Organization Integration and New Strategies for Improving the System Group presentation 5 Race Against Time Health System Organization 1 Designing a Primary Health Care System Builds on principles of ID: 1041435
Download Presentation The PPT/PDF document "Session 8 – May 18, 2011" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1. Session 8 – May 18, 2011Organization, Integration and New Strategies for Improving the SystemGroup presentation #5: Race Against TimeHealth System Organization1
2. Designing a Primary Health Care SystemBuilds on principles of:EquityUniversal AccessCommunity ParticipationIntersectoral CollaborationEncompasses broad population health issues, including public health functions.Creates conditions responsive to the needs of vulnerable/underserved groups.Coordinates care across the continuum – links prevention, acute care & chronic care.Fosters continuous evaluation and improvement. 2
3. Challenges to System Re-designWorkforceSize, composition, distribution, training, remuneration, migrationInformation SystemsClinical and administrativeFinancing MechanismsSource, sufficiency, sustainability and stewardshipPolitical WillRole of/tools available to local, state & national governments, and international bodies 3
4. Impact of Managed Care on Primary CareImprove cost effectiveness by increasing reliance on primary care/decreasing specialty care.MCOs employ more PCPs and fewer specialists per capita.Increase employment opportunities and earnings for PCPs relative to specialists.This was all in a 1997 article…4
5. Primary Care & Managed Care5Percentage of Physician Time Spent in Primary Care in Metropolitan Areas, by Involvement with Managed Care, 1995. Simon, et al (1997) Analysis of AMA Socioeconomic Monitoring System Survey. (HlthAff, 16(6): 89.)
6. Implications for Primary CareManaged care influences practice style of PCPs and specialists.Pros and Cons for quality of care.Physician workforce – sufficiency and composition.6
7. Managed Care BacklashReversal of integrated delivery progress.Abandon capitation as a payment mechanism, and along with it alignment of hospital and physician incentives.Reversal of primary care and specialist fortunes.Increased bargaining leverage for hospitals, decreased leverage for physicians.Increased concentration in insurance markets due to merger and/or exit.7
8. What About Now: Managed Care, or Managing Care? Definition of “Managed Care” vs. definition of “Patient-Centered Medical Home”Integration of health service delivery functions.Key concept around ‘gatekeeping’ and utilization.Relationship between managing/integrating care and cost/quality/access.Other strategies healthcare delivery systems use to integrate care.Other issues regarding organization, financing and managing health services delivery.8
9. BreakWhen You Return: Group 5 Presentation9