Home Visits, Innovation Models for Chronically Ill Flashcards
(61 cards)
1
Q
What is Different Now?
- Status Quo is ____ working
- Quality/Cost and V____
- Ag____ Population
- F_____ Unit
- M______
A
- Status Quo is NOT working
- Quality/Cost and Value
- Aging Population
- Family Unit
- Mobility
+COVID
2
Q
How is the US doing: Quality vs. Cost compared to other countries?
A
We have the highest healthcare spending with the lowest health system performance
3
Q
US _____ Spending is Similar to Other Countries; (2) Spending Are Higher Than Most
A
US Public Spending is Similar to Other Countries; Out of Pocket and Private Spending Are Higher Than Most
4
Q
US Cost of Healthcare vs. Social Spending?
A
We don’t spend that much on social spending but literally the highest in healthcare, denmark is a good example
5
Q
US Population Health Quality Metrics
- Life expectancy vs. other countries?
- Infant mortality vs. other countries?
- 65+ with 2 or more chronic conditions vs. other countries?
- Obesity rate vs. other countries?
- Smoking?
A
- Pretty low life expectancy
- Highest neonatal mortality
- Highest # of 65+ with chronic conditions, lower percentage of people above 65
- Highest obesity rate
- Lower rates of smoking
6
Q
Summary of US Health and Quality Outcomes
- Life expectancy =
- Suicide rate =
- Chronic disease burden =
- Hip replacement =
- 5 year survival for cervical cancer =
- Rates of hospitalization from preventable causes like DM and HTN =
- Rate of avoidable death =
A
- Life expectancy = Lowest
- Suicide rate = Highest
- Chronic disease burden = Highest
- More hip replacements
- 5 year survival for cervical cancer = Lowest
- Rates of hospitalization from preventable causes like DM and HTN = Highest
- Rate of avoidable death = Highest
7
Q
Summary of US Health and Quality Outcome Cont.
- # of physician visits =
- Average hospitalization =
- Rate of MRI scan =
- Prevention for breast cancer and flu =
- Average 5 year survival rate of breast CA =
A
- # of physician visits = Less
- Average hospitalization = Middle (similar to france and switzerland)
- Rate of MRI scan = Highest rate
- Prevention for breast cancer and flu = High prevention
- Average 5 year survival rate of breast CA = Highest average
8
Q
Effect of Covid on Mental Health?
A
Prevalence of anxiety and depression more than doubled the levels prior to the pandemic
(Huge mental health burden)
9
Q
Aging Population
- The number of individuals aged 60 years and over is expected to increase globally from 841 million to 2013 to more than __ billion by 2050
- By 2030, the number of US adults aged 65 or older will more than double to about ___ million
- Uprecedented demands on the provision of healthcare and aging-related services
A
- The number of individuals aged 60 years and over is expected to increase globally from 841 million to 2013 to more than 2 billion by 2050
- By 2030, the number of US adults aged 65 or older will more than double to about 71 million
- Uprecedented demands on the provision of healthcare and aging-related services
10
Q
Does the US invest in long term care?
A
No, the US spends more on administrative costs and less on long term healthcare than other wealthy countries
11
Q
What is the distribution of health care spending for US Civilian Non-Institutionalized Population?
(Who spends the most??
A
Top 5% of spenders account for 50.4% of spending
12
Q
What type of care do we spend the most on?
A
We spend way more on hospitalizations
13
Q
High-need adults had higher spending on health care than those with three of more chronic conditions without functional limitations
Top 5% spends the most on health care even when?
A
Top 5% spends the most on health care even for the same conditions that others have
14
Q
Preventable Spending by Category
We spend the most on preventative spending for those who are (1) and the least on (1)
A
We spent the most on preventable spending for those already frail, disabled, and major complex chronic illnesses and the least on those who are relatively healthy
15
Q
Waste in the US Health Care System
Top (3) Categories
A
Administrative
Operational
Clinical waste
16
Q
Potential Savings from Interventions
- Failure of care d____
- Failure of care c_____
- ____treatment/___-value care
- Pr____ failure
- Fr___ and Ab_____
A
- Failure of care delivery
- Failure of care coordination
- Overtreatment/low-value care
- Pricing failure
- Fraud and Abuse
17
Q
Social Determinants of Health
Median Annual Medicare Spending, by Disability and Experience of Negative Consequences Due to Inadequate Support
We medicare spends the most on?
A
Self care for those with disabilities and negative consequences
18
Q
Where are we today?
- H______ care is costly
- Patients prefer to be treated at _____
- COVID showed us things _____ to be done differently
- Home care reimbursement is ___creasing
- Chronic disease burden: the more, the _____ outcome
- F______ status is KEY
- W_____ in Healthcare: redundancy
- Care_____/____liness
A
- Hospital care is costly
- Patients prefer to be treated at home
- COVID showed us things NEED to be done differently
- Home care reimbursement is increasing
- Chronic disease burden: the more, the worse outcome
- Functional status is KEY
- Waste in Healthcare: redundancy
- Caregiving/loneliness
19
Q
How are we addressing these cases?
- Try to identify the population at r____/HNHC (high need high cost): lack of a common def_____
- Need a more holistic T___ based approach
- Unmet physical, ps____ and s_____ needs
- Issue with coordination of care, mis_____ incentives
- Integrated data (hospitalization/ER utilization, readmissions, diagnosis…): AI and predictive analytics
A
- Try to identify the population at risk/HNHC: lack of a common definition
- Need a more holistic TEAM based approach
- Unmet physical, psychological and social needs
- Issue with coordination of care, misaligned incentives
- Integrated data (hospitalization/ER utilization, readmissions, diagnosis…): AI and predictive analytics
20
Q
Model of Cares
- S_____ clinics
- Hy_____ model
- V_____ health
- Hospital at h___
- S_ _ virtual
- TOC support =
A
- Senior clinics
- Hybrid model
- Virtual health
- Hospital at home
- SNF virtual
- TOC support = transition of care support
21
Q
When can you treat a patient at home?
3 settings
1) P____ care/Ger_____
2) Tr______ care visit
3) Acute s______ management/p______ care: crisis management and prevention
A
1) Primary care/Geriatrics
2) Transitional care visit
3) Acute symptom management/palliative care: crisis management and prevention
22
Q
Comprehensive Assessment
- F____ and safety assessment (rugs, clutters…)
- Activities of (2)
- L____liness
- Dep____
- Fr____
- F____ insecurity (check the fridge, the pantry…)
- Me)______ review
A
- Fall and safety assessment (rugs, clutters…)
- ADA, IADL
- Loneliness
- Depression
- Frailty
- Food insecurity (check the fridge, the pantry…)
- Medication review
23
Q
What can we treat at home?
(1)
- F______: 20-50% may lack fever, low grade temperature or hypothermia
- Change in _______ status: not alone, be careful in dementia/overdiagnosis, need workup
- Reason for difference: impaired thermoregulation, hypothalamus regulation, decrease response in immune system
- P______ analysis: location: hospitalization, adult daycare, risk factors: dialysis, catheter, recent infection
A
Infection
- Fever: 20-50% may lack fever, low grade temperature or hypothermia
- Change in mental status: not alone, be careful in dementia/overdiagnosis, need workup
- Reason for difference: impaired thermoregulation, hypothalamus regulation, decrease response in immune system
- Pathogens analysis: location: hospitalization, adult daycare, risk factors: dialysis, catheter, recent infection
24
Q
Consideration for Treatment
- What lab value?
- Do we start abx at a lower dose for elderly?
- In_______with other medication
- Antibiotics St_______ MRSA, VRE, FQ resistant strep pneumo and MDR Gram negative bacilli
- _____ coverage
- Cl______ d_______
A
- GFR
- Do NOT “start low and go slow” (for abx)
- Interaction with other medication
- Antibiotics Stewardship: MRSA, VRE, FQ resistant strep pneumo and MDR Gram negative bacilli
- Broad coverage
- Clostridium Difficile
25
Examples of Infections
UTI
* **Organisms (3)**
* **Diagnosis =**
* **Consideration**: \_\_\_stitis vs. \_\_\_\_\_\_\_itis, ca\_\_\_\_\_, local resistance
* **Treatment**: (3) first line OR – (1) if complicated 7 days
* Avoid (2) abx
* **Need for prophylaxis**: pros and cons - include prognosis
* **Organism**: Ecoli, Klebsiella pneumoniae, Enterococcus Faecalis
* **Diagnosis**: Need for urine culture
* **Consideration**: Cystitis vs. pylenephritis, catheter, local resistance
* **Treatment**: Trimethoprim-sulfamethoxazole, Amox-Clavulanate, Cefpodoxime (5-7 days) OR Cipro/levofloxacin (3d) – if complicated 7 days
* Avoid Nitrofurantoin, ampicillin
* **Need for prophylaxis**: pros and cons - include prognosis
26
Pneumonia
* **Organism: (4)**
* Diagnosis: (1) vs. not
* Consideration: As\_\_\_\_\_ pneumonia
* Treatment:
* **Low risk**:**(1)** (not _____ in US due to resistance)
* **High risk due to comorbidities or** **recent antibiotics** 1g of (1) TID, or (1), (1) PLUS a (1) OR (1) (Levofloxacin or moxifloxacin)
* **Duration of treatment:** \_\_*-*\_ days (data is lacking in outpatient setting)
* ______ CXR in high risk individual, smoker, suspicious Xray in 7-12 weeks
* **Organism: Streptococcus pneumoniae, H. influenza, Legionella pneumophilia, Klebsiella**
* Diagnosis: CXR vs. not
* Consideration: Aspiration pneumonia
* Treatment:
* Low risk: Doxycycline (not macrolide in US due to resistance)
* High risk due to comorbidities or recent antibiotics 1g of amoxicillin TID, or amox/clavulanate, cefpodoxime PLUS a macrolide OR fluroqionolone (Levofloxacin or moxifloxacin)
* Duration of treatment: 3-7 days (data is lacking in outpatient setting)
* Repeat CXR in high risk individual, smoker, suspicious Xray in 7-12 weeks
27
Stop and Think
* High suspicion for ______ virus in flu season
* Reactivation T\_\_\_\_\_\_
* Bacteremia can be s\_\_\_\_\_
* Review c\_\_\_\_\_ presence at home
* Longer treatment for p\_\_\_\_\_ephritis and pr\_\_\_\_\_\_
* Do you treat asymptomatic bacteruria?
* High suspicion for Influenza virus in flu season
* Reactivation Tuberculosis
* Bacteremia can be subtle
* Review catheter presence at home
* Longer treatment for pyelonephritis and prostatitis
* Don’t treat asymptomatic bacteriuria
28
Prevention is Key
* Position, Hy\_\_\_\_, D\_\_\_\_ change, Dr\_\_, Or\_\_\_ hygiene, T\_\_\_ feeding
* Review/Discontinuation of med - P\_\_\_ and H\_\_ Blockers
* Per\_\_\_\_\_ hygiene
* Vaccination: yearly \_\_\_, pneumo\_\_\_\_ (+ PCV\_\_), Sh\_\_\_\_, C\_\_\_\_, T\_\_\_\_
* Position, Hygiene, Dietary change, Drug, Oral hygiene, Tube feeding
* Review/Discontinuation of med - PPI and H2 Blockers
* Perineal hygiene
* Vaccination: yearly flu, pneumovax (+ PCV13), Shingles, Covid, TDAP
29
COPD Exacerbation
* Depend on pr\_\_\_\_\_, may use st\_\_\_\_\_ longer or more often
* Conventional treatment following the guideline - May need to teach _______ inhaler if they are unable to \_\_\_- administer
* O2 qualification and education
* Depend on prognosis, may use steroid longer or more often
* Conventional treatment following the guideline - May need to teach change inhaler if they are unable to self- administer
* O2 qualification an education
30
CHF Exacerbation
* Following guideline depending on s\_\_\_\_\_ vs. d\_\_\_\_\_\_
* W\_\_\_\_\_ management and d\_\_\_\_
* Hy\_\_\_tension monitoring
* De\_\_\_\_\_\_\_ with diuretics
* Following guideline depending on systolic vs. diastolic
* Weight management and diet
* Hypotension monitoring
* Dehydration with diuretics
31
COPD Treatment/Education
32
Constipation
* A good h\_\_\_\_\_
* R/O im\_\_\_\_\_
* Review me\_\_\_\_\_, d\_\_\_\_
* Assess w\_\_\_\_\_ intake
* A good history
* R/O impaction
* Review medication, diet
* Assess water intake
33
Constipation Treatment
Bulking agents (3)
Osmotic Laxatives (5)
Stool softeners (1)
Stimulant Laxative (2)
Chloride channel activators (1)
Peripherally acting mu-opioid antagonist (1)
Other (1)
34
Dementia
Dementia related mood changes
* ____ pharmacological treatment
* \_\_\_\_giver education
* Avoid anti\_\_\_\_ and b\_\_\_\_\_
* Mindful of t\_\_\_\_ of the day and sun\_\_\_\_
* Medication: mir\_\_\_\_\_, tra\_\_\_\_\_, dep\_\_\_\_
* Assess for del\_\_\_\_\_
* Non pharmacological treatment
* Caregiver education
* Avoid antipsychotic and benzodiazepine
* Mindful of time of the day and sundown
* Medication: mirtazapine, trazodone, depakote
* Assess for delirium
35
Nonpharm Therapies for Management of Alzheimer Disease
1. Enjoyable l\_\_\_\_ activities
2. Mental st\_\_\_\_\_ programs
3. O\_\_\_\_\_\_ therapy
4. Structured ph\_\_\_\_\_ exercise programs
1. Enjoyable leisure activities
2. Mental stimulation programs
3. Occupational therapy
4. Structured physical exercise programs
36
Depression
* Risk factors
* gender =
* co\_\_\_\_\_\_ (CVA)
* nursing h\_\_\_\_\_\_
* wid\_\_\_
* p\_\_\_\_\_, in\_\_\_\_\_\_
* Emphasis on a change in mood or interest with at least ____ weeks duration, non-physical symptoms, and social regression or incapacity
* Screening: P\_\_\_\_, G\_\_\_\_, frail older
* Specific criteria in A\_\_\_\_\_\_
* Risk factor
* female
* comorbidities (CVA),
* nursing homes
* widowed
* pain, insomnia
* Emphasis on a change in mood or interest with at least two weeks duration, non-physical symptoms, and social regression or incapacity
* Screening: PHQ2, GAD, frail older
* Specific criteria in Alzheimer
37
Depression Medication in Elderly
* Rx (2) = safe, not sedating
* Citalopram = caution with \_\_\_
* Rx (1)= activating, long half-life
* Rx (1) = Beer’s 2019, sedating, anticholinergic
* SNRI = d\_\_\_\_\_\_ with pain
* M\_\_\_\_\_\_ = insomnia/appetite *(i prefer this before going to SSRI)*
* Bu\_\_\_\_\_\_ = stimulant/dopaminergic
* Escitalopram/Sertraline = safe, not sedating
* Citalopram = caution with QT
* Fluoxetine = activating, long half-life
* Paxil = Beer’s 2019, sedating, anticholinergic
* SNRI = duloxetine with pain
* Mirtazapine = insomnia/appetite *(i prefer this before going to SSRI)*
* Buproprion = stimulant/dopaminergic
38
Anorexia
* Social situation
* ______ appetite stimulant
* Rx (1) that can help
* Social situation
* Avoid appetite stimulant
* Mirtazapine
39
Insomnia
Start with ____ pharm treatment
Rx (1) can help
Start with non pharm treatment
Trazodone
40
Loneliness
C\_\_\_\_\_ help
Mu\_\_\_\_
Re\_\_\_\_
Sh\_\_\_\_
Vol\_\_\_\_\_\_\_
Caregiver help
Music
Reading
Shopping
Volunteer
41
Approach to cancer and screening for homebound patients
* Pr\_\_\_\_\_\_ dependent
* G\_\_\_\_ of care
* Logistics
* Va\_\_\_\_\_\_ important
* Sh\_\_\_\_\_ decision making
* Prognosis dependent
* Goal of care
* Logistics
* Vaccination is important
* Shared decision making
42
Polypharmacy
* **OTC and prescribing medication**
* Anticholinergic
* Beers criteria
* B\_\_\_\_\_ and hyperkalemia with ACE/ARB
* Avoid op\_\_\_\_/b\_\_\_\_\_/ga\_\_\_\_\_ medication together
* Avoid S\_\_\_\_ in patient with fracture and falls
* As\_\_\_\_
* In\_\_\_\_\_
* Par\_\_\_\_\_\_
* Underutilizing/Under-prescribing to increase adherence
* **OTC and prescribing medication**
* Anticholinergic
* Beers criteria
* Bactrim and hyperkalemia with ACE/ARB
* Avoid opioid/benzo/gabapentinoid medication together
* Avoid SNRI in patient with fracture and falls
* Aspirin
* Insulin
* Paroxetine
* Underutilizing/Under-prescribing to increase adherence
43
Social Determinants of Health
* Caregiving
* Caregiving st\_\_\_\_
* Ad\_\_\_\_\_ care planning
* Real time co\_\_\_\_ of care
* S\_\_\_\_\_\_ assessment
* Partnership with CBO (community based organization) for f\_\_\_\_
* Health lit\_\_\_\_\_\_
* Caregiving
* Caregiving stress
* Advance care planning
* Real time coordination of care
* Safety assessment
* Partnership with CBO for food
* Health literacy
44
Examples of Addressing Social Determinants
* ______ worker to connect with volunteer program and back-up care
* Educate about internet/phone sc\_\_\_\_
* Apply for county/local help/gr\_\_\_\_\_
* Apply for Medi\_\_\_\_
* F\_\_\_\_ security
* Cr\_\_\_\_\_ management
* Advance d\_\_\_\_\_\_\_: POA and living will
* Social worker to connect with volunteer program and back-up care
* Educate about internet/phone scams
* Apply for county/local help/grants
* Apply for Medicaid
* Food security
* Crisis management
* Advance directives: POA and living will
45
Falls
* Screening
* Did you fall in the last ___ months? Ba\_\_\_ issue?
* Evaluate in person:
* R\_\_\_, furniture, path, bathroom
* Assess:
* Med\_\_\_\_\_
* Hy\_\_tension
* F\_\_\_\_ problem
* Educate
* Screening
* Did you fall in the last 12 months? Balance issue?
* Evaluate in person:
* Rug, furniture, path, bathroom
* Assess:
* Medication
* Hypotension
* Foot problem
* Educate
46
Palliative Care in the Home
**Pain Management**
* **Chronic somatic pain:** OA, fibromyalgia, back pain
* Untreated it can cause d\_\_\_\_\_
* **Chronic Malignant pain**
* Need for o\_\_\_\_\_, adjuvant, other modalities
* **Treatment:**
* Shared decision making, prognosis and frailty assessment, caregiver/home situation and goals in life
* Assessment of Neuropathic pain: G\_\_\_\_\_\_\_ medication in specific situation
* OTC: local and medication. Avoid overdose
* CBD and Medical Marijuana
* NSAID: Consideration for bl\_\_\_\_\_\_ and k\_\_\_\_\_ function
* **Chronic somatic pain:** OA, fibromyalgia, back pain
* Untreated it can cause depression
* **Chronic Malignant pain**
* Need for opioid, adjuvant, other modalities
* **Treatment:**
* Shared decision making, prognosis and frailty assessment, caregiver/home situation and goals in life
* Assessment of Neuropathic pain: Gabapentinoid medication in specific situation
* OTC: local and medication. Avoid overdose
* CBD and Medical Marijuana
* NSAID: Consideration for bleeding and kidney function
47
Goal of Care Discussion
* POA =
* POLST/MOLST =
* Cr\_\_\_\_\_\_ prevention
* Fa\_\_\_\_ education
* Help disseminate to family and care t\_\_\_\_
* Com\_\_\_\_\_\_ skills
* POA = Power of Attorney
* POLST/MOLST = Medical Orders for Life Sustaining Treatment
* Crisis prevention
* Family education
* Help disseminate to family and care team
* Communication skills
48
Hospice Discussion
* How to present hospice
* Have the right partnership:
* Fast hospice ad\_\_\_\_\_, weekend
* Fast res\_\_\_\_\_\_ to patient’s need
* Medication/opioid del\_\_\_\_\_
* S\_\_\_\_\_ support
* Stay inv\_\_\_\_\_\_
* How to present hospice
* Have the right partnership:
* Fast hospice admission, weekend
* Fast response to patient’s need
* Medication/opioid delivery
* Social support
* Stay involved
49
Transitional Care Period - TC Management
* **After discharge from an in\_\_\_\_\_ to co\_\_\_\_\_\_**
* Hospital, SAR, nursing home
* Discharge to community
* **Non face to face and a face to face**
* T\_\_\_\_ sensitive
* Team approach
* **H\_\_\_\_ visit very beneficial for chronically ill**
* Medication management and re\_\_\_\_\_
* Effective services
* S\_\_\_\_\_ management and coordination if care team
* Care\_\_\_\_\_ situation assessment
* G\_\_\_\_ of care
* W\_\_\_\_ were you in the hospital?
* What would you do if same cr\_\_\_\_ happens?
* **After discharge from an institution to community**
* Hospital, SAR, nursing home
* Discharge to community
* **Non face to face and a face to face**
* Time sensitive
* Team approach
* **Home visit very beneficial for chronically ill**
* Medication management and reconciliation
* Effective services
* Symptom management and coordination if care team
* Caregiver situation assessment
* Goal of care
* Why were you in the hospital?
* What would you do if same crisis happens?
50
Hospital at Home
* Criteria/Regulatory issues - st\_\_\_\_ specific
* D\_\_\_\_ clinician round and extended RN round
* Clinical care pathways
* Present in many state now \>\_\_\_
* Safety and quality
* Having the right patient
* Criteria/Regulatory issues - state specific
* Daily clinician round and extended RN round
* Clinical care pathways
* Present in many state now \>20
* Safety and quality
* Having the right patient
51
Home Care
* One of the fastest growing sector of Healthcare
* Ep\_\_\_\_\_ of care payment
* Still l\_\_\_\_ full coordination and integration
* Role can be limited by Medi\_\_\_\_ rules
* Services such as ph\_\_\_\_ therapy, occ\_\_\_\_\_ therapy, sk\_\_\_\_\_ nursing and home heath \_\_\_\_
* Can play an important role in the care of _______ ill population
* One of the fastest growing sector of Healthcare
* Episode of care payment
* Still lack full coordination and integration
* Role can be limited by Medicare rules
* Services such as physical therapy, occupational therapy, skilled nursing and home heath aid
* Can play an important role in the care of chronically ill population
52
Home Visit Etiquette
* Be __ time but be fl\_\_\_\_
* Update of any ch\_\_\_\_
* Ask about any hab\_\_\_\_ (removing shoes..)
* Don’t t\_\_\_\_\_ anything without permission
* Take your t\_\_\_\_
* Res\_\_\_\_ their rules
* Have your eq\_\_\_\_\_
* Be on time but be flexible
* Update of any change
* Ask about any habits (removing shoes..)
* Don’t touch anything without permission
* Take your time
* Respect their rules
* Have your equipment
53
Barriers to Home Visits
* Patient’s pr\_\_\_\_\_\_\_
* Clinician’s concerns: t\_\_\_, p\_\_\_ment, sa\_\_\_\_
* Services at home: DME = , HHA =
* Safety assessment
* Regulatory environment: quality and payment
* Interoperability of EMR and communication
* Integration of CBO =
* Education: medical school and CME
* Patient’s preference
* Clinician’s concerns: time, payment, safety
* Services at home: DME (durable medical equipment), HHA (home health aid)
* Safety assessment
* Regulatory environment: quality and payment
* Interoperability of EMR and communication
* Integration of CBO (community based organization)
* Education: medical school and CME
54
Solutions
* Use of A\_
* Real time algorithm data: use of O2, order of a hospital b\_\_\_
* Payment models/R\_\_\_\_ incentives
* Team based approach: mutual respect
* Coordination of care - Care m\_\_\_\_\_\_\_
* Sharing documentation: inter\_\_\_\_\_\_\_
* Improving care tr\_\_\_\_\_\_ across settings
* Use of AI
* Real time algorithm data: use of O2, order of a hospital bed
* Payment models/RIGHT incentives
* Team based approach: mutual respect
* Coordination of care - Care management
* Sharing documentation: interoperability
* Improving care transitions across settings
55
Innovations
* Al\_\_\_\_\_ for senior and other gadgets
* AI
* High t\_\_\_\_ models
* T\_\_\_medicine
* Sm\_\_\_\_ homes
* Investing in SDOH/CM/Loneliness
* Senior care/Medicare Ad\_\_\_\_\_ and technology
* Alexa for senior and other gadgets
* AI
* High touch models
* Telemedicine
* Smart homes
* Investing in SDOH/CM/Loneliness
* Senior care/Medicare Advantage and technology
56
Advanced Illness Programs
(4)
1. Aetna Compassionate Care
2. Aspire Health
3. Northwell Health Advanced Illness Management
4. Sutter Health Advanced Illness Management
57
Issue: The Payment Model
How are most providers paid?
Fee for service
58
Payment Model is Key
* Pr\_\_\_\_\_ care first
* Seriously ill patient (SIP) patient model S\_\_\_\_\_\_\_
* Announced April 2019
* Started January 2020
* Primary care first
* Seriously ill patient (SIP) patient model STOPPED
* Announced April 2019
* Started January 2020
59
The Clinician of the Future
* T\_\_\_\_ player
* P\_\_\_\_\_\_ first
* Understand v\_\_\_\_ and c\_\_\_\_
* Identify and follow key metrics
* Understand business mod\_\_\_\_
* Build partnership with g\_\_\_\_\_\_, C _ \_ payers
* Hol\_\_\_\_\_ vision of health
* Excellent clinical AND co\_\_\_\_\_\_ skills
* Team player
* Patient first
* Understand value and cost
* Identify and follow key metrics
* Understand business models
* Build partnership with government, CBO payers
* Holistic vision of health
* Excellent clinical AND communication skills
60
The Future
* We can’t depend on the “ethics” of clinicians - _____ out
* Stop the bl\_\_\_\_\_ and get to work - there is research that shows the gap
* St\_\_\_\_\_\_\_ of education
* Decrease Health in\_\_\_\_\_
* Pri\_\_\_\_-Pu\_\_\_\_ partnership
* Q\_\_\_\_\_\_ first then saving will follow and not the opposite
* Quality cost money, so we won’t see saving before we improve the imbalance
* We can’t depend on the “ethics” of clinicians - Burn out
* Stop the blaming and get to work - there is research that shows the gap
* Standardization of education
* Decrease Health inequity
* Private-Public partnership
* Quality first then saving will follow and not he opposite
* Quality cost money, so we won’t see saving before we improve the imbalance
61
Career Path and Opportunities
* V\_\_\_\_\_ Medical services - Primary care
* Palliative care program through h\_\_\_\_\_
* Palliative care program - h\_\_\_\_ visit programs
* Payer home visits programs
* Visiting Medical services - Primary care
* Palliative care program through hospices
* Palliative care program - home visit programs
* Payer home visits programs
