Trends in Domestic Primary Care MinistriesAn introductory discussion on trends in American Primary        Care provided to...
Trends in DomesticPrimary Care Ministries“Part 2” of the Discussion:   Community Medicine: Rethinking medical missions   i...
Trends in DomesticPrimary Care Ministries Questions?   Text 379541 and your question to 22333http://www.polleverywhere.com...
Trends in DomesticPrimary Care MinistriesObjectives:  Participants will be introduced to current statistics  surrounding t...
IntroductionBackground:   Crossroad Health Center is a non-denominational Christian,   Federally-Qualified Health Center, ...
Introduction
Introduction
Ground RulesApolitical DiscussionSquare Pegs in Round HolesBig Picture OverviewAsk “AND” vs. “OR”Consideration not consens...
The Health Landscape               ACOs?               PCMH?               HIEs?                                          ...
American DisparitiesHealth Outcome Measures:  Prenatal Care     African American mothers     were 2.3 times as likely as  ...
Infant Mortality Rates, Hamilton County, Ohio, 2012http://www.cincinnatichildrens.org/service/j/anderson-center/community-...
Infant Mortality Rates, Global, 2012U.S.: 5.98 (168th)Hamilton County, OH: 17.8 (102nd)                         http://www...
Self-Reported Obesity Among U.S. Adults       http://www.cdc.gov/obesity/data/adult.html          Trends in Domestic Prima...
Obesity and Diabeteshttp://apps.nccd.cdc.gov/DDTSTRS/default.aspx     Trends in Domestic Primary Care Ministries – IHCF 2013
Heart Diseasehttp://www.cdc.gov/dhdsp/data_statistics/fact_sheets/images/fs_heart_disease.jpg               Trends in Dome...
Smoking Rateshttp://www.cdc.gov/vitalsigns/tobaccouse/smoking/images/StateInfo_smoking1_730px.jpg  Trends in Domestic Prim...
Racial/Ethnic Make-Up Changeshttp://facts.kff.org/upload/jpg/enlarge/Distribution_of_US_Population_by_RE_2010_and_2050.jpg...
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Nursing Labor Force Supply vs. Demand        Chart 1: National Supply and Demand Projections for FTE Registered           ...
Age Distribution of Nursing Labor Force                        C h a rt 4 : Ag e D is trib u tio n o f R N s : 1 9 8 0 , 2...
American DisparitiesSocial Measures:   Food Deserts      A low-income census tract where either a substantial     number o...
Food Desertshttp://www.ers.usda.gov/data-products/food-desert-locator/go-to-the-locator.aspx                Trends in Dome...
Food Deserts (Cincinnati)http://www.ers.usda.gov/data-products/food-desert-locator/go-to-the-locator.aspx                T...
Food Deserts (Searcy)http://www.ers.usda.gov/data-products/food-desert-locator/go-to-the-locator.aspx                Trend...
Food Deserts (DFW)http://www.ers.usda.gov/data-products/food-desert-locator/go-to-the-locator.aspx                Trends i...
American DisparitiesSocial Measures:  Unemployment rates        http://www.bls.gov/news.release/empsit.nr0.htm            ...
The Economic Landscape                                              K. Vath      Trends in Domestic Primary Care Ministrie...
Percentage of persons of all ages without health insurance coverage at the time of                       interview: United...
2012 Federal Poverty Guidelines                                                    Average Household Size, 2010: 2.59     ...
Models of Care  Trends in Domestic Primary Care Ministries – IHCF 2013
Models of Care  Trends in Domestic Primary Care Ministries – IHCF 2013
Models of Care  Trends in Domestic Primary Care Ministries – IHCF 2013
Models of Care  Trends in Domestic Primary Care Ministries – IHCF 2013
Models of Care  Trends in Domestic Primary Care Ministries – IHCF 2013
Health Expenditures By Agehttp://www.nihcm.org/pdf/DataBrief3%20Final.pdf      Trends in Domestic Primary Care Ministries ...
Common Conditions Among Elderly High-Spenders   http://www.nihcm.org/pdf/DataBrief3%20Final.pdf         Trends in Domestic...
The Pending “Perfect Storm”Growing National Deficit                  Income Gap    Aging Workforce                Growing ...
Healthcare DeliveryThe IHI “Triple Aim” (The Institute for Healthcare Improvement)   Improving the patient experience of c...
Models of CareThe PPACA  Signed into law March  23, 2010  June 28, 2012 SCOTUS Upheld     Upheld individual mandate     Me...
Models of CareThe PPACA (Key Features)  By 2022, extend insurance coverage to 33 million.              Trends in Domestic ...
Models of CareThe PPACA (Key Features)  By 2022, extend insurance coverage to 33 million.              Trends in Domestic ...
Models of CareThe PPACA (Key Features)     Extended option to stay on parents’ insurance until age 26     Prohibits Insura...
Health ReformThree Main Stages (JAMA, January 2, 2013)  Insurance Reform (Politicians, laws)  Payment Reform (Economists, ...
Healthcare DeliveryAccountable Care Organizations (ACOs)             Trends in Domestic Primary Care Ministries – IHCF 2013
Healthcare DeliveryAccountable Care Organizations (ACOs)  A network of doctors and hospitals that shares responsibility  (...
Healthcare DeliveryAccountable Care Organizations (ACOs)    Cons           Tremendous learning curve for the uninitiated p...
Healthcare DeliveryAccountable Care Organizations (ACOs)   Pros       Objectivity is brought to the care of patients.     ...
Healthcare Delivery  Health Insurance Exchanges$3.50               Trends in Domestic Primary Care Ministries – IHCF 2013
Healthcare Delivery  Health Insurance Exchanges$3.50                                              $2.89               Tren...
Healthcare Delivery  Health Insurance Exchanges$3.50                                              $2.89               Tren...
Healthcare DeliveryHealth Insurance Exchanges         http://statehealthfacts.kff.org/comparemapdetail.jsp?ind=962&cat=17&...
Healthcare DeliveryHealth Insurance Exchanges         http://statehealthfacts.kff.org/comparemapdetail.jsp?ind=962&cat=17&...
Healthcare DeliveryHealth Insurance Exchanges   Pros      New requirements to decrease administrative costs will      lowe...
Models of Care  Trends in Domestic Primary Care Ministries – IHCF 2013
Models of Care$120       $40                              $15,000/mo                        $1300 $1000       Trends in Do...
Models of Care      $120                                      $15,000/mo$40                                               ...
Models of Care              Patient-Centered Medical Homes (PCMHs)•       Traditional                             •PCMH   ...
Models of CarePatient-Centered Medical Homes(PCMHs) •   1967 - Pediatric Health Homes (AAP) •   1978 - Tenets of MHs (WHO)...
Models of CarePatient-Centered Medical Homes(PCMHs) •   1967 - Pediatric Health Homes (AAP) •   1978 - Tenets of MHs (WHO)...
Models of Care    Patient-Centered Medical Homes(PCMHs)•     NCQA’s Six Standard Categories (27 elements, 149      factors...
Models of CareWhat Does This Mean For Free Clinics?  Will need to consider moving from a short-term  missions model to a P...
Case Studies“Hot-Spotting”  Dr. Jeff Brenner, Camden, NJ  Focus is on high-utilizers  Ambulatory ICU              Trends i...
Case StudiesSafetyN.E.T. (Non-Emergency Transportation)             Trends in Domestic Primary Care Ministries – IHCF 2013
Case StudiesED Alerts             Trends in Domestic Primary Care Ministries – IHCF 2013
Case StudiesED Alerts   27% reduction   $1198/diversion   saved   $230,016 annual   savings             Trends in Domestic...
Case StudiesSafetyN.E.T. (Non-Emergency Transportation)Program  Began discussion with local FD  Some estimates show misuse...
Case StudiesInnovative Collaborative Relationships              Trends in Domestic Primary Care Ministries – IHCF 2013
Current Model  COA                Trends in Domestic Primary Care Ministries – IHCF 2013
10,000+ patients                               160 patients over 60yrs                         32 sharedCOA               ...
Current Model  COA                Trends in Domestic Primary Care Ministries – IHCF 2013
The Cincinnati Pilot ModelCOA         Trends in Domestic Primary Care Ministries – IHCF 2013
The Cincinnati Pilot ModelCOA        Trends in Domestic Primary Care Ministries – IHCF 2013
Case StudiesPay For Performance Plans (P4P)   Working with Medicaid HMO to develop P4P   Payment for Care Coordination   B...
Case StudiesInnovative Collaborative Relationships   Senior Services (COA)   Medicaid HMOs   FNP Students   Home Health Or...
Key “Take-Homes”Don’t work in “silos”Continuity vs. episodic careEngage the healthcare reform discussionInnovate!Move from...
http://www.polleverywhere.com/free_text_polls/LTE3NDAxMjc3NzI                 Trends in Domestic Primary Care Ministries –...
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Ihcf presentation trends in domestic primary care ministries

  1. 1. Trends in Domestic Primary Care MinistriesAn introductory discussion on trends in American Primary Care provided to underserved populations Kyle Vath, BSN, RNClinical Coordinator, Crossroad Health Center, Cincinnati, Ohio
  2. 2. Trends in DomesticPrimary Care Ministries“Part 2” of the Discussion: Community Medicine: Rethinking medical missions in the age of chronic disease - Robert Lawrence, M.D. in Windsor II
  3. 3. Trends in DomesticPrimary Care Ministries Questions? Text 379541 and your question to 22333http://www.polleverywhere.com/free_text_polls/LTE3NDAxMjc3NzI Want to Follow Along? Scan the QR codes to access the slides
  4. 4. Trends in DomesticPrimary Care MinistriesObjectives: Participants will be introduced to current statistics surrounding the underserved, chronic diseases, and health economics. Participants will be introduced to current initiatives in American primary care (i.e. Accountable Care Organizations, Patient-Centered Medical Home, The Affordable Care Act, etc.). Participants will be given examples of innovative initiatives that are working to improve the quality of care while reducing costs to the health system.
  5. 5. IntroductionBackground: Crossroad Health Center is a non-denominational Christian, Federally-Qualified Health Center, located in inner-city Cincinnati, Ohio. Crossroad has been in existence since 1992 and serves the poor and uninsured, regardless of their ability to pay. Kyle is a graduate of Harding University Carr College of Nursing. Kyle serves as the Clinical Coordinator, leading Quality Improvement efforts, Patient-Centered Medical Home recognition, personnel management, etc.. Worked as staff nurse in intensive care unit in NLR. Kyle (together with wife, Melissa) served in Tanzania, East Africa at Chimala Mission Hospital for one year in 2008. Worked as Nursing Home Administrator of a Senior Living Center (NH/AL).
  6. 6. Introduction
  7. 7. Introduction
  8. 8. Ground RulesApolitical DiscussionSquare Pegs in Round HolesBig Picture OverviewAsk “AND” vs. “OR”Consideration not consensus K. Vath Trends in Domestic Primary Care Ministries – IHCF 2013
  9. 9. The Health Landscape ACOs? PCMH? HIEs? K. Vath Trends in Domestic Primary Care Ministries – IHCF 2013
  10. 10. American DisparitiesHealth Outcome Measures: Prenatal Care African American mothers were 2.3 times as likely as non-Hispanic white mothers to begin prenatal care in the 3rd trimester, or not receive prenatal care at all. (CDC, 2008) S. Stafford – Used With Permission http://minorityhealth.hhs.gov/templates/content.aspx?ID=6907 Trends in Domestic Primary Care Ministries – IHCF 2013
  11. 11. Infant Mortality Rates, Hamilton County, Ohio, 2012http://www.cincinnatichildrens.org/service/j/anderson-center/community-population-health/infant-mortality/ Trends in Domestic Primary Care Ministries – IHCF 2013
  12. 12. Infant Mortality Rates, Global, 2012U.S.: 5.98 (168th)Hamilton County, OH: 17.8 (102nd) http://www.globalhealthfacts.org/data/topic/map.aspx?ind=91 Trends in Domestic Primary Care Ministries – IHCF 2013
  13. 13. Self-Reported Obesity Among U.S. Adults http://www.cdc.gov/obesity/data/adult.html Trends in Domestic Primary Care Ministries – IHCF 2013
  14. 14. Obesity and Diabeteshttp://apps.nccd.cdc.gov/DDTSTRS/default.aspx Trends in Domestic Primary Care Ministries – IHCF 2013
  15. 15. Heart Diseasehttp://www.cdc.gov/dhdsp/data_statistics/fact_sheets/images/fs_heart_disease.jpg Trends in Domestic Primary Care Ministries – IHCF 2013
  16. 16. Smoking Rateshttp://www.cdc.gov/vitalsigns/tobaccouse/smoking/images/StateInfo_smoking1_730px.jpg Trends in Domestic Primary Care Ministries – IHCF 2013
  17. 17. Racial/Ethnic Make-Up Changeshttp://facts.kff.org/upload/jpg/enlarge/Distribution_of_US_Population_by_RE_2010_and_2050.jpg Trends in Domestic Primary Care Ministries – IHCF 2013
  18. 18. 0 25,000 5,000 10,000 20,000 15,000 Under 5 years 5 to 9 years 10 to 14 years 15 to 19 years 20 to 24 years 25 to 29 years 30 to 34 years 35 to 39 years 40 to 44 years 45 to 49 years 50 to 54 years 2010 55 to 59 years 60 to 64 years 65 to 69 years 70 to 74 years 75 to 79 years 80 to 84 years 85 to 89 years www.census.gov/compendia/statab/2012/tables/12s0009.xls 90 to 94 years Baby Boomer Tidal Wave, 2010 95 to 99 years 100 years and over 2010 1946-1964Trends in Domestic Primary Care Ministries – IHCF 2013
  19. 19. 0 25,000 5,000 10,000 15,000 Under 5 years 20,000 5 to 9 years 10 to 14 years 15 to 19 years 20 to 24 years 25 to 29 years 30 to 34 years 35 to 39 years 40 to 44 years 45 to 49 years 50 to 54 years 2015 55 to 59 years 60 to 64 years 65 to 69 years 70 to 74 years 75 to 79 years 80 to 84 years 85 to 89 years www.census.gov/compendia/statab/2012/tables/12s0009.xls 90 to 94 years Baby Boomer Tidal Wave, 2015 95 to 99 years 100 years and over 2015Trends in Domestic Primary Care Ministries – IHCF 2013
  20. 20. 0 25,000 5,000 10,000 15,000 Under 5 years 20,000 5 to 9 years 10 to 14 years 15 to 19 years 20 to 24 years 25 to 29 years 30 to 34 years 35 to 39 years 40 to 44 years 45 to 49 years 50 to 54 years 55 to 59 years 2020 60 to 64 years 65 to 69 years 70 to 74 years 75 to 79 years 80 to 84 years 85 to 89 years www.census.gov/compendia/statab/2012/tables/12s0009.xls 90 to 94 years 95 to 99 years Baby Boomer Tidal Wave, 2020 100 years and over 2020Trends in Domestic Primary Care Ministries – IHCF 2013
  21. 21. 0 25,000 5,000 10,000 15,000 Under 5 years 20,000 5 to 9 years 10 to 14 years 15 to 19 years 20 to 24 years 25 to 29 years 30 to 34 years 35 to 39 years 40 to 44 years 45 to 49 years 50 to 54 years 2025 55 to 59 years 60 to 64 years 65 to 69 years 70 to 74 years 75 to 79 years 80 to 84 years 85 to 89 years www.census.gov/compendia/statab/2012/tables/12s0009.xls 90 to 94 years Baby Boomer Tidal Wave, 2025 95 to 99 years 100 years and over 2025Trends in Domestic Primary Care Ministries – IHCF 2013
  22. 22. 0 5,000 10,000 25,000 15,000 Under 5 years 20,000 5 to 9 years 10 to 14 years 15 to 19 years 20 to 24 years 25 to 29 years 30 to 34 years 35 to 39 years 40 to 44 years 45 to 49 years 50 to 54 years 55 to 59 years 2030 60 to 64 years 65 to 69 years 70 to 74 years 75 to 79 years 80 to 84 years 85 to 89 years www.census.gov/compendia/statab/2012/tables/12s0009.xls 90 to 94 years 95 to 99 years Baby Boomer Tidal Wave, 2030 100 years and over 2030Trends in Domestic Primary Care Ministries – IHCF 2013
  23. 23. 0 10,000 25,000 5,000 20,000 30,000 15,000 Under 5 years 5 to 9 years 10 to 14 years 15 to 19 years 20 to 24 years 25 to 29 years 30 to 34 years 35 to 39 years 40 to 44 years 45 to 49 years 50 to 54 years 2035 55 to 59 years 60 to 64 years 65 to 69 years 70 to 74 years 75 to 79 years 80 to 84 years 85 to 89 years www.census.gov/compendia/statab/2012/tables/12s0009.xls 90 to 94 years Baby Boomer Tidal Wave, 2035 95 to 99 years 100 years and over 2035Trends in Domestic Primary Care Ministries – IHCF 2013
  24. 24. 0 25,000 5,000 10,000 15,000 20,000 30,000 Under 5 years 5 to 9 years 10 to 14 years 15 to 19 years 20 to 24 years 25 to 29 years 30 to 34 years 35 to 39 years 40 to 44 years 45 to 49 years 50 to 54 years 55 to 59 years 2040 60 to 64 years 65 to 69 years 70 to 74 years 75 to 79 years 80 to 84 years 85 to 89 years www.census.gov/compendia/statab/2012/tables/12s0009.xls 90 to 94 years 95 to 99 years Baby Boomer Tidal Wave, 2040 100 years and over 2040Trends in Domestic Primary Care Ministries – IHCF 2013
  25. 25. 0 25,000 5,000 10,000 15,000 20,000 30,000 Under 5 years 5 to 9 years 10 to 14 years 15 to 19 years 20 to 24 years 25 to 29 years 30 to 34 years 35 to 39 years 40 to 44 years 45 to 49 years 50 to 54 years 55 to 59 years 2045 60 to 64 years 65 to 69 years 70 to 74 years 75 to 79 years 80 to 84 years 85 to 89 years www.census.gov/compendia/statab/2012/tables/12s0009.xls 90 to 94 years 95 to 99 years Baby Boomer Tidal Wave, 2045 100 years and over 2045Trends in Domestic Primary Care Ministries – IHCF 2013
  26. 26. 0 25,000 5,000 10,000 20,000 30,000 15,000 Under 5 years 5 to 9 years 10 to 14 years 15 to 19 years 20 to 24 years 25 to 29 years 30 to 34 years 35 to 39 years 40 to 44 years 45 to 49 years 50 to 54 years 55 to 59 years 2050 60 to 64 years 65 to 69 years 70 to 74 years 75 to 79 years 80 to 84 years 85 to 89 years www.census.gov/compendia/statab/2012/tables/12s0009.xls 90 to 94 years 95 to 99 years Baby Boomer Tidal Wave, 2050 100 years and over 2050Trends in Domestic Primary Care Ministries – IHCF 2013
  27. 27. Nursing Labor Force Supply vs. Demand Chart 1: National Supply and Demand Projections for FTE Registered Nurses: 2000 to 20203,000,000 Demand2,500,0002,000,000 Supply1,500,0001,000,000 0 02 06 08 10 12 16 18 0 04 14 0 2 20 20 Source: Bureau of Health Professions, RN Supply and Demand Projections ftp://ftp.hrsa.gov/migrated/bhpr/nursing/rnsupplyanddemandreport10.doc Trends in Domestic Primary Care Ministries – IHCF 2013
  28. 28. Age Distribution of Nursing Labor Force C h a rt 4 : Ag e D is trib u tio n o f R N s : 1 9 8 0 , 2 0 0 0 a n d 2 0 2 0 P ro je c te d20% 1980 200018% 202016%14%12%10%8%6%4%2%0% <25 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 >= 65 Ag e 1980 2000 2020 S ource: B ureau of H ealth P rofessions, R N S am ple S urvey and S upply P rojections. ftp://ftp.hrsa.gov/migrated/bhpr/nursing/rnsupplyanddemandreport10.doc Trends in Domestic Primary Care Ministries – IHCF 2013
  29. 29. American DisparitiesSocial Measures: Food Deserts A low-income census tract where either a substantial number or a share of residents has low access to a supermarket or large grocery store. "Low income" tracts are defined as those where at least 20 percent of the people have income at or below the federal poverty levels for family size, or where median family income for the tract is at or below 80 percent of the surrounding areas median family income. Tracts qualify as "low access" tracts if at least 500 persons or 33 percent of their population live more than a mile from a supermarket or large grocery store (for rural census tracts, the distance is more than 10 miles). http://www.usda.gov/wps/portal/usda/usdahome?contentid=2011/05/0191.xml&contentidonly=true Trends in Domestic Primary Care Ministries – IHCF 2013
  30. 30. Food Desertshttp://www.ers.usda.gov/data-products/food-desert-locator/go-to-the-locator.aspx Trends in Domestic Primary Care Ministries – IHCF 2013
  31. 31. Food Deserts (Cincinnati)http://www.ers.usda.gov/data-products/food-desert-locator/go-to-the-locator.aspx Trends in Domestic Primary Care Ministries – IHCF 2013
  32. 32. Food Deserts (Searcy)http://www.ers.usda.gov/data-products/food-desert-locator/go-to-the-locator.aspx Trends in Domestic Primary Care Ministries – IHCF 2013
  33. 33. Food Deserts (DFW)http://www.ers.usda.gov/data-products/food-desert-locator/go-to-the-locator.aspx Trends in Domestic Primary Care Ministries – IHCF 2013
  34. 34. American DisparitiesSocial Measures: Unemployment rates http://www.bls.gov/news.release/empsit.nr0.htm Trends in Domestic Primary Care Ministries – IHCF 2013
  35. 35. The Economic Landscape K. Vath Trends in Domestic Primary Care Ministries – IHCF 2013
  36. 36. Percentage of persons of all ages without health insurance coverage at the time of interview: United States, 1997–2011 http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201206_01.pdf Trends in Domestic Primary Care Ministries – IHCF 2013
  37. 37. 2012 Federal Poverty Guidelines Average Household Size, 2010: 2.59 http://www.census.gov/newsroom/releases/archives/families_households/cb10-174.html FPL, Family of 3, 2012: $19,090 FPL, PayChk, Family of 3, 2012: $734.23 FPL, Hrly, Family of 3, 2012: $9.17/hrhttp://aspe.hhs.gov/poverty/12poverty.shtml Trends in Domestic Primary Care Ministries – IHCF 2013
  38. 38. Models of Care Trends in Domestic Primary Care Ministries – IHCF 2013
  39. 39. Models of Care Trends in Domestic Primary Care Ministries – IHCF 2013
  40. 40. Models of Care Trends in Domestic Primary Care Ministries – IHCF 2013
  41. 41. Models of Care Trends in Domestic Primary Care Ministries – IHCF 2013
  42. 42. Models of Care Trends in Domestic Primary Care Ministries – IHCF 2013
  43. 43. Health Expenditures By Agehttp://www.nihcm.org/pdf/DataBrief3%20Final.pdf Trends in Domestic Primary Care Ministries – IHCF 2013
  44. 44. Common Conditions Among Elderly High-Spenders http://www.nihcm.org/pdf/DataBrief3%20Final.pdf Trends in Domestic Primary Care Ministries – IHCF 2013
  45. 45. The Pending “Perfect Storm”Growing National Deficit Income Gap Aging Workforce Growing Unemployment Baby-Boom Tidal Wave Substance AbuseIncreasing Chronic Disease Breakdown of Family Partisan Politics Warner Brothers Trends in Domestic Primary Care Ministries – IHCF 2013
  46. 46. Healthcare DeliveryThe IHI “Triple Aim” (The Institute for Healthcare Improvement) Improving the patient experience of care (including quality and satisfaction). Improving the health of populations. Reducing the per capita cost of health care. http://www.ihi.org/offerings/Initiatives/TripleAim/Pages/default.aspx Trends in Domestic Primary Care Ministries – IHCF 2013
  47. 47. Models of CareThe PPACA Signed into law March 23, 2010 June 28, 2012 SCOTUS Upheld Upheld individual mandate Medicaid Expansion constitutional – withholding existing funds is not. WhiteHouse.gov Trends in Domestic Primary Care Ministries – IHCF 2013
  48. 48. Models of CareThe PPACA (Key Features) By 2022, extend insurance coverage to 33 million. Trends in Domestic Primary Care Ministries – IHCF 2013
  49. 49. Models of CareThe PPACA (Key Features) By 2022, extend insurance coverage to 33 million. Trends in Domestic Primary Care Ministries – IHCF 2013
  50. 50. Models of CareThe PPACA (Key Features) Extended option to stay on parents’ insurance until age 26 Prohibits Insurance companies from rescinding coverage Requires insurances to provide free preventative care Eliminates lifetime insurance limits Strengthens community health centers Initiates external insurance appeals and reviews By 2022, extend insurance coverage to 33 million. Medicaid Expansion Option to States. Insurance Premiums Capped (Incomes <400%FPL, 9.5%) Fines For No Insurance (2.5% or $695). Small business tax credit (to help with insurance) Pre-Existing Condition Non-Discrimination High Insurance Premium Tax on Employers Insurance Company Service Expenditure Minimum Establishes State Health Insurance Exchanges Increasing focus of quality/efficiency vs. volume/waste CBO predicts slight reduction in deficit in 10 yrs Healthcare delivery reform will result in greatest savings Trends in Domestic Primary Care Ministries – IHCF 2013
  51. 51. Health ReformThree Main Stages (JAMA, January 2, 2013) Insurance Reform (Politicians, laws) Payment Reform (Economists, FFS to P4P and bundled payments) Delivery Reform (Clinicians, ACOs, PCMHs) Leadership Incentives Patient role Trends in Domestic Primary Care Ministries – IHCF 2013
  52. 52. Healthcare DeliveryAccountable Care Organizations (ACOs) Trends in Domestic Primary Care Ministries – IHCF 2013
  53. 53. Healthcare DeliveryAccountable Care Organizations (ACOs) A network of doctors and hospitals that shares responsibility (risk) for providing care to patients. Would agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years. Medicare would provide P4P (pay for performance) incentives and shared savings plans. HHS estimates $940 million in savings over first 4 years (-0.1% of $556B annual budget). ACO-Look-Alikes (With private insurers, Medicaid HMOs, etc.) http://www.kff.org/medicare/upload/7305-07.pdf http://www.kaiserhealthnews.org/stories/2011/january/13/aco-accountable-care-organization-faq.aspx Trends in Domestic Primary Care Ministries – IHCF 2013
  54. 54. Healthcare DeliveryAccountable Care Organizations (ACOs) Cons Tremendous learning curve for the uninitiated physician and practice. Extremely high costs of setting up the infrastructure. Complexity of payment. Unclear regulations. Delayed payments. Government involvement extremely high. Extremely data-driven; thus, physician groups and practices will need to hire specialists in IT, database management, utilization, quality control, customer service, compliance, finance administration, and physician networking. Close work with hospitals is essential; solo or silo practices will be increasingly vulnerable, and corporatization of medicine will happen. In fact, it already has begun. Physicians will need to follow rules, often set by nonmedical personnel. Patient care will become more time-consuming with the increased need for documentation, coordination of care, communication with other specialists and patients, and review of data. Physician performance will be under the scanner of customers, vendors, peers, and the government. Physicians will have less ability to be independent and will be held accountable. https://www.phyaura.com/resources-2/accountable-care-organizations/ Trends in Domestic Primary Care Ministries – IHCF 2013
  55. 55. Healthcare DeliveryAccountable Care Organizations (ACOs) Pros Objectivity is brought to the care of patients. Goals and objectives are defined and made mandatory. Patient and peer communication will improve. Teamwork among physicians and administrators will improve. The patient experience will improve, along with patient care, due to continuity of care. The horizontal and vertical integration of medicine is happening, driven by data, finances, and organizational interrelationships. Compliance is critical and is better for patients and physicians. Reduction of costs is possible if healthcare can be integrated. Goals and business strategies are shared among hospitals, physician practices, and management service organizations. A paradigm shift will occur in healthcare if appropriately drafted and implemented, and this shift this will reduce mortality and morbidity. https://www.phyaura.com/resources-2/accountable-care-organizations/ Trends in Domestic Primary Care Ministries – IHCF 2013
  56. 56. Healthcare Delivery Health Insurance Exchanges$3.50 Trends in Domestic Primary Care Ministries – IHCF 2013
  57. 57. Healthcare Delivery Health Insurance Exchanges$3.50 $2.89 Trends in Domestic Primary Care Ministries – IHCF 2013
  58. 58. Healthcare Delivery Health Insurance Exchanges$3.50 $2.89 Trends in Domestic Primary Care Ministries – IHCF 2013
  59. 59. Healthcare DeliveryHealth Insurance Exchanges http://statehealthfacts.kff.org/comparemapdetail.jsp?ind=962&cat=17&sub=205&yr=1&typ=5 Updated: 1/4/13 Trends in Domestic Primary Care Ministries – IHCF 2013
  60. 60. Healthcare DeliveryHealth Insurance Exchanges http://statehealthfacts.kff.org/comparemapdetail.jsp?ind=962&cat=17&sub=205&yr=1&typ=5 Updated: 1/4/13 Trends in Domestic Primary Care Ministries – IHCF 2013
  61. 61. Healthcare DeliveryHealth Insurance Exchanges Pros New requirements to decrease administrative costs will lower premiums. New ACA requirements will mandate reviews of any premium hikes 10% or higher. Competitive market place should lower premiums. Cons Insurance premiums are already higher. Insurance companies will be forced to cover more services. Insurance companies will be forced to cover more high risk individuals. Trends in Domestic Primary Care Ministries – IHCF 2013
  62. 62. Models of Care Trends in Domestic Primary Care Ministries – IHCF 2013
  63. 63. Models of Care$120 $40 $15,000/mo $1300 $1000 Trends in Domestic Primary Care Ministries – IHCF 2013
  64. 64. Models of Care $120 $15,000/mo$40 $1300 $1000 Trends in Domestic Primary Care Ministries – IHCF 2013
  65. 65. Models of Care Patient-Centered Medical Homes (PCMHs)• Traditional •PCMH • Provider-centered •Patient-centered • Provider-based treatment plans •Evidence-based treatment plans • Focus on individual treatment •Population/condition management • Physician does it all •Care team • Reactive - patient presents •Proactive - Care plans and outreach • Answer patient questions •Patient education and resources • Patient as passive recipient of care •Patient engaged in self-mgmt goals • Scheduled out for weeks •Same-day access available • Decisions based on comfort and tradition •Decisions based on data and trends • Random communication within practice •Purposeful communication Trends in Domestic Primary Care Ministries – IHCF 2013
  66. 66. Models of CarePatient-Centered Medical Homes(PCMHs) • 1967 - Pediatric Health Homes (AAP) • 1978 - Tenets of MHs (WHO) • 1990 - MH in Literature (IOM) • 2002 - 37 Criteria of MHs (AAP) • 2004 - Chronic Care Model (E. Wagner) • 2010 - PPACA Signed into Law • 2012 - ACA Funding for PCMH/FQHCs Trends in Domestic Primary Care Ministries – IHCF 2013
  67. 67. Models of CarePatient-Centered Medical Homes(PCMHs) • 1967 - Pediatric Health Homes (AAP) • 1978 - Tenets of MHs (WHO) • 1990 - MH in Literature (IOM) • 2002 - 37 Criteria of MHs (AAP) • 2004 - Chronic Care Model (E. Wagner) • 2010 - PPACA Signed into Law • 2012 - ACA Funding for PCMH/FQHCs Trends in Domestic Primary Care Ministries – IHCF 2013
  68. 68. Models of Care Patient-Centered Medical Homes(PCMHs)• NCQA’s Six Standard Categories (27 elements, 149 factors) • Enhance Access and Continuity • Identify and Manage Patient Populations • Plan and Manage Care • Provide Self-Care Support and Community Resources • Track and Coordinate Care • Measure and Improve Performance Trends in Domestic Primary Care Ministries – IHCF 2013
  69. 69. Models of CareWhat Does This Mean For Free Clinics? Will need to consider moving from a short-term missions model to a PCMH model. Continuous community needs assessment Will need to have greater focus on Hispanic population. Will need to consider few paid staff vs. numerous volunteer staff. Will need to reconsider funding sources. Collaboration rather than re-creation. Trends in Domestic Primary Care Ministries – IHCF 2013
  70. 70. Case Studies“Hot-Spotting” Dr. Jeff Brenner, Camden, NJ Focus is on high-utilizers Ambulatory ICU Trends in Domestic Primary Care Ministries – IHCF 2013
  71. 71. Case StudiesSafetyN.E.T. (Non-Emergency Transportation) Trends in Domestic Primary Care Ministries – IHCF 2013
  72. 72. Case StudiesED Alerts Trends in Domestic Primary Care Ministries – IHCF 2013
  73. 73. Case StudiesED Alerts 27% reduction $1198/diversion saved $230,016 annual savings Trends in Domestic Primary Care Ministries – IHCF 2013
  74. 74. Case StudiesSafetyN.E.T. (Non-Emergency Transportation)Program Began discussion with local FD Some estimates show misuse of 911 – 60% Average EMS Run: $1000 Average ED Visit: $1318 (http://meps.ahrq.gov/mepsweb/data_stats/tables_compendia_hh_interactive.jsp?_SERVICE=MEPSSocket0&_PROGRAM=MEPSPGM.TC.SAS&File=HCFY2009&Table=HCFY2009%5FPLEXP%5FE&VAR1=AGE&VAR2=SEX&VAR3=RACETH5C&VAR4=INS URCOV&VAR5=POVCAT09&VAR6=MSA&VAR7=REGION&VAR8=HEALTH&) Average N.E.T. Transportation: $44 Average PCP Visit: $120 $2154 in savings (avoiding 911/EMS and going to PCP/NET) Trends in Domestic Primary Care Ministries – IHCF 2013
  75. 75. Case StudiesInnovative Collaborative Relationships Trends in Domestic Primary Care Ministries – IHCF 2013
  76. 76. Current Model COA Trends in Domestic Primary Care Ministries – IHCF 2013
  77. 77. 10,000+ patients 160 patients over 60yrs 32 sharedCOA patients Trends in Domestic Primary Care Ministries – IHCF 2013
  78. 78. Current Model COA Trends in Domestic Primary Care Ministries – IHCF 2013
  79. 79. The Cincinnati Pilot ModelCOA Trends in Domestic Primary Care Ministries – IHCF 2013
  80. 80. The Cincinnati Pilot ModelCOA Trends in Domestic Primary Care Ministries – IHCF 2013
  81. 81. Case StudiesPay For Performance Plans (P4P) Working with Medicaid HMO to develop P4P Payment for Care Coordination Blackstone Valley Community Health Center (http://www.blackstonechc.org), $5M in savings on 5,000 patients! Trends in Domestic Primary Care Ministries – IHCF 2013
  82. 82. Case StudiesInnovative Collaborative Relationships Senior Services (COA) Medicaid HMOs FNP Students Home Health Organizations Pediatric SW Diabetic Hot-Spotter Diabetic Educator (CDE) Parish Nursing Organization Behavioral Health Organization Pre-Med Volunteers Trends in Domestic Primary Care Ministries – IHCF 2013
  83. 83. Key “Take-Homes”Don’t work in “silos”Continuity vs. episodic careEngage the healthcare reform discussionInnovate!Move from “OR” questions to “AND” questionsUse Resources Christian Community Health Fellowship Trends in Domestic Primary Care Ministries – IHCF 2013
  84. 84. http://www.polleverywhere.com/free_text_polls/LTE3NDAxMjc3NzI Trends in Domestic Primary Care Ministries – IHCF 2013

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