Housecalls, baby!

29 12 2011

Direct Primary Care is the future of medicine.  With insurance premiums spiraling out of control, more and more people are looking for the least expensive alternative to traditional insurance.  It’s the classic problem of insurance.  How much insurance do you need if you are in reasonably good health?  Actuaries will tell you, for example, that a traditional health insurance plan with high premiums, low co-pays for doctor visits and prescriptions doesn’t really make financial sense for say, a 25 year old male in good health (it makes more sense for a woman of the same age, who should be getting annual exams and has the possibility of getting pregnant).  He’s unlikely to see a doctor unless he’s seriously ill, doesn’t want to spend a lot of time in a heavy consult with his doctor and certainly doesn’t want to hassle with the average wait time to see his doctor. His doctor, similarly, is not likely to be stumped by the average ailment for this person and if she suspects its a common illness going around (like the flu), she’s likely to prescribe bed rest and plenty of fluids, and probably only do a diagnostic test out of obligation instead of necessity.  Hardly a case of House, M.D.  Compare this with the same guy with a bad case of the sniffles stopping off at the Minuteclinic (or, the Wal-Mart), waiting 15 minutes to see a nurse practitioner with automated tools at his disposal.  In about 15 minutes, the nurse has checked our guy’s blood pressure (it’s fine, he’ll want to check it more often after his 30th birthday), determined our 25 year old has a sinus infection and prescribed an antibiotic our patient can pick up in 15 minutes by walking across the store (and maybe picking up a bottle of Gatorade and a Snickers as an anodyne to his misery).  The whole affair is addressed in less than an hour.

Oh, and he paid $35 for the visit by swiping his card at the nurse’s terminal.  And $25 for the prescription.  And the whole visit including diagnosis and prescription can be captured electronically and saved in our patients’ personal health record like MS HealthVault or similar, so should this be part of a chronic problem, it can be shared with all the medical providers he may visit in the future.

The time involved with a traditional doctor’s office visit almost certainly took longer, then the patient has to travel to another location to pick up the prescription that maybe the doctor sent ahead, or maybe it’s on a little piece of paper that the pharmacist has to put in the queue. Then, there’s the small army of staff in a doctor’s office.  Their main purpose: to wrangle the myriad of paperwork for a whole variety of health insurance plans, engaging in the back and forth with the payer to get reimbursed and pass bills on to those patients who either don’t have insurance or have enough insurance. It’s all about the administrative overhead.  Is this for everyone?  Definitely not, but not only will this approach make sense for those in reasonable health (paired with some form of catastrophic insurance), but also those with chronic diseases that require close management.

Or, maybe the doc comes to you.  Why isn’t this happening, then?  It will and it’s probably closer than you think.  As more and more people are becoming active consumers of healthcare services, we will see more uninsured (and insured) people trying out MinuteClinics, (maybe) Wal-Mart, MedLion or a handful of similar concepts.  I’m waiting for a single entrepreneurial medical professional to figure out how to safely care for people from a roving van, armed with a few key medical instruments, a cell phone and a laptop.

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An Oldie But a Goodie: Escape Fire

27 01 2008

Here’s a link to a personal review I wrote for Don Berwick’s Escape Fire: Designs for the Future of Health Care. If you haven’t read it, I highly recommend it for setting the context and the mission.





How Do You Get People Who Can Afford it to Buy Health Insurance?

21 01 2008

Do you scare the dickens out of them? I’d like to meet the creative team behind this commercial brought to the people of Ontario, Canada by their Workplace Safety and Insurance Board. (this video is definitely not for sensitive viewers, although you might just see it on TV if you’re channel surfing in Ontario)





The Nation’s Health Dollar

7 01 2008

dollars1.jpg

“Physician and Clinical Services” includes offices of physicians, outpatient care centers, and medical and diagnostic laboratories. “Other Spending” includes dentist services, other professional services, home health, durable medical products, over-the-counter medicines and sundries, public health, other personal health care, research, and structures and equipment. Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group.





Dispatches from the Field – January 2, 2008

2 01 2008

Hospitals Slow in Heart Cases, Research Finds

In nearly a third of cases of sudden cardiac arrest in the hospital, the staff takes too long to respond, increasing the risk of brain damage and death, a new study finds.

Researchers estimate that the delays contribute to thousands of deaths a year in the United States.

http://www.nytimes.com/2008/01/03/health/research/03heart.html?ex=1357016400&en=3d9a627e28ec54c9&ei=5088&partner=rssnyt&emc=rss

Fewer Small Firms Offer Health Insurance

Fewer small employers offered health insurance this year, despite the widespread availability of new, lower-cost high-deductible insurance plans, a survey released today by benefit firm Mercer shows.

Advocates of the high-deductible plans touted them as one solution to the growing number of uninsured, expecting the plans to appeal to small employers, who would continue to offer health insurance as a result.

“That’s not happening,” says Blaine Bos, a Mercer partner and one of the study authors. “In fact, the reverse is happening.”

http://www.usatoday.com/money/industries/insurance/2007-11-19-health-insure_N.htm

 

Students Face Health Issues Without Insurance After College

Patrick Rastelli ’08 had hoped to take a year off after graduating from Brown this spring. But after some thought, Rastelli decided to travel last summer instead, and when he graduates, he wants to get a job as quickly as possible. He’s not seeking prestige or money, but rather something most college students take for granted: health insurance.

http://media.www.browndailyherald.com/media/storage/paper472/news/2007/10/29/CampusNews/Graduating.To.The.Ranks.Of.The.Uninsured-3061887.shtml

Report Links Higher Rates of Uninsured and Suicide

The higher the percentage of residents in a state who say they can’t afford health care, the greater the prevalence of serious depression and the higher the suicide rate in that state, suggests a report released to USA TODAY.

http://www.usatoday.com/news/health/2007-11-28-healthcare-suicide_N.htm





Dispatches from the Field – November 21, 2007

21 11 2007

Interest in Wellness Programs Grows: Survey

More employers are providing financial incentives designed to drive employee participation in wellness efforts, a survey shows.

http://www.businessinsurance.com/cgi-bin/news.pl?newsId=11554

Employers Shift Focus to Prevent Obesity

The seven most common chronic diseases — six of which can be caused or worsened by obesity — are costing employers $1.1 trillion in lost productivity, a recent study says.

http://seattletimes.nwsource.com/html/health/2003997221_webobesity06.html

Program Quantifies Costs of Chronic Conditions

It’s no secret that chronic medical problems, such as high blood pressure and low back pain, can mean time off the job. What’s hard to quantify, is how much that absenteeism can cost a company. Until now.

http://www.bizjournals.com/pittsburgh/stories/2007/11/05/story2.html?b=1194238800^1544416

Consultant: Prepare for PHRs

Patients will demand personal health records, so health care organizations should be preparing technology and privacy models now, a consultant specializing in emerging technologies says.

http://www.healthdatamanagement.com/news/personal_health_records_PHRs_privacy_security25179-1.html

Drugstore Clinics Spread, and Scrutiny Grows

“We’ve got big problems in health care, and this is not the answer,” said Dr. Rick Kellerman, president of the American Academy of Family Physicians. “They are a response, they are a niche market and an economic opportunity, but we still have an underlying primary care crisis in this country.”

Patients, however, have flocked to the clinics, according to a new industry group, the Convenient Care Association.

http://www.nytimes.com/2007/08/23/nyregion/23clinic.html?pagewanted=1&ei=5070&en=0b7cd9bcc251d519&ex=1188792000





Dispatches from the Field – August 13, 2007

13 08 2007

Meet the Consumer-Directed HMO

It took a while for a managed care company to combine a consumer-directed plan with a traditional HMO. Health Net of California, taking advantage of the strengths of California’s managed care market, is launching a hybrid product called OptimizerHMO that “provides tools to help [members] make better health care decisions and incentives for demonstrating healthy behaviors,” says Stephen Lynch, president of Health Net.

http://www.managedcaremag.com/archives/0707/0707.news_meetconsumer.html

Health IT Businesses See Rise in Private Equity Investments
Health IT businesses are attracting investors and buyers from private equity firms, a sign that the industry is rife with growth and opportunity, Modern Healthcare reports.

http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20070803/FREE/308030001&SearchID=73289151525029

U.S. Trails 41 Other Countries in Life Expectancy Rates

Life expectancy in the U.S. has reached its highest point ever, but it is exceeded by the rates in 41 other countries, the AP/Arizona Daily Star reports.

http://www.californiahealthline.org/articles/2007/8/13/US-Trails-41-Other-Countries-in-Life-Expectancy-Rates.aspx