Follow the Yellow Brick Road

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Follow the Yellow Brick Road

• Michael Fine, M.D.
• FMEC
• November 1, 2008

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How we can take an idea everyone hates, throw in
a service everyone takes for granted, dice in a
vision of a health care system we all share, add
a little working togetherand create a health
care system that is affordable, personal,
rational, and just.
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Our failed medical services marketplace

• Most expensive in the world
• Costs 2.3 trillion a year, of which 30-50
  percent is wasted
• Population health outcomes rank us between 25th
  and 75th in the world
• 47 million uninsured
• Huge disparities based on race and income
• Kills 100,000 people a year through errors
• No direct way to improve the public health

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Our hope is primary care

• Improved health outcomes
• Reduced cost 30-50 percent!!!
• Builds local economies and communities
• Provides most medical services people need
• Accessible and affordable
• Consumes less the 6 percent of medical expense
• Promotes relationships, which is what most people
  mean by health.
• A public health system, once everyone is in.

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Roadblocks to a primary health care system for all

• Primary care funding has been controlled by
  insurance companies
• Choking off capital for growth
• Primary care has been Balkanized
• Private practice
• Community health centers
• Academic medicine
• Primary care physicians are shy people
• We invented the health care system that works,
  and then forgot to tell anyone

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The numbers

• Per person per year cost of health care in the US
  6500-7000
• Per person per year cost of health plan
  administration -- 500-1000
• Per person per year cost of primary care
  --200-300

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HELP!!!!!!
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Eyes on the Prize Population-Based Primary Care

• Every person assigned to a primary care practice
• Each primary care practice responsible for the
  primary health care of everyone who lives nearby.

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Imagine

• Having one practice care for 90 percent of a
  communitys health care needs
• That 90 percent of a community uses
• Imagine the grand union of community oriented
  primary care and public health
• Then imagine having a country blanketed with
  these practices.
• Imagine.. A health care system!!!! built from
  the ground up!!!! In these United States!!!!

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Guess What ? we can fix this ourselves!!!!
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Better Together!!!Follow the Yellow Brick Road !

• How can you start with existing primary care
  practice, sprinkle in direct primary care, season
  with an HealthAccess network -- and be able to
  serve up a population-based primary care health
  system for the US?

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Better Together!!!Follow the Yellow Brick Road !

• Primary Care practices offer per patient per
  month primary care.
• Primary Care practices begin to develop pools of
  people looking to purchase high deductible
  insurance.
• We market the value of primary care.
• Health care costs shrink.
• Outcomes improve

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Better Together!!!Follow the Yellow Brick Road !

• We negotiate for high deductible major medical
  insurance
• We create create benefit designs that are serve
  our patients, and are community rated.
• Costs drop, reflecting the cost advantages of
  having a primary care physician

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Better Together!!!Follow the Yellow Brick Road !

• Communities begin to appreciate the value of
  primary care, and begin competing for primary
  care practices.
• We hit an economic downturn, the unemployment
  rate rises to 10 percent, and we go to 25-30
  percent uninsured.

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Better Together!!!Follow the Yellow Brick Road !

• Local government struggles with the cost of its
  own health insurance, which wrecks budgets and
  causes tax increases.
• There is no purchasing mechanism for many people,
  who look to government for help.

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Better Together!!!Follow the Yellow Brick Road !

• Government looks to primary care practices, which
  have experience amalgamating pools of people
  needing high deductible major medical insurance.
• We point out that the purchase of high deductible
  insurance is best achieved by larger pools, pools
  local government can assemble, using the
  population as the denominator.

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The Transition to Population-Based Primary Care.

• Local government partners with us
• to develop population-based primary care
  practice, which, because of advanced access,
  breadth of services, ability to leverage
  community relationships, and chronic disease
  management skills, alone have the ability to help
  contain rising medical cost.

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The Transition to Population-Based Primary Care.

• State and federal government gets into the act,
  providing incentives for public health work
  (outreach, screening, surveillance, the
  elimination of health disparities, prevention and
  chronic disease management)
• State and Federal Government start to build
  specialty polyclinics, to support the work of
  population-based primary care centers, and then
  acquire hospitals, to support the polyclinics.

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The Transition to Population-Based Primary Care.

• Good morning! The US has a health care system.
• And then everyone lives happily ever after, in a
  health care system that is affordable, local,
  personal, rational and just.

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Summary and Conclusions

• Direct primary care
• Provides primary care to people without insurance
• Improves the primary care business model
• Gives us market leverage
• Illustrates the value of primary care to the
  individual and communities.

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Summary and Conclusions

• Direct Practice networks
• Allow us to spread the direct practice business
  model
• Allow us to market the value of primary care in a
  very public way
• Provide the opportunity to consolidate large
  numbers of lives and create savings in insurance
  purchasing
• Allows us to reduce the cost of health care for
  communities.
• Allows us to bring everyone in
• Allows us to build a health care system from the
  ground us

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We have just met the health care system, and the
health care system is.US!!!
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Is this really Possible?
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