Designing a 21st Century Approach to Primary Care

1
Designing a 21st Century Approach to Primary Care

• John R. Griffith, Kyle L. Grazier, Scott B.
  Ransom
• University of Michigan
• Center for Health Management Research
• Industry Advisory Board
• October 7, 2005

2

• Thank you for your generous funding.
• John, Kyle, Scott

3
It is the grind that makes the happiness. To
feel that your hours are filled to overflowing,
that you can barely steal minutes enough for
sleep, that the welfare of many is entrusted to
you, that the world looks on and approves, that
some good is always done to others,that is
happiness. For myself, I can conceive none
other.
4
(No Transcript)
5
(No Transcript)
6
WHY MIGHT DOCTORS BE UNHAPPY?
7
(No Transcript)
8
Primary Care-Selective and Integrative

• Responsive to patient needs as patients perceive
  them
• Provide benchmark care
• Delight practitioners
• Care that maximizes value
• Financial incentives- designed by patients,
  providers, buyers

9







Very scary, Jenniferdoes anyone else have an
H.M.O. horror story? The New Yorker July 19,
1999
10
For Caregivers

• Personnel management
• Work/life concerns
• Staffing
• Locum tenens
• Staff development
• Transparent business operations
• Incentive pay- quality, effectiveness,
  satisfaction
• Capital- maintenance, expansion
• Accountability

11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
For Patients

• Coordinated choices
• Integrated information and treatment support
• Geographic access to care
• Alternative practitioners- risk adjusted
• Cost control-variable copays
• Screening and prevention

16
Business Model

• Retailer of medical care
• Organized vendors
• PCP service lines
• Financial gain
• Business efficiencies
• Revised clinical care
• Improved prevention
• Reduced unnecessary care
• Managed chronic illness
• Improved patient comfort compliance with
  reliability quality

17
Hastings and St. Leonards Primary Care Trust
18
Organizational Forms

• Entrepreneurial and patient focused IDS
• Groups of PCPs with business/technological
  acumen and success
• Insurance companies
• Health departments

19
Attributes of a 21st Century Primary Care
Management Organization
Service Excellence Promotion of convenience,
comprehensiveness, service, reliability
Clinical Practice safe, effective,
patient-centered, timely, efficient, and
equitable care
Support Network Recruitment, training,
information, accounting, supplies, facilities
Health Care Finance Patient cost sharing,
provider performance, incentives, and protection
against major loss
20
So Why Do It?

• Central to the organizations mission
• Addresses the most pressing issues of the 21st
  Century
• A competitor is (always) in the wings

21
How To Do it?

• Leadership
• Understanding market needs
• Understanding provider needs
• Understanding consumer needs
• Implementation
• Financial modeling
• Pilot and Roll- Out

22
Research and Evaluation

• Ask the questions
• Measure the process
• Monitor the outcomes
• Qualitative and quantitative methods
• Design
• Data collection
• Analysis

23
Study Finds Bubkes

• June 4, 2003 Issue 3921
• BALTIMOREA team of scientists at Johns Hopkins
  University announced Monday that a five-year
  study has found absolutely nothing.
• "I can't explain what happened," head researcher
  Dr. Jeremy Dhen said. "We meticulously followed
  correct scientific procedure. Our methods were
  sufficiently rigorous that they should have
  produced some sort of result. Instead, we found
  out nothing."
• Dr. Dhen took the podium to make the
• team's closing statements.
• "I just want to clarify that we had the
• best intentions going into this study,"
• Dhen said.
• We thought we would make a scientific discovery
• that would benefit the health of millions.
• I guess we were wrong.
• We tried to find a link, but instead we found
  bubkes.
• .

24
Research and Evaluation

• Dont miss the action
• Feedback to stakeholders, designers
• Does it work?

25
(No Transcript)
26
End of presentation
Linda Frances Happiness