Medical Home Mike Albert Presented by: Doug Linz, MD Medical Director TriHealth Corporate Health September 11, 2012
Medical Home • Your “Medical Home” is your healthcare and wellness support system • Just as having a strong support system of family and friends is vital to your overall well- being, • Having a well-coordinated network of support for your health and wellness is vital to your health and wellness
Objective For Both Employers & Employees Maintain a healthy and productive workplace by: • Keeping well people well • Keeping healthy people healthy • Optimizing productivity for healthy workers • Minimizing lost work productivity associated with chronic medical conditions
Wellness and Health Management Strategies 1. Identify and reduce “modifiable” RISK FACTORS – Not family history – Not genetically determined outcomes – Risk factors that can be modified through changes in behaviors, like diet and exercise 2. Identify and manage CHRONIC MEDICAL CONDITIONS and associated work disability
RISK FACTOR - Wellness Management
HERO Study: Medical Costs Associated with Health Risks • Hero = Health Enhancement Research Organization • Top 10 modifiable risk factors add 27% to total medical costs • This corresponds to $768 per employee Remember, if it costs the employer, it costs the employee!
HERO Study: Excess Medical Cost Associated with Health Risks • Risk factors in the order of impact : Depression 70 % Stress 46 % Glucose 35 % Obesity 21 % Former Tobacco smoker 20 % Current Tobacco smoker 15 % Blood Pressure 12 % Exercise 10 %
The Change Process For Reducing Risks • Identify modifiable health risks (blood pressure, stress, depression, smoking, obesity, blood pressure, cholesterol, blood sugar, sedentary lifestyle + seat belts, helmets, cell phone use, etc. through Health Risk Appraisal (HRA) • If you reduce these risk factors, you will reduce your chances of future illness • Primary Intervention: Health & wellness promotion and fitness training
Health Risk Reduction Processes • Examples of programs that reduce risk factors – Smoking cessation – Stress management – Exercise programs – Weight management programs
Chronic Medical Illness Management
Institute for Health & Productivity Management - Goetzel 2004 Top 10 Medical Conditions Allergy Diabetes Arthritis Heart Disease Asthma Hypertension Any Cancer Migraine/Headache Depression/Mental Respiratory Infections Illness These 10 conditions account for about 80% of employer health and productivity costs
Categories of Employer Cost • Medical Costs – Total = 30% – Outpatient care – Inpatient care – Emergency care – Pharmacy costs • Work Productivity Costs – Total = 70% – Absenteeism – Presenteeism
The Process Chronic Medical Conditions • Identify workers with chronic medical conditions: allergies, asthma, other lung disease, hypertension, high cholesterol, diabetes mellitus, headaches, heart disease, depression & anxiety, cancer, & arthritis (back and joint problems) • Optimize medical care • Primary Intervention: Education and coaching to optimize timing and effectiveness of health care
The Process Chronic Medical Conditions • Avoid unnecessary & inappropriate medical interventions & costs • Promote and assure necessary medical interventions
Medical Condition Management • Training in self-care for individuals and families including diet and exercise • Assuring appropriate and timely medical care and follow up • Optimize understanding and engagement of employees in managing their chronic medical problems
Exercise is Medicine • Increasing evidence to support the preventive and therapeutic value of regular exercise
The Deliverables - Expectations • Improved brain function • Improved psychological hardiness; less emotional reactivity; faster to problem solving mode • Improved immune function; fewer colds • Injury prevention - both sprain/strain & fall risk • Weight management - reduced obese body mass and better control of medical conditions associated with obesity - e.g. less medication for diabetes, hypertension, cholesterol
The Deliverables - Expectations • Decreased risk of chronic illnesses: diabetes, hypertension, heart disease, vascular disease, stroke, independent of obesity • Decreased cancer risk • Less pain and improved function related to arthritis and other back, neck and joint problems • Decreased risk of depression and anxiety and reduced medication requirements for treatment in those who have these conditions
The Deliverables - Expectations • Lowers death risk by 20 to 25% after heart attack • Osteoporosis – prevention & treatment • It’s not just about decreasing the frequency and impact of preventable illnesses and injuries … • It’s not just about maintaining current productivity and performance … • It’s about What’s Above the Line Improved performance, productivity, satisfaction AND Happiness!!
Improving Quality of Health Care • Becoming a knowledgeable healthcare consumer • Engaging in self-care for yourself and your family • Selecting a primary care provider who will work with you and “your” team
Current Patterns in Health Care Use Approximately... • 30% of hospital days have been found to be unnecessary • 60% of emergency room use is clinically inappropriate • 30% of physician visits are not clinically necessary • Bottom line, we both under and over-utilize primary health care!
Current Patterns in Health Care Use Approximately... • 45% of patients fully comply with medical advice • 65% of current medical care is potentially avoidable and/or could be postponed • 25% of prescribed medications are not necessary • Thus, both prescribed treatment and patient compliance are a problem
Becoming an Active Health Consumer Self - Care • Identifying symptoms & conditions that occur frequently, but may not need a physician visit for each occurrence, e.g. urinary infection, yeast infection, tennis elbow • Breast, testicular & skin exam • First aid for common, uncomplicated injuries • Blood pressure, weight checks
Becoming an Active Health Consumer Self - Care • Home pregnancy and ovulation tests • Periodic cholesterol checks • Using self-help books, tapes, videos & web-based resources • Using relaxation and stress management techniques • Adhering to guidelines regarding nutrition, physical activity & exercise, and adequate sleep
Becoming an Active Health Consumer Awareness & Education • Be aware of medical • Be aware of the cost conditions and risk and value of levels treatments • Be aware of what • Know about actions to take to prescription and reduce risks and over-the-counter manage medical drugs conditions
Becoming an Active Health Consumer Awareness & Education • Know about • Be aware of the diagnostic tests risks and benefits of alternative medical • Be aware of what to and surgical expect (What are options, including risks?, What is effects on ability to normal?, What are work options?, What if you refuse recommended treatment?)
Becoming an Active Health Consumer Patient Accountability • Seek health care • Communicate with information practitioners • Understand cost • Report side effects implications • Lead a healthy • Make appropriate lifestyle plan and provider • Manage chronic selections conditions • Practice self-care • Practice prevention
Choosing a Health Care Provider • Check with provider list for you Healthcare Plan • Who is available to see new patients? • Practices with strong doctors at the helm are generally strong across the board • Need for a generalist! • Do they have Nurse practitioners, physician assistants, patient educators?
Choosing a Health Care Provider • Check with friends, physician referral services • Check credentials, specialties, office locations • How do they manage acute illnesses, on-call? • Which hospitals do they admit to? • Arrangements for telephone advice? • On-site services: x-rays, injury care, lab tests • How do they handle payment/co-pays?
Choosing a Health Care Provider • Does the provider or a staff member follow up on tests/results? How? Make sure you obtain a copy of your results • What does the practice do to help with prevention? • Philosophy about obtaining consultation • Attend to how your ?’s are answered. Are the provider and staff engaged? Listening? Put-off? • Communication style? Clear, understandable?
Personal Commitment • To get the most from your relationship with your PCP and his/her practice, you must be willing to meet them halfway
Personal Commitment • Follow the provider’s advice • Take medications as prescribed; if problems, report them • Abide by commitments to change wellness behaviors, ask for help if you fall off the wagon • Don’t tell your provider what you think they want to hear … tell them the truth, even if embarrassing • Keep appointments, call to reschedule as far in advance as possible for conflicts
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