Physician Practice in the Dynamic Health Care Environment Edward O’Neil, Ph.D. MPA Professor Family and Community Medicine...
Current Drivers - Demographic - Aging Source: U.S. Census Bureau
Current Drivers - Demographic - Aging Source: U.S. Census Bureau,  U.S. Bureau of the Census, Population Division, Populat...
Current Drivers - Demographic - Diversity <ul><li>Still Assume Mainstream </li></ul><ul><li>From diversity to multicultura...
Current Drivers - Demographic - Diversity
Changes in Cause of Death,  1900–1999 Source: Centers for Disease Control and Prevention. Control of infectious diseases, ...
Current Drivers- Epidemiology SOURCE: Health US, 2003, USHHS, CDC,NCHCS, October 2003,  56.
Current Drivers- Epidemiology SOURCE: Health US, 2003, USHHS, CDC,NCHCS, October 2003,  56.
Current Drivers – Technology - Biotech
Current Drivers – Technology - Biotech <ul><li>US owns 85% of intellectual property in bio-technology </li></ul><ul><li>On...
<ul><li>Rapid expansion </li></ul><ul><li>Image of what can happen with enlarged consumer role </li></ul>Current Drivers –...
The Most Important Step is to Recognize that Health Care is a  Knowledge Based Service  Undertaking Current Drivers – Tech...
Source of health information Source: Pew Internet and Public Life.
Source of health information Source: Pew Internet and Public Life, 2002.
Current Drivers – Technology – Info Tech <ul><li>33 Million Admissions </li></ul><ul><li>4.8 Billion claims </li></ul><ul>...
<ul><li>Consumer value </li></ul><ul><li>More participation </li></ul><ul><li>More control  </li></ul>Current Drivers - Va...
Current Drivers – Health Care Environment <ul><li>Stressed care delivery system and institutions </li></ul><ul><ul><li>Tig...
Current Drivers –Continued Disequilibrium in Health Care <ul><li>Enormous range in definition of quality  </li></ul>Duplic...
Current Drivers –Continued Disequilibrium in Health Care Premiums Earnings Inflation Source: HJ Kaisier Foundation, HRET E...
Current Drivers- Economic Disparity SOURCE: Health US, 2003, USHHS, CDC,NCHCS, October 2003,  113. All Items Health Care
Current Drivers –Continued Disequilibrium in Health Care <ul><li>Familiar story of services following reimbursement </li><...
Current Drivers –Continued Disequilibrium in Health Care General Colorectal Hip Fracture Cardiac Percent Increase Risk of ...
Current Drivers –Continued Disequilibrium in Health Care Source: HHS,  CMS, www.cms.hhs.gov/statistics/nhe/default.asp Sub...
Current Drivers –Continued Disequilibrium in Health Care Source:  OECD, Health Reports, 2001. Substitution
<ul><li>Access  - 15% uninsured </li></ul>Current Drivers –Continued Disequilibrium in Health Care Policy and Market Solut...
<ul><li>Changing Role </li></ul><ul><li>“ When one doesn’t know what one wants or needs, one can never have enough” Eric H...
<ul><li>Tower mentality of the guilds </li></ul><ul><li>Driven in part by choice of consumers </li></ul><ul><li>Prerogativ...
Percentage of Physicians Receiving Incentive, Office-Based and Kaiser Permanente Physicians, 2001
Factors Affecting the Calculation of Incentives, Office-Based and Kaiser Permanente Primary Care Physicians, 2001
Factors Affecting the Calculation of Incentives, Primary Care Physicians, 1996–2001
Physician Income, 1996–2001
Average Work Hours Per Week, Primary Care Physicians and Specialists, 2001
Change in Hours, Primary Care Physicians, 2001
Change in Hours, Specialists, 2001
Mean Change in Hours among Physicians with a Change in Work Hours, Primary Care Physicians and Specialists, 2001
Work Hours Per Week by Physician Sex, 2001
Percentage of Physicians Reporting Disease Management Offered, Office-Based and Kaiser Permanente Physicians, 2001
Percentage of Physicians Receiving Practice Pattern Information, by Type of Information, Primary Care Physicians, 2001
Percentage of Physicians Experiencing Practice Pressures, Office-Based and Kaiser Permanente Primary Care Physicians, 2001
Percentage of Primary Care Physicians Working with Non-Physician Clinicians, Office-Based and Kaiser Permanente, 2001
For Physician Practices <ul><li>Success in the future means: </li></ul><ul><ul><li>Vision of practice that understands and...
For Physician Practices <ul><li>Success in the future means: </li></ul><ul><ul><li>Ability to deploy technology and system...
For Physician Practices <ul><li>Success in the future means: </li></ul><ul><ul><li>Ability to deliver safe, affordable, co...
Center for the Health Professions  University of California, San Francisco For more information,  please contact: UCSF Cen...
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Physician Practice in the Dynamic Health Care Environment Physician Practice in the Dynamic Health Care Environment

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  • Physician Practice in the Dynamic Health Care Environment Physician Practice in the Dynamic Health Care Environment

    1. 1. Physician Practice in the Dynamic Health Care Environment Edward O’Neil, Ph.D. MPA Professor Family and Community Medicine and Dental Public Health Director of the Center for the Health Professions, University of California, San Francisco HTTP://FUTUREHEALTH.UCSF.EDU
    2. 2. Current Drivers - Demographic - Aging Source: U.S. Census Bureau
    3. 3. Current Drivers - Demographic - Aging Source: U.S. Census Bureau, U.S. Bureau of the Census, Population Division, Population Paper Listing #47, Population Electronic Product #45
    4. 4. Current Drivers - Demographic - Diversity <ul><li>Still Assume Mainstream </li></ul><ul><li>From diversity to multicultural </li></ul><ul><li>New consumer demands </li></ul><ul><li>Serious mismatch Latino and Black populations </li></ul>
    5. 5. Current Drivers - Demographic - Diversity
    6. 6. Changes in Cause of Death, 1900–1999 Source: Centers for Disease Control and Prevention. Control of infectious diseases, 1900–1999. Morbidity and Mortality Weekly Report 1999; 48:621–629.
    7. 7. Current Drivers- Epidemiology SOURCE: Health US, 2003, USHHS, CDC,NCHCS, October 2003, 56.
    8. 8. Current Drivers- Epidemiology SOURCE: Health US, 2003, USHHS, CDC,NCHCS, October 2003, 56.
    9. 9. Current Drivers – Technology - Biotech
    10. 10. Current Drivers – Technology - Biotech <ul><li>US owns 85% of intellectual property in bio-technology </li></ul><ul><li>Only “industrial policy” followed consistently by both political parties </li></ul><ul><li>Consumer demand and expectation growing </li></ul><ul><li>Morph from bio tech to care management technology </li></ul><ul><li>How the market is betting: </li></ul><ul><li>Market Capitalization </li></ul><ul><li>Biotech, Pharma, Equipment = $1,300B </li></ul><ul><li>Rest of Health Care = $169B </li></ul>
    11. 11. <ul><li>Rapid expansion </li></ul><ul><li>Image of what can happen with enlarged consumer role </li></ul>Current Drivers – Technology - Biotech Source: Conlan, M, In Your Face Pharmacy: Will the Boom in Rx ads aimed at consumers continue, Drug Topics 140 (13): 92-98.IMS Health Promotion Service and Competitive Media Reporting , 1994-2001. … and more consumer titillation…
    12. 12. The Most Important Step is to Recognize that Health Care is a Knowledge Based Service Undertaking Current Drivers – Technology – Info Tech <ul><li>Information </li></ul>Management Consumer Clinic
    13. 13. Source of health information Source: Pew Internet and Public Life.
    14. 14. Source of health information Source: Pew Internet and Public Life, 2002.
    15. 15. Current Drivers – Technology – Info Tech <ul><li>33 Million Admissions </li></ul><ul><li>4.8 Billion claims </li></ul><ul><li>505 Million outpatient visits </li></ul><ul><li>1.7 Billion prescriptions filled </li></ul>SOURCE: AHA, Hospital Statistics, 2002. Healthcare Infirmities, December 2001, p15.
    16. 16. <ul><li>Consumer value </li></ul><ul><li>More participation </li></ul><ul><li>More control </li></ul>Current Drivers - Values –
    17. 17. Current Drivers – Health Care Environment <ul><li>Stressed care delivery system and institutions </li></ul><ul><ul><li>Tighter resources </li></ul></ul><ul><ul><li>Lack of direction </li></ul></ul><ul><ul><li>Greater demands </li></ul></ul><ul><ul><ul><li>Technology </li></ul></ul></ul><ul><ul><ul><li>Quality </li></ul></ul></ul><ul><ul><ul><li>Safety </li></ul></ul></ul><ul><ul><li>Job cuts </li></ul></ul><ul><ul><li>Uncertainty </li></ul></ul><ul><ul><li>Inability to adapt and change rapidly </li></ul></ul><ul><ul><li>Half born revolution </li></ul></ul>
    18. 18. Current Drivers –Continued Disequilibrium in Health Care <ul><li>Enormous range in definition of quality </li></ul>Duplication <ul><li>Over/under supply of care providers, hospitals, insurers. </li></ul><ul><li>Substitutable inputs </li></ul>Cost <ul><li>Total system costs are a huge burden </li></ul>Variation Capacity
    19. 19. Current Drivers –Continued Disequilibrium in Health Care Premiums Earnings Inflation Source: HJ Kaisier Foundation, HRET Employer Sponsored Health Benefits, 2003, p21. Cost
    20. 20. Current Drivers- Economic Disparity SOURCE: Health US, 2003, USHHS, CDC,NCHCS, October 2003, 113. All Items Health Care
    21. 21. Current Drivers –Continued Disequilibrium in Health Care <ul><li>Familiar story of services following reimbursement </li></ul>Surgeons Specialists All MDs Beds Source: NY Times, 9/13/03, A9;Fisher, Elliot, Annals, February 2002. Family MD Provider Resources in High Medicare Areas Variation
    22. 22. Current Drivers –Continued Disequilibrium in Health Care General Colorectal Hip Fracture Cardiac Percent Increase Risk of Death Source: NY Times, 9/13/03, A9;Fisher, Elliot, Annals, February 2002. Services Received in High Medicare Areas Variation
    23. 23. Current Drivers –Continued Disequilibrium in Health Care Source: HHS, CMS, www.cms.hhs.gov/statistics/nhe/default.asp Substitution
    24. 24. Current Drivers –Continued Disequilibrium in Health Care Source: OECD, Health Reports, 2001. Substitution
    25. 25. <ul><li>Access - 15% uninsured </li></ul>Current Drivers –Continued Disequilibrium in Health Care Policy and Market Solutions
    26. 26. <ul><li>Changing Role </li></ul><ul><li>“ When one doesn’t know what one wants or needs, one can never have enough” Eric Hoffer </li></ul><ul><ul><li>Choice </li></ul></ul><ul><ul><li>Cost </li></ul></ul><ul><ul><li>Preferences </li></ul></ul>Current Driver – Changing Consumer <ul><li>Consumer </li></ul>
    27. 27. <ul><li>Tower mentality of the guilds </li></ul><ul><li>Driven in part by choice of consumers </li></ul><ul><li>Prerogatives of incumbents remain paramount </li></ul><ul><li>Less of a system more a collection </li></ul>Current Drivers –Continued Movement to Systems How did we get here? Where are we going?
    28. 28. Percentage of Physicians Receiving Incentive, Office-Based and Kaiser Permanente Physicians, 2001
    29. 29. Factors Affecting the Calculation of Incentives, Office-Based and Kaiser Permanente Primary Care Physicians, 2001
    30. 30. Factors Affecting the Calculation of Incentives, Primary Care Physicians, 1996–2001
    31. 31. Physician Income, 1996–2001
    32. 32. Average Work Hours Per Week, Primary Care Physicians and Specialists, 2001
    33. 33. Change in Hours, Primary Care Physicians, 2001
    34. 34. Change in Hours, Specialists, 2001
    35. 35. Mean Change in Hours among Physicians with a Change in Work Hours, Primary Care Physicians and Specialists, 2001
    36. 36. Work Hours Per Week by Physician Sex, 2001
    37. 37. Percentage of Physicians Reporting Disease Management Offered, Office-Based and Kaiser Permanente Physicians, 2001
    38. 38. Percentage of Physicians Receiving Practice Pattern Information, by Type of Information, Primary Care Physicians, 2001
    39. 39. Percentage of Physicians Experiencing Practice Pressures, Office-Based and Kaiser Permanente Primary Care Physicians, 2001
    40. 40. Percentage of Primary Care Physicians Working with Non-Physician Clinicians, Office-Based and Kaiser Permanente, 2001
    41. 41. For Physician Practices <ul><li>Success in the future means: </li></ul><ul><ul><li>Vision of practice that understands and delivers on the needs of key stakeholders: </li></ul></ul><ul><ul><ul><li>purchasers, </li></ul></ul></ul><ul><ul><ul><li>payers, </li></ul></ul></ul><ul><ul><ul><li>consumers, </li></ul></ul></ul><ul><ul><ul><li>and operators </li></ul></ul></ul><ul><ul><li>Competitive ability to understand, market and manage patients at population level </li></ul></ul>
    42. 42. For Physician Practices <ul><li>Success in the future means: </li></ul><ul><ul><li>Ability to deploy technology and systems against population problems and/or emergent health markets </li></ul></ul><ul><ul><li>Ability align practice with prevailing reimbursement scheme and adjust as it changes </li></ul></ul>
    43. 43. For Physician Practices <ul><li>Success in the future means: </li></ul><ul><ul><li>Ability to deliver safe, affordable, consumer orientated care that is at or above average on quality indicators </li></ul></ul><ul><ul><li>Create and manage an adaptive culture of practice that can: </li></ul></ul><ul><ul><ul><li>Evolve quickly </li></ul></ul></ul><ul><ul><ul><li>Create and support collaboration </li></ul></ul></ul><ul><ul><ul><li>Sponsor innovation </li></ul></ul></ul>
    44. 44. Center for the Health Professions University of California, San Francisco For more information, please contact: UCSF Center for the Health Professions 3333 California Street, Suite 410, San Francisco, CA 94118 Phone: 415/476-8181 HTTP://FUTUREHEALTH.UCSF.EDU [email_address]

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