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

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, Population Paper Listing #47, Population Electronic Product #45

Current Drivers - Demographic - Diversity Still Assume Mainstream From diversity to multicultural New consumer demands Serious mismatch Latino and Black populations

Still Assume Mainstream

From diversity to multicultural

New consumer demands

Serious mismatch Latino and Black populations

Current Drivers - Demographic - Diversity

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.

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 US owns 85% of intellectual property in bio-technology Only “industrial policy” followed consistently by both political parties Consumer demand and expectation growing Morph from bio tech to care management technology How the market is betting: Market Capitalization Biotech, Pharma, Equipment = $1,300B Rest of Health Care = $169B

US owns 85% of intellectual property in bio-technology

Only “industrial policy” followed consistently by both political parties

Consumer demand and expectation growing

Morph from bio tech to care management technology

How the market is betting:

Market Capitalization

Biotech, Pharma, Equipment = $1,300B

Rest of Health Care = $169B

Rapid expansion Image of what can happen with enlarged consumer role 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…

Rapid expansion

Image of what can happen with enlarged consumer role

The Most Important Step is to Recognize that Health Care is a Knowledge Based Service Undertaking Current Drivers – Technology – Info Tech Information Management Consumer Clinic

Information

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 33 Million Admissions 4.8 Billion claims 505 Million outpatient visits 1.7 Billion prescriptions filled SOURCE: AHA, Hospital Statistics, 2002. Healthcare Infirmities, December 2001, p15.

33 Million Admissions

4.8 Billion claims

505 Million outpatient visits

1.7 Billion prescriptions filled

Consumer value More participation More control Current Drivers - Values –

Consumer value

More participation

More control

Current Drivers – Health Care Environment Stressed care delivery system and institutions Tighter resources Lack of direction Greater demands Technology Quality Safety Job cuts Uncertainty Inability to adapt and change rapidly Half born revolution

Stressed care delivery system and institutions

Tighter resources

Lack of direction

Greater demands

Technology

Quality

Safety

Job cuts

Uncertainty

Inability to adapt and change rapidly

Half born revolution

Current Drivers –Continued Disequilibrium in Health Care Enormous range in definition of quality Duplication Over/under supply of care providers, hospitals, insurers. Substitutable inputs Cost Total system costs are a huge burden Variation Capacity

Enormous range in definition of quality

Over/under supply of care providers, hospitals, insurers.

Substitutable inputs

Total system costs are a huge burden

Current Drivers –Continued Disequilibrium in Health Care Premiums Earnings Inflation Source: HJ Kaisier Foundation, HRET Employer Sponsored Health Benefits, 2003, p21. Cost

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 Familiar story of services following reimbursement 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

Familiar story of services following reimbursement

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

Current Drivers –Continued Disequilibrium in Health Care Source: HHS, CMS, www.cms.hhs.gov/statistics/nhe/default.asp Substitution

Current Drivers –Continued Disequilibrium in Health Care Source: OECD, Health Reports, 2001. Substitution

Access - 15% uninsured Current Drivers –Continued Disequilibrium in Health Care Policy and Market Solutions

Access - 15% uninsured

Changing Role “ When one doesn’t know what one wants or needs, one can never have enough” Eric Hoffer Choice Cost Preferences Current Driver – Changing Consumer Consumer

Changing Role

“ When one doesn’t know what one wants or needs, one can never have enough” Eric Hoffer

Choice

Cost

Preferences

Consumer

Tower mentality of the guilds Driven in part by choice of consumers Prerogatives of incumbents remain paramount Less of a system more a collection Current Drivers –Continued Movement to Systems How did we get here? Where are we going?

Tower mentality of the guilds

Driven in part by choice of consumers

Prerogatives of incumbents remain paramount

Less of a system more a collection

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 Success in the future means: Vision of practice that understands and delivers on the needs of key stakeholders: purchasers, payers, consumers, and operators Competitive ability to understand, market and manage patients at population level

Success in the future means:

Vision of practice that understands and delivers on the needs of key stakeholders:

purchasers,

payers,

consumers,

and operators

Competitive ability to understand, market and manage patients at population level

For Physician Practices Success in the future means: Ability to deploy technology and systems against population problems and/or emergent health markets Ability align practice with prevailing reimbursement scheme and adjust as it changes

Success in the future means:

Ability to deploy technology and systems against population problems and/or emergent health markets

Ability align practice with prevailing reimbursement scheme and adjust as it changes

For Physician Practices Success in the future means: Ability to deliver safe, affordable, consumer orientated care that is at or above average on quality indicators Create and manage an adaptive culture of practice that can: Evolve quickly Create and support collaboration Sponsor innovation

Success in the future means:

Ability to deliver safe, affordable, consumer orientated care that is at or above average on quality indicators

Create and manage an adaptive culture of practice that can:

Evolve quickly

Create and support collaboration

Sponsor innovation

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]