SLIDE 1
The Health Care Delivery Spectrum
Ambulatory Hospital Long‐Term
Primary Care
Specialty Ambulatory
Care
Introduction to the Community Health Sector Tom Manning Primary Care - - PowerPoint PPT Presentation
Introduction to the Community Health Sector Tom Manning Primary Care - - PowerPoint PPT Presentation
Introduction to the Community Health Sector Tom Manning Primary Care Development Corporation November 15, 2011 The Health Care Delivery Spectrum Ambulatory Hospital Long Term Specialty Acute Primary Emergency Home Nursing Ambulatory Inpatient
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An Effective Community Health Sector
Centered on Primary Care to produce:
- Better Health
- Lower Costs
- Reduced health disparities between socio‐economic
groups – akin to environmental justice
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Use of the System Across the Spectrum
Ambulatory Hospital Long‐Term
Primary Care
Specialty Ambulatory
Care
Emergency Depts Acute Inpatient Care Home Care Nursing Homes
The Acutely Ill The Chronically Ill The “Well”
Short Term Episodes
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1000 2000 3000 4000 5000 6000 7000
1980 1984 1988 1992 1996 2000 2004
Australia* Canada France Germany Netherlands New Zealand Switzerland United Kingdom United States
Average spending on health per capita ($US)
2 4 6 8 10 12 14 16
1980 1984 1988 1992 1996 2000 2004
Australia* Canada France Germany Netherlands New Zealand Switzerland United Kingdom United States
Total expenditures on health as percent of GDP
U.S. Far Outspends its Peers ‐ OECD Health Care Costs 1980 – 2006
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Comparison of Average Cost of Care: Preventable (Ambulatory Care Sensitive) Conditions
Community Health Center Visit ER Visit Non‐emergent Hospital Admission Non‐acute $140 $600‐1600 $9,000
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Healthy Communities
(Nutrition, prevention, physical fitness, healthy living, environment)
Community Resources
(Supportive housing, social services, eligibility programs, etc.)
Medical Neighborhood
(Specialists, ER, Inpatient, LTC + Behavioral Health)
Medical Home
(Primary Care)
The Health Care Paradigm is Changing
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What is Primary Care?
The principal point of consultation for patients within a health care system, including all routine and preventive care plus initial consultations on new health conditions. Quality primary care is fully integrated into its community and will meet this definition: The provision of accessible health care services that are comprehensive, coordinated and continuous, by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (the Institute of Medicine)
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Who Provides Primary Care in LICs?
- FQHCs
- FQHC Look‐Alikes
- Hospital Out‐Patient Departments (OPDs) & satellites
- Hospital Emergency Rooms
- Freestanding Clinics
- Free Clinics
- Rural Health Centers
- Private doctors
- In‐store clinics
- Special Needs Providers:
– Developmentally Disabled – Frail Elderly (Program of All‐inclusive Care for the Elderly, or PACE) – Substance Abuse / HIV+ / Homeless; including Homeless FQHCs
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Where is there opportunity?
- FQHC expansion
- Establishment of medical practices by Special Needs
providers
- Hospitals – reconfiguring care
- Closing hospitals – saving the primary care
- Health IT
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Acknowledgements:
- Use along the health care spectrum – United Hospital Fund
- OECD health costs – OECD data, compiled by The Commonwealth Fund
- Costs of care, ACS conditions – National Assn. of Community Health Centers
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