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

8/14/2012 1

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 Past President and Past Chairman of the Board American Academy of Family Physicians Co-Chair, Center on Accountable Care Patient Centered Primary Care Collaborative

Region

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

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$2,600,000,000,000

National Health Spending in Billions

$27 $75 $256 $724 $1,378 $2,021 $2,486 $2,584 $2,708 $2,824 $3,227 $3,632 $4,080 $4,638 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

8/14/2012 3 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)

8/14/2012 4 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.

8/14/2012 5 Fellowships

• Sports Medicine
• HIV Primary Care
• Geriatrics (2013)
• Rural
• Obstetrics
• Palliative Care

Distributive Family Medical Education Model

Boise Pocatello Caldwell Coeur d’Alene Cottonwood Moscow McCall Magic Valley Rexburg Wood River

Boise/ Pocatello/ Caldwell McCall Magic Valley Rexburg Wood River Coeur d’Alene Moscow/ Cottonwood

Patient Centered Medical Home Clinics within Ada County

8/14/2012 6 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

8/14/2012 7 Symphony of Care

NEW BOOK

“Never, never, never, give up.”

• Winston Churchill

8/14/2012 8 Farming, Nutrition, and Medicine

Eat Food Not too Much Mostly Fruits and Vegetables Get Health Care Not too Much Mostly Primary Care

Questions