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(No Transcript)
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About that lunch

• Food Calories
• Lasagna 330
• Roasted Vegetables 170
• Caesar Salad 185
• Bread 180
• Carrot Cake 350
• TOTAL 1215
• Half of todays required calories.
• Just sayin.

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Next time in Asheville
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I am my own medical home
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Transparent healthcare markets

• Owning the patient

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Primary care
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• Comments or questions
• on this scenario?

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Agenda

• I Am My Own Medical Home
• Project Background
• Three More Scenarios
• Using the Scenarios

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Project background

• Primary Care 2025 A Scenario Exploration

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Scenarios What and Why

• Alternative stories about the future
• They bound uncertainty and explore major pathways
• Used to
• Understand change
• Identify emerging challenges and opportunities
• Clarify assumptions
• Consider alternatives
• Develop vision

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Scenarios Should

• Consider whats likely and whats preferable
• Aid in understanding and creating the future
• Lead to enhanced focus on vision, visionary
  success, and sensitivity to opportunities
• Be constructed around archetypes
• Expectable
• Challenging
• Visionary

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IAFs approachAspirational Futures
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What is primary care?

• An evolving definition
• IOM (1978) - Primary Care is
• Accessible
• Comprehensive
• Coordinated
• Continuous
• Accountable
• Barbara Starfield (1992) - Primary Care is
• First contact
• Accessibility
• Longitudinality
• Comprehensiveness
• IOM, Defining Primary Care An Interim Report,
  1994, page 27 8

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Primary Care 2025

• Funded by the Kresge Foundation
• Produced forecasts of key forces shaping primary
  care, and the Primary Care 2025 scenarios
• Included interviews with 56 thought leaders and
  10 focus groups
• Included a national workshop to develop
  recommendations to the nation
• Produced a scenario toolkit which your
  organizations can use for their own planning
• Project deliverables available at
  www.altfutures.org/primarycare2025

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Three more scenarios

• Primary Care 2025 A Scenario Exploration

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The Four Scenarios

1. Many Needs, Many Models
2. Lost Decade, Lost Health
3. Primary Care That Works for All
4. I Am My Own Medical Home (already presented)

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Scenario 1Many needs, many models

• Expansion of Patient-Centered Medical Home (PCMH)
• Increased emphasis on prevention
• Primary care provider (PCP) shortages -
• All PCMH team members practice at top
• of license

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Scenario 1Advances in technology

• Electronic medical records widespread
• Dr. Watson expert support for providers
• More care delivered virtually
• Personalized vital signs
• Digital health agents, health games,
• and social networking

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Scenario 1Primary care
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Scenario 1Insurance market

• Many employers dropped coverage as Health
  Insurance Exchanges came online in mid-2010s
• HIX effectiveness varies from state to state
• Many rely on high-deductible catastrophic plans
  and pay out-of-pocket for most care
• Some states create single payer systems

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Scenario 1Many needs, many models

• Nurse practitioner-managed primary care expands
• Significant disparities remain for access and
  quality
• Poor patients can rarely afford biomonitoring
  technologies that could help predict or preempt
  disease

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• Comments or questions
• on this scenario?

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Scenario 2Lost Decade, Lost Health

• Recurrent severe recessions
• 10 across-the-board cuts in federal spending in
  2018 and 2022
• Shortage of PCPs With reimbursement cuts,
  Boomer doctors retire if they can

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Scenario 2Primary care
30 integrated systems with capitation and
continuity
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Scenario 2Virtual care expands, at a risk

• Many rely on virtual doctors and low-quality
  digital health coaches
• Drug vendors align with software developers to
  market to their patients
• 3,000 people die from interaction between
  prescription drug and herbal product recommended
  by EconoDoc

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• Comments or questions
• on this scenario?

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Scenario 3Primary care that works for all

• PCMH expansion accelerates, with an expanding
  care team and incentives for quality
• Health Insurance Exchanges prove effective many
  employers drop coverage
• Localized PCP shortages inhibit access

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Scenario 3The Triple Aim

• Three components
• Enhancing patients experience of care
• Reducing per capital healthcare costs
• Improving population health
• Policies address social and economic foundations
  of equitable health, and create healthy
  communities
• If its smart, well pay for it payment
  systems apply sophisticated statistical models to
  large health outcome data sets

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Scenario 3Community-centered health home

• Evolves from PCMH
• Works with community partners to collect data on
  social, economic, and community conditions
• Aggregates health and safety data -
  systematically reviews health and safety trends
• Identifies priorities and strategies with
  community partners and coordinate activity
• Acts as community health advocates
• Mobilizes patient populations
• Strengthens partnerships with local health care
  organizations and establishes model
  organizational practices

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Scenario 3Community health mapping

• Allows CCHHs to
• Identify and mitigate health risks in their
  community
• Intervene in local hot spots of ill health
• Leverage Big Data multiple data repositories
  from multiple sources

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Scenario 3Primary care
Near-Universal Healthcare Coverage
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• Comments or questions
• on this scenario?

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Using the scenarios

• Primary Care 2025 A Scenario Exploration

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Using Scenarios

• Download scenario toolkit at www.altfutures.org/pr
  imarycare2025.
• Includes full-day and half-day workshop agendas,
  instructions, and worksheets.
• See the recommendations in the report. Do you
  agree? What else should be done?

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Key Questions

• What strategies would be effective in each
  scenario?
• What robust strategies would be effective in
  multiple scenarios?
• What are you doing now that would be
  counterproductive in one or more of the
  scenarios?
• Which scenario is most likely? Most preferable?
• What can you do to make the preferable scenario
  more likely?

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Thank you!
Eric Meade Vice President Senior
Futurist Institute for Alternative
Futures 703-684-5880 www.altfutures.org emeade_at_al
tfutures.org