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Primary Care

"First-contact Care" - Basic or General Health Care

MOST ACESSIBLE type of care: 80-90% of visits to providers

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Who are PRIMARY CARE Physicians?

PCP = Primary Care Providers
Pediatricians / Gynecology / Internal Medicine


sometimes NP's / PA's / Chripractors
depends on your Health Plan - may require a REFERRAL to specialist

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Secondary Care

Physician SPECIALIST

FACILITIES treating problems like

SURGERY / HOSPITALIZATION / REHAB

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Tertiary Care

MOST COMPLEX DISORDERS

Specialized CONSULTATIVE care --

typically need Referral from PCP

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Preventative Care

PREVENT disiease or injury

Reduce EXPOSURES to health problems

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Chronic Care

opposite of acute diseases

CHRONIC diseases that persist over time

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Respite Care

service for DEPENDENT patients

provides TEMPORARY CARE RELIEF

to their informal caregivers (family)

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Long-Term Care (LTC)

EXTENDED ASSISTANCE

for the chronically/mentally/disabled ill people

Assists those who have limitations in ADLS or IADLS

activities of daily living (instrumental ADLS)

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Acute Care

Short-Term / INTENSE care for an illness or injury usually HOSPITILIZATION (inpatient)

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Sub-acute care

comprehensive INPATIENT services for those who need

MORE intensive skilled nursing --> nursing homes

 

TOO WELL FOR HOSPITAL, but too frail for nursing homes

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Rehabilitative Care

Therapies to RESTORE/MAINTAIN levels of FUNCTIONING and to PREVENT further deterioration

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Palliative Care

Serving to RELIEVE or COMFORT/ALLEVIATE

rather than curing

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HOSPICE CARE (end-of-life)

Humane / compassionate services for the DYING

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Common classifications for HOSPITALS

Size = # of beds

Length of Stay: short / long

Location: urban / rural

Type of Service: general / surgical / specialized

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Hospital Classifications - OWNERSHIP

Public = federal/state/municipal

Private Not-For-Profit

Private PROPRIETARY = for-profit / investor owned

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Ambulatory Care

OUTPATIENT healthcare services that do NOT require inpatient hospitilzations

wide variety of practitioners for the "WALKING" / non-institutionalized patient

Disease prevention / health promotion / medical care

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Accountable Care Organization = ACO

MODEL OF CARE

From the AFFORDABLE CARE ACT - sought to reduce healthcare cost by encouraging physicians / healthcare providers

to FORM NETWORKS to COORDINATE CARE & receive bonuses for EFFICIENT care delivery ACCOUNTABLE forquality / cost of care delivered

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ACO

Accountable Care Organization

INCENTIVIES hold ACO's responsible for both COST & QUALITY OF CARE

Houses numerous medical practices within 1 organizing entity, PCP leadership ACCOUNTABILITY ( quality metrics )

SHARED SAVINGS

FREE CHOICE in PROVIDERS for the patients

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Patient-Centered Medical Home = PCMH

Enhanced PRIMARY CARE delivery MODEL

PCMH uses Physician-led, coordinated team based approach to care:

Spectrum of disease state / various life stages while MANAGING COSTS

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PCMH

Patient Centered Medical Home

PRIMARY CARE
Centered around a SINGLE MEDICAL PRACTICE (small/independent office)


Payers give providers a BONUS for imrpoving primary care services for each patient in PCMH

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Universal goal of the healthcare system?

Adequate ACCESS to QUALITY CARE at a REASONABLE COST

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Triple Aims of the healthecare system:

In concert with the universal goal:

Better Individual Care + Experiences

Better Population health

lower Costs

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Major components of ACCESS
to health care

ABILITY to PAY (self or insurance coverage)

AVAILABILITY of health care personnel / facilitites

Issues affecting EASE OF USE / BARRIERS to timely participation
(Transportation / Language / Culture / Scheduling)

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Total U.S Health Care Expenditures in 2016

3.3 TRILLION

 

17.9% of US GDP

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Major Factors Contributing to the

COSTS of Healthcare

Social Factors
Lifestyle Factors & personal behaviors

Chronic Disease + AGING Population
Longer lives -> more CHRONIC conditions / comorbidities

Prescription Drugs + Medical Advancements

Fragmented Healthcare Delivery

Current Payment / Reimbursement Mechanisms

Administrative Costs
for providers & payers

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Financial Barriers to Healthcare

28 million UNINSURED in the US
mainly due to COST BEING TOO HIGH / LOST JOB or emplyer change

41 million UnderInsured  in the US

When out-of pocket costs (includes PREMIUMS) add up to
10% or more of houshold income

or
Deductables amount to 5% of income or HIGHER

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Under-insured Definition

41 million UnderInsured  in the US

When out-of pocket costs (excluding premiums) amount to:
10% +  of household income

or

When deductables amount to
5% + of income or higher