Changing Healthcare Landscape


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A brief slideshow about the changing environment in which healthcare is delivered.

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  • What’s driving the task shifting in the practice of medicine and where will it ultimately lead… How it used to be: You went to your family doctor when you were sick You went to the emergency room after office hours when you were sick You stayed in the hospital until you were better You saw a specialist on referral from your family doctor PAs and NPs now provide care under doctor’s supervision Why would practices hire NPs/PAs Patient volume Lower cost to practice (alt hire another doc) Why patients would choose to see NP/PA Access Fulfill different pt needs (communication skills; spend more time) Why the necessity for alternatives to ED? Cost to insurance companies Cost to patients Access/convenience for patients Why do hospitals discharge to nursing homes and rehabs? Cost – insurance companies set the rules now Why do patients choose alternatives to specialists? Access – average wait for specialist Patient choice – alternative medicine becoming more acceptable Fulfill different needs – more natural childbirth experience Cost to patients Common themes for the shift – access/convenience for patients; cost to patients; needs of patients
  • When I was growing up, my mom had what my dad and our family physician considered a very dangerous thing—six kids and a big white medical encyclopedia. She had an inquiring mind; no insurance; very little cash on hand To keep my mom from scaring the crap out of us and herself, my father threw the big white book in the trash, but I can’t help thinking my mom was on to something. What may be considered a dangerous weapon in one person’s hand, can also be a lifesaving tool in another’s.
  • Today, millions of people have unprecidented access to information and are making unprecidented contributions to collective medical knowledge. This is not without its dangers, but I’m glad my dad can’t throw away the world wide web, because now I’m sure we’re on to something. I’ll talk about this more a little later
  • The internet has provided users with services that cut out the “middleman” from a variety of professions – these professionals have either had to redefine themselves or drift off to obscurity. Some examples Travel agents – don’t see ‘em in the mall anymore Stock brokers – Discount online stock brokerage Personal accountants – turbo tax – we still need accountants, but I’m sure some old schoolers were put out of business by turbo tax Real estate agents – FSBO I remember my first real estate agent making fun of or discounting FSBOs – bet he’s not laughing now I could sell my house on eBay if I thought anyone would want it Some of these “professionals” have survived, albeit in modified roles
  • Is the internet replacing the primary care physician? WebMD and Mayo Clinic among the top 10 medical websites Symptom trackers Patients use sites like these to diagnose themselves often arriving in the doctors office with their research results Instead of taking their internet search information to their primary care doc, will patients bypass the PCD all together and head straight for the specialist? Obviously patients having unmet needs will find a way to fulfill those needs Only website I’m going to show PLM because even I was awed by the potential contributions patients could make when my sister and I went there to see what patients were saying about treatment for fatigue and cognitive problems. Sister has MS Fear as a motivator Steve Jobs learned from the United Network for Organ Sharing that the national median waiting time for liver transplant was 306 days—48 days in Tennessee; no residency requirements in TN. In this case the application of readily available medical knowledge saved his life. EPD diagnosed w/stage iv renal carcinoma – peer reviewed research doomed him; there’s a whole different lesson around what the experts “agree” is best and what patient crowd wisdom “shows” is best
  • Access -The gap is shrinking – 74% of US population has broadband internet access 138% increase since tracking began in 2000 Overload Credible sources – there are dangers; cyberquacks do exist, but let’s face it, how credible is your grandmother or neighbor, or your best friend -- but many listen to advice anyway. There are emerging symbols of trust to help identify credible sources Skills Needed No known case of death by internet but Patients do need help -- are they getting it from their doctors? Apomediaries and expert patients are helping people navigate the healthcare system and find appropriate and reliable information
  • Will technology enabled tools and services eventually replace the primary care physician? Will expanded minute clinics do much of the work of Emergency Departments in the future? Will patients receive much of their long-term care in the home? Will primary care physicians be providing more specialized care? Will patient networks eventually replace specialists? What will enable task shifting to the next level (technology – e.g., home monitoring; web – e.g., social networking, distributed knowledge)
  • Changing Healthcare Landscape

    1. 1. The Changing Healthcare Landscape Kathie Rose Resilient Ambassadors of Change October 14, 2009
    2. 2. Specialist Hospital/Ward Primary Care Physician Emergency Room Urgent Care Centers/Walk-in Clinics Midwives, Alternative Medicine Rehab Centers, Nursing Homes, Visiting Nurses Physician Assistants/Nurse Practitioners The Changing Healthcare Landscape Patient volume, access, convenience, cost and patient needs will likely continue to affect task shifting and future healthcare delivery
    3. 3. A very dangerous thing In the 1960s my mother had: Six children and a medical encyclopedia No health insurance Very little cash on hand
    4. 4. A very promising thing Today Millions of people have unprecedented access to medical information The ability to contribute to collective medical knowledge Social tools and connections to effect change
    5. 5. A propensity for cutting out the middleman
    6. 6. 80% of American Internet users have searched for health information <ul><li>The Internet as a first opinion </li></ul><ul><ul><li>Patients use “Dr. Google” for a first opinion </li></ul></ul><ul><ul><ul><ul><li>WebMD and Mayo Clinic among top 10 medical websites </li></ul></ul></ul></ul><ul><ul><li>Doctors are unknowingly relegated to the second opinion </li></ul></ul><ul><li>The Internet for support and treatment alternatives </li></ul><ul><ul><li>Patients like me </li></ul></ul><ul><ul><ul><li>400K in US with MS </li></ul></ul></ul><ul><ul><ul><ul><li>14K MS patients use PLM </li></ul></ul></ul></ul><ul><ul><li>iStore – </li></ul></ul><ul><ul><ul><li>1544 medical apps (and counting) </li></ul></ul></ul><ul><ul><ul><ul><li>Doctor in a purse or on your belt </li></ul></ul></ul></ul><ul><li>The Internet as a life saver </li></ul><ul><ul><li>Savvy users </li></ul></ul><ul><ul><ul><li>Steve Jobs (Apple) liver transplant </li></ul></ul></ul><ul><ul><ul><li>ePatient Dave – </li></ul></ul></ul><ul><li>Patients are the biggest stakeholder and fear is a great motivator </li></ul>
    7. 7. Concerns/Cautions <ul><li>Access to internet </li></ul><ul><ul><li>The gap is shrinking </li></ul></ul><ul><ul><ul><li>74.1% broadband access </li></ul></ul></ul><ul><ul><ul><li>Elderly and minorities closing the gap </li></ul></ul></ul><ul><li>Information overload </li></ul><ul><ul><li>Credible sources </li></ul></ul><ul><li>Skills needed to assimilate information </li></ul><ul><ul><li>Apomediaries (case management for a fee) </li></ul></ul><ul><ul><li>Expert patients (motivated to learn and share) </li></ul></ul>
    8. 8. Primary Care Physician Hospital/Ward Specialist Emergency Room Tertiary Care Center Physician Assistants/Nurse Practitioners Urgent Care Centers/Walk-in Clinics Rehab Centers, Nursing Homes, Visiting Nurses Midwives, Alternative Medicine A Future Healthcare Landscape Patient networks Web diagnostic tools (expert systems) Google Expanded Minute clinics Home Primary care physician Patient networks