Major Health Care Problems 50 Million Uninsured Wrong Focus - PDF document

8/14/2012 NATIONAL ORGANIZATION OF STATE OFFICES OF RURAL HEALTH: REGION E GRANTEE MEETING AUGUST 15, 2012 BOISE, IDAHO Ted Epperly, MD, FAAFP Program Director and Chief Executive Officer, Family Medicine Residency of Idaho, Boise, Idaho Clinical Professor of Family and Community Medicine University of Washington School of Medicine Region Past President and Past Chairman of the Board American Academy of Family Physicians Co-Chair, Center on Accountable Care Patient Centered Primary Care Collaborative Major Health Care Problems • 50 Million Uninsured • Wrong Focus • Disease Instead of Health • Wrong Delivery Model • Poor Access • Staggering Costs • Quality Problems • Health Care Insurance Problems 1

8/14/2012 $2,600,000,000,000 National Health Spending in Billions $4,638 $4,080 $3,632 $3,227 $2,824 $2,708 $2,584 $2,486 $2,021 $1,378 $724 $256 $75 $27 1960 1970 1980 1990 2000 2005 2009 2010P 2011P 2012P 2014P 2016P 2018P 2020P Note: Selected rather than continuous years of data are shown prior to 2000. Years 2004 forward are CMS projections. Source: Centers for Medicare and Medicaid Services (CMS) of the Actuary. Health Spending Everything Else 1935 3.8% GDP 2009 16% GDP 2025 25% GDP 2082 50% GDP 2

8/14/2012 In An Average Month: White KL, Williams TF, Greenberg BG. The ecology of medical care. N Engl J Med 1961;265:885-892. Green LA, Fryer GE, Yawn BP, Lanier D, Dovey SM. The ecology of medical care revisited. N Engl J Med 2001;344:2021-2025. Patient Centered Medical Home • Place • Process Rationale for the Benefits of Primary Care for Health • Greater Access to Needed Services • Better Quality of Care • A Greater Focus on Prevention • Early Management of Health Problems • Cumulative Effect of Primary Care to more Appropriate Care • Reducing Unnecessary and Potentially Harmful Specialist Care Source: Starfield B., Leiyu S., Mackinko J., Contribution of Primary Care to Health Systems and Health, (Milbank Quarterly, Vol. 83., No. 3, 2005) 457-501) 3

8/14/2012 Mission • Train • Outstanding family medicine physicians in a federally designated Teaching Health Center. • Prepare • Broadly trained family medicine physicians and encourage them to work in Idaho’s underserved and rural areas. • Serve • The low income, uninsured, disabled, and other vulnerable populations in a Patient Centered Medical Home. Rural Training Sites 266 Graduates • 144 (54%) of graduates remain in Idaho; of those who remain, • 57 (40%) practice in rural or underserved Idaho. 4

8/14/2012 Fellowships • Sports Medicine • HIV Primary Care • Geriatrics (2013) • Rural • Obstetrics • Palliative Care Distributive Family Medical Education Model Coeur d’Alene Boise/ Pocatello/ Caldwell Magic Valley Moscow Rexburg Coeur d’Alene Cottonwood McCall Moscow/ Cottonwood Wood River McCall Wood River Rexburg Caldwell Boise Pocatello Magic Valley Patient Centered Medical Home Clinics within Ada County 5

8/14/2012 Patient Centered Medical Home • Place • Process • Primary Care • Family Physicians • Internal Medicine • General Pediatricians • Nurse Practitioners • Physician Assistants • Psychologists • Social Workers • Nutritionists • Nurses / MA’s • Pharmacists • Dental Health Integration • EMR • PCMH • ACO PCMH and ACO’s PCMH ACO’s 6

8/14/2012 Symphony of Care NEW BOOK “Never, never, never, give up.” - Winston Churchill 7

8/14/2012 Farming, Nutrition, and Medicine Eat Food Not too Much Mostly Fruits and Vegetables Get Health Care Not too Much Mostly Primary Care Questions 8