Designing a 21st Century Approach to Primary Care

John R. Griffith, Kyle L. Grazier, Scott B. RansomUniversity of Michigan

Center for Health Management Research Industry Advisory Board

October 7, 2005

Thank you for your generous funding.

John, Kyle, Scott

“It is the grind that makes the happiness. To feel that your hours are filled to overflowing, that you can barely steal minutes enough for sleep, that the welfare of many is entrusted to you, that the world looks on and approves, that some good is always done to others,…that is happiness. For myself, I can conceive none other.”

WHY MIGHT DOCTORS BE UNHAPPY?

Primary Care-Selective and Integrative

Responsive to patient needs as patients perceive them

Provide benchmark care

Delight practitioners

Care that maximizes value

Financial incentives- designed by patients, providers, buyers

“Very scary, Jennifer—does anyone else have an H.M.O. horror story?”

The New Yorker July 19, 1999

For Caregivers

Personnel managementWork/life concernsStaffingLocum tenensStaff development

Transparent business operationsIncentive pay- quality, effectiveness,

satisfactionCapital- maintenance, expansionAccountability

21st Century Primary Care Model

NursePractitioner

SchoolNurse

Mall Nurse

PhysicianAssistant

Church Nurse

Phone/e-mailconnectivity

NurseMidwife

GroceryStoreNurse

In Home HealthConsults

Nur

se P

hone

Ser

vice

Invi

sib

le S

pec

ialis

tA

cces

s

InteractiveEducation

Patien

t

Po

pu

lation

Alerts

Mall-based

Healthcare

Primary Care Physician

On-line

reminders

Web access

For Patients

Coordinated choicesIntegrated information and treatment

supportGeographic access to careAlternative practitioners- “risk”

adjustedCost control-variable copaysScreening and prevention

Business Model

• Retailer of medical care• Organized vendors• PCP service lines• Financial gain

– Business efficiencies– Revised clinical care

• Improved prevention• Reduced unnecessary care• Managed chronic illness• Improved patient comfort & compliance with

reliability & quality

Hastings and St. Leonards Primary Care Trust

Organizational Forms

Entrepreneurial and patient focused IDS

Groups of PCPs with business/technological acumen and success

Insurance companiesHealth departments

Clinical Clinical Practice:Practice:

safe, safe, effective, effective, patient-patient-

centered, centered, timely, timely,

efficient, and efficient, and equitable careequitable care

Service Service Excellence:Excellence: Promotion of Promotion of

convenienceconvenience, , comprehensivenecomprehensivene

ss, service, ss, service, reliabilityreliability

Health Care Health Care Finance: Finance: Patient cost Patient cost

sharing, provider sharing, provider performance, performance,

incentives, and incentives, and protection against protection against

major lossmajor loss

Support Support Network:Network:

RecruitmentRecruitment, training, , training,

information, information, accounting, accounting, supplies, & supplies, &

facilitiesfacilities

Attributes of a 21st Century Primary Care Management Organization

So… Why Do It?

Central to the organization’s missionAddresses the most pressing issues of

the 21st CenturyA competitor is (always) in the wings

How To Do it?

LeadershipUnderstanding market needsUnderstanding provider needsUnderstanding consumer needsImplementationFinancial modelingPilot and Roll- Out

Research and Evaluation

Ask the questionsMeasure the processMonitor the outcomesQualitative and quantitative

methodsDesignData collectionAnalysis

“Study Finds …Bubkes”June 4, 2003 | Issue 39•21 BALTIMORE—A team of scientists at Johns Hopkins

University announced Monday that a five-year study has found absolutely nothing.

"I can't explain what happened," head researcher Dr. Jeremy Dhen said. "We meticulously followed correct scientific procedure. Our methods were sufficiently rigorous that they should have produced some sort of result. Instead, we found out nothing."

Dr. Dhen took the podium to make the team's closing statements.

"I just want to clarify that we had the best intentions going into this study,"

Dhen said. “We thought we would make a scientific discovery

that would benefit the health of millions. I guess we were wrong.

We tried to find a link, but instead we found bubkes.“.

Research and Evaluation

• Don’t miss the action• Feedback to stakeholders, designers• Does it work?

End of presentation

Linda Frances Happiness