Medical Home Mike Albert Presented by: Doug Linz, MD Medical - - PowerPoint PPT Presentation

Medical Home Mike Albert

Presented by: Doug Linz, MD Medical Director TriHealth Corporate Health September 11, 2012

Medical Home

• Your “Medical Home” is your healthcare and

wellness support system

• Just as having a strong support system of

family and friends is vital to your overall well- being,

• Having a well-coordinated network of support

for your health and wellness is vital to your health and wellness

Objective For Both Employers & Employees

Maintain a healthy and productive workplace by:

• Keeping well people well
• Keeping healthy people healthy
• Optimizing productivity for healthy workers
• Minimizing lost work productivity associated with

chronic medical conditions

Wellness and Health Management Strategies

• 1. Identify and reduce “modifiable” RISK FACTORS

– Not family history – Not genetically determined outcomes – Risk factors that can be modified through changes in behaviors, like diet and exercise

• 2. Identify and manage CHRONIC MEDICAL

CONDITIONS and associated work disability

RISK FACTOR - Wellness Management

HERO Study:

Medical Costs Associated with Health Risks

• Hero = Health Enhancement Research Organization
• Top 10 modifiable risk factors add 27% to total

medical costs

• This corresponds to $768 per employee

Remember, if it costs the employer, it costs the employee! 

HERO Study:

Excess Medical Cost Associated with Health Risks

• Risk factors in the order of impact :

Depression 70 % Stress 46 % Glucose 35 % Obesity 21 % Former Tobacco smoker 20 % Current Tobacco smoker 15 % Blood Pressure 12 % Exercise 10 %

The Change Process For Reducing Risks

• Identify modifiable health risks (blood pressure,

stress, depression, smoking, obesity, blood pressure, cholesterol, blood sugar, sedentary lifestyle + seat belts, helmets, cell phone use, etc. through Health Risk Appraisal (HRA)

• If you reduce these risk factors, you will reduce your

chances of future illness

• Primary Intervention: Health & wellness promotion

and fitness training

Health Risk Reduction Processes

• Examples of programs that reduce risk factors

– Smoking cessation – Stress management – Exercise programs – Weight management programs

Chronic Medical Illness Management

Institute for Health & Productivity Management - Goetzel 2004

Top 10 Medical Conditions Allergy

Diabetes Arthritis Heart Disease Asthma Hypertension Any Cancer Migraine/Headache Depression/Mental Respiratory Infections Illness These 10 conditions account for about 80% of employer health and productivity costs

Categories of Employer Cost

• Medical Costs – Total = 30%

– Outpatient care – Inpatient care – Emergency care – Pharmacy costs

• Work Productivity Costs – Total = 70%

– Absenteeism – Presenteeism

The Process Chronic Medical Conditions

• Identify workers with chronic medical conditions:

allergies, asthma, other lung disease, hypertension, high cholesterol, diabetes mellitus, headaches, heart disease, depression & anxiety, cancer, & arthritis (back and joint problems)

• Optimize medical care
• Primary Intervention: Education and coaching to
• ptimize timing and effectiveness of health care

The Process Chronic Medical Conditions

• Avoid unnecessary & inappropriate medical

interventions & costs

• Promote and assure necessary medical interventions

Medical Condition Management

• Training in self-care for individuals and families

including diet and exercise

• Assuring appropriate and timely medical care and

follow up

• Optimize understanding and engagement of

employees in managing their chronic medical problems

Exercise is Medicine

• Increasing evidence to support the preventive and

therapeutic value of regular exercise

The Deliverables - Expectations

• Improved brain function
• Improved psychological hardiness; less emotional

reactivity; faster to problem solving mode

• Improved immune function; fewer colds
• Injury prevention - both sprain/strain & fall risk
• Weight management - reduced obese body mass

and better control of medical conditions associated with obesity - e.g. less medication for diabetes, hypertension, cholesterol

The Deliverables - Expectations

• Decreased risk of chronic illnesses: diabetes,

hypertension, heart disease, vascular disease, stroke, independent of obesity

• Decreased cancer risk
• Less pain and improved function related to arthritis

and other back, neck and joint problems

• Decreased risk of depression and anxiety and

reduced medication requirements for treatment in those who have these conditions

The Deliverables - Expectations

• Lowers death risk by 20 to 25% after heart attack
• Osteoporosis – prevention & treatment
• It’s not just about decreasing the frequency and

impact of preventable illnesses and injuries …

• It’s not just about maintaining current productivity and

performance …

• It’s about What’s Above the Line

Improved performance, productivity, satisfaction AND Happiness!!

Improving Quality of Health Care

• Becoming a knowledgeable healthcare consumer
• Engaging in self-care for yourself and your family
• Selecting a primary care provider who will work with

you and “your” team

Current Patterns in Health Care Use

Approximately...

• 30% of hospital days have been found to be

unnecessary

• 60% of emergency room use is clinically inappropriate
• 30% of physician visits are not clinically necessary
• Bottom line, we both under and over-utilize primary

health care!

Current Patterns in Health Care Use

Approximately...

• 45% of patients fully comply with medical advice
• 65% of current medical care is potentially avoidable

and/or could be postponed

• 25% of prescribed medications are not necessary
• Thus, both prescribed treatment and patient

compliance are a problem

Becoming an Active Health Consumer Self - Care

• Identifying symptoms & conditions that occur

frequently, but may not need a physician visit for each occurrence, e.g. urinary infection, yeast infection, tennis elbow

• Breast, testicular & skin exam
• First aid for common, uncomplicated injuries
• Blood pressure, weight checks

Becoming an Active Health Consumer Self - Care

• Home pregnancy and ovulation tests
• Periodic cholesterol checks
• Using self-help books, tapes, videos & web-based

resources

• Using relaxation and stress management techniques
• Adhering to guidelines regarding nutrition, physical

activity & exercise, and adequate sleep

Becoming an Active Health Consumer Awareness & Education

• Be aware of medical

conditions and risk levels

• Be aware of what

actions to take to reduce risks and manage medical conditions

• Be aware of the cost

and value of treatments

• Know about

prescription and

• ver-the-counter

drugs

Becoming an Active Health Consumer Awareness & Education

• Know about

diagnostic tests

• Be aware of what to

expect (What are risks?, What is normal?, What are

• ptions?, What if you

refuse recommended treatment?)

• Be aware of the

risks and benefits of alternative medical and surgical

• ptions, including

effects on ability to work

Becoming an Active Health Consumer Patient Accountability

• Seek health care

information

• Understand cost

implications

• Make appropriate

plan and provider selections

• Practice self-care
• Communicate with

practitioners

• Report side effects
• Lead a healthy

lifestyle

• Manage chronic

conditions

• Practice prevention

Choosing a Health Care Provider

• Check with provider list for you Healthcare Plan
• Who is available to see new patients?
• Practices with strong doctors at the helm are

generally strong across the board

• Need for a generalist!
• Do they have Nurse practitioners, physician

assistants, patient educators?

Choosing a Health Care Provider

• Check with friends, physician referral services
• Check credentials, specialties, office locations
• How do they manage acute illnesses, on-call?
• Which hospitals do they admit to?
• Arrangements for telephone advice?
• On-site services: x-rays, injury care, lab tests
• How do they handle payment/co-pays?

Choosing a Health Care Provider

• Does the provider or a staff member follow up on

tests/results? How? Make sure you obtain a copy of your results

• What does the practice do to help with prevention?
• Philosophy about obtaining consultation
• Attend to how your ?’s are answered. Are the

provider and staff engaged? Listening? Put-off?

• Communication style? Clear, understandable?

Personal Commitment

• To get the most from your relationship with your PCP

and his/her practice, you must be willing to meet them halfway

Personal Commitment

• Follow the provider’s advice
• Take medications as prescribed; if problems, report

them

• Abide by commitments to change wellness

behaviors, ask for help if you fall off the wagon

• Don’t tell your provider what you think they want to

hear … tell them the truth, even if embarrassing

• Keep appointments, call to reschedule as far in

advance as possible for conflicts

Remember: Taking responsibility for your own health will serve you well. Your lifestyle choices, such as exercise habits, eating patterns, how you handle stress, whether you use a seat belt, whether you use tobacco, have much more of an impact on your health than the many things Doctors can do for you. So…take good care of yourself!

Questions /Discussion

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