometry and Medical Management • Shortage of ophthalmic providers: • Patients requiring care expected to increase by 18% in 2015.(2) • Number of ophthalmologists expected to grow by 0.67% during same timeframe.(2) • Health Care Reform legislation designates vision care for children as an essential health benefit, how is this defined? (1)Source: Bureau of Labor Statistics (2)Source: 2009 study conducted by Market Scope, LLC

  10. Ophthalmology Trends Source: DHHS Physician Supply and Demand Projections to 2020

  11. Optometry in the Primary Care Team • Detect associated systemic and non-systemic medical diseases and conditions, through retina examination and imaging and measuring visual field loss. • Take comprehensive systemic and family health history • Perform other tests in-office, such as measuring blood pressure and taking blood samples from diabetes suspects. • Determine the presence of risk factors for at least 57 diseases and conditions. See Handout for complete list of conditions.

  12. Optometry and Healthcare $$

  13. Current Practice Patterns • NCQA measures and Medical Home don’t cut it • Level 1 CHCs ONLY 35% of diabetics had a retinal exam in 12 months • Current involvement: • EYEPACS • Excellent screening • Where do we send the patient? • Limited CHC involvement • Health Plans: skip Primary Care directly to Tertiary

  14. Current Provider Availability (CHCs) • 118 FQHCs in CA (444 CHCs as of late 2010) • Current FTE in the system: • Dentist 407.63 • Optometrist 31.4 • Barriers: • No inclusion in National Health Service Corps • No inclusion in Public 330 funding from Congress for CHCs Source: HRSA

  15. $343,689,500 • Potential savings by ensuring Optometrists are a critical component of the Primary Care Team • Assumed increase of 35% in eye exams based on current Medical Home • Additional 71,900 diabetics seen of the current 2.9 million CHC patients • Savings of $4345 Annual expenditure/member

  16. Barriers to Overcome • Inclusion on Health Plan Panels • Cal-Search Program • Pathway for student to resident to provider • National Health Service Corp inclusion • 3/15/2012 bill introduced by Senator Mark Pryor, AK • Concurrent legislation running in the House • State Funding

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