DIRECT PRIMARY CARE: POLICY AND PLANNING PRIMER James J. Eischen, - PDF document

DIRECT PRIMARY CARE: POLICY AND PLANNING PRIMER James J. Eischen, Jr.

Why Fee for Covered S ervice Is Not Working • Reimburses for specific interventions/ services performed • Not: time spent, quality of care, patient outcomes • Financially incentivizes over-utilization via high reimbursement intervention • Financially disincentives preventable care and early patient education not reimbursed Public and Private Plans S eek Reimbursement Alternatives The U.S . ranks near last among industrialized nations in several quality measures – While remaining the most expensive system in the world: double the GDP of most nations Mirror, Mirror on t he Wall, 2014 Updat e: How t he U.S . Healt h Care S yst em Compares Int ernat ionally, T HE C OMMONWEALTH F UND http://www.commonwealthfund.org/publicatio ns/fund-reports/2014/jun/mirror-mirror

Public and Private Plans S eek Reimbursement Alternatives: Hospital/ Provider Perspective The push towards value-based reimbursement http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact ‐ sheets/2015 ‐ Fact ‐ sheets ‐ items/2015 ‐ 01 ‐ 26 ‐ 3.html Public and Private Plans S eek Reimbursement Alternatives: Innovator Perspective Technology outpacing the health care marketplace But fee-for-service provides little or uncertain reimbursement for wellness solutions

Public and Private Plans S eek Reimbursement Alternatives: Patient Improvement? How mHealth Should Help Patients Control Their Health – Janis Powers, HFM A . ORG http://www.hfma.org/Content.aspx?id=28498 • mHealth = Mobile Health • Shifting towards patient centered mHealth Public and Private Plans S eek Reimbursement Alternatives: The Wellness Marketplace

Public and Private Plans S eek Reimbursement Alternatives: The Wellness Marketplace There is room for exponential growth and innovation in the U.S. wellness/health marketplace! Public and Private Plans S eek Reimbursement Alternatives: The Wellness Marketplace 5 Healthcare Trends You Could Cash in on – Murray Newlands, I NC . COM HTTP :// WWW . INC . COM / MURRAY - NEWLANDS / MEDICAL - HEALTH - TRENDS - AND - STARTUPS - GROWING . HTML • Within the next 5 years, the health wellness industry is expected to grow to a $737 billion market ( hint: people might pay for health … ) • “ Big dat a has already earned it s place as one of t he t op ‘ t rends t o wat ch’ . Among t he many indust ries likely t o be heavily reliant on analyt ics is healt hcare .”

Public and Private Plans S eek Reimbursement Alternatives: Marketplace Experiments Early-stage Telehealth Business ExamMed Wants ‘MedCoins’ to Push Boundaries of Concierge Care – S tephanie Baum, M EDCITY N EWS http://medcitynews.com/2015/01/early-stage-telehealth-business-exammed-wants-med-coins- push-boundaries-concierge-care/ ExamMed attempts to induce patient and physician behaviors with alternative currency transparency ( int riguing )… But is it “ moving the needle” on: • direct physician/ patient connection • direct patient investment Public and Private Plans S eek Reimbursement Alternatives: Marketplace Experiments Engaging Patients to Decrease Costs and Improve Outcomes – Alexandra Kimball, Kristen Corey, and Joseph Kvedar, M EDICAL E CONOMICS HTTP :// MEDICALECONOMICS . MODERNMEDICINE . COM / MEDICAL - ECONOMICS / NEWS / ENGAGING - PATIENTS - DECREASE - COSTS - AND - IMPROVE - OUTCOMES • 79% of surveyed patient respondents said they were more likely to select a health provider who allows them to conduct health care interactions online, on a mobile device, or at a self-service kiosk • "One study found that many would even pay for such online services."

Public and Private Plans S eek Reimbursement Alternatives: Marketplace Experiments Aetna Claims Yoga Classes Are Worth $3K Per Employee Each Year – Heather Caspi, M EDICAL HEALTHCARE D IVE HTTP :// WWW . HEALTHCAREDIVE . COM / NEWS / AETNA - CLAIMS - YOGA - CLASSES - ARE - WORTH -3 K - PER - EMPLOYEE - EACH - YEAR /370673/ – CITING : The Journal of Occupational Health Psychology. http://psycnet.apa.org/psycinfo/2012-04383-001/ • “ Employees report, on average: a 28% reduction in stress; a 20% improvement in sleep quality; and a 19% reduction in pain.” • Reported $3K/ year savings due to both health costs and work efficiency Public and Private Plans S eek Reimbursement Alternatives: Marketplace Experiments Telemedicine and Employers: The New Frontier – Epstein Becker Green HTTP :// WWW . LEXOLOGY . COM / LIBRARY / DETAIL . ASPX ? G = EE 9 FC 27 D - D 56 C -4 FC 8-9 B 17- 42 B 381 DB 495 A & UTM _ SOURCE =L EXOLOGY +D AILY +N EWSFEED & UTM _ MEDIUM =HTML+ EMAIL +-+B ODY +- +F EDERAL + SECTION & UTM _ CAMPAIGN =C ALBAR +R EAL +P ROPERTY + SECTION + SUBSCRIBER + DAILY + FEED & UTM _ CONTENT =L EXOLOGY +D AILY +N EWSFEED + 2015-03-04& UTM _ TERM • 74% of consumers would use telehealt h services if available • 76% of patients prioritize access to care over the need for human interactions • 70% of patients are comfortable communicating with their health care providers via text, e-mail, or video

Public and Private Plans S eek Reimbursement Alternatives: Marketplace Experiments Telemedicine and Employers: The New Frontier – Epstein Becker Green HTTP :// WWW . LEXOLOGY . COM / LIBRARY / DETAIL . ASPX ? G = EE 9 FC 27 D - D 56 C -4 FC 8-9 B 17- 42 B 381 DB 495 A & UTM _ SOURCE =L EXOLOGY +D AILY +N EWSFEED & UTM _ MEDIUM =HTML+ EMAIL +-+B ODY +- +F EDERAL + SECTION & UTM _ CAMPAIGN =C ALBAR +R EAL +P ROPERTY + SECTION + SUBSCRIBER + DAILY + FEED & UTM _ CONTENT =L EXOLOGY +D AILY +N EWSFEED + 2015-03-04& UTM _ TERM = Use of telemedicine is increasingly viewed as efficient and cost-effective because: • S hift from fee-for-service • Increase in sophisticated health technologies Viable option to avoid employee time-off-work for visits Public and Private Plans S eek Reimbursement Alternatives: Marketplace Experiments 3 Off-the-Wall Things Insurers are Doing to Increase Engagement – Heather Caspi, H EALTHCARE D IVE HTTP :// WWW . HEALTHCAREDIVE . COM / NEWS /3- OFF - THE - WALL - THINGS - INSURERS - ARE - DOING - TO - INCREASE - ENGAGEMENT /364555/ Food Deals: – One health plan is using the app NutriS avings. The app scores their groceries upon checkout. If their total score is high enough  $20 per – month for participating

Public and Private Plans S eek Reimbursement Alternatives: Marketplace Experiments 3 Off-the-Wall Things Insurers are Doing to Increase Engagement – Heather Caspi, H EALTHCARE D IVE HTTP :// WWW . HEALTHCAREDIVE . COM / NEWS /3- OFF - THE - WALL - THINGS - INSURERS - ARE - DOING - TO - INCREASE - ENGAGEMENT /364555/ Workouts: – Pact Health, a health plan which started as a health app, increases and decreases deductibles $5 per workout – “ A loss is three times more motivating than a gain.” Public and Private Plans S eek Reimbursement Alternatives: Marketplace Experiments 3 Off-the-Wall Things Insurers are Doing to Increase Engagement – Heather Caspi, H EALTHCARE D IVE HTTP :// WWW . HEALTHCAREDIVE . COM / NEWS /3- OFF - THE - WALL - THINGS - INSURERS - ARE - DOING - TO - INCREASE - ENGAGEMENT /364555/ Integrated Technology: – Another plan offers a $1 per day incentive for reaching steps per day goals – The goal is that fitness tracking app users will be encouraged to utilize other app features like provider cost comparisons

Public and Private Plans S eek Reimbursement Alternatives: Marketplace Experiments How Mayo’s “Dr. Google” Deal Disrupts Medicine – Michael Milenson, F ORBES HTTP :// WWW . FORBES . COM / SITES / MICHAELMILLENSON /2015/02/25/ HOW - MAYOS - DR - GOOGLE - DEAL - DISRUPTS - MEDICINE /? SS = PHARMA - HEALTHCARE & UTM _ SOURCE =S AILTHRU & UTM _ MEDIUM = EMAIL & UTM _ TERM =H EALTHCARE %20D IVE & UTM _ CAMPAIGN =I SSUE :%202015-02-25%20H EALTHCARE %20D IVE • “ Recommending a Google search ‘ as the first stop for those needing health information,’ in the words of a Mayo physician executive, represents a true paradigm change.” • Information technology is forcing a new doctor-patient relationship with new rules for new roles. The S ilo Effect of Passive Patient Engagement Patient engagement is great, but without physician integration, primary care and wellness marketplace remain disconnected silos

Are we creating a sustainable health care economy? Are the physicians the “missing trees” of Easter Island? Patients/ Consumers http://www.unsv.com/voanews/specialenglish/scripts/2011/10/23/0040/

Employees’ share of medical expenses (premiums plus deductibles) was almost 10% of the median U.S. income in 2013. I’ m busy… .is anyone paying me to do this?