Policy assignment
Assignment: Healthcare Options-How Does Your Community Measure Up?
What types of acute and long-term healthcare services are available in your community? Are there gaps in the types of care services available to community residents? What impact do different healthcare services have on the health of individuals and the community as a whole?
Access to a variety of healthcare options is important to the health of a community. Communities that provide a variety of healthcare services are better equipped to meet the health needs of its population. In some communities, the need for some types of services may be a greater because of the characteristics of the population. For example, more long-term care services are needed in communities with a large senior population. In Week 4, you will explore access to health services in more depth.
For this Assignment, you will examine the different types of acute and long-term healthcare services in your community, identifying any gaps in services. You will also explain how these services (or lack thereof) might impact the health of people who live in your community. You will create a PowerPoint (PPT) presentation to present your findings.
To prepare for this Assignment:
Review the Learning Resources related to the acute healthcare facilities and services presented this week (Week 2) and the long-term healthcare facilities and services that will be presented next week (Week 3).
Identify the healthcare (both acute and long-term) facilities and services in your community.
Gather specific information about the different healthcare options that you selected, such as services, coverage, and accessibility
Review U.S. News & World Report’s. “2018Healthiest Communities Rankings,” located in the Learning Resources.
The Assignment
Imagine that you are a member of a community health advocacy group whose mission is to advocate for access to comprehensive, quality healthcare in the community. You have been asked by the group to prepare a presentation for the city council that will describe the communitys current healthcare facilities and services, any gaps in services, and the impact the services or lack of services have on the community.
The presentation should be 6 to 8 slides, not including the title and the reference slides. To complete the presentation, each PowerPoint (PPT) slide (except the title, objectives, and references slides) should contain talking points in the Speaker Notes section of the PPT that act as a narration script for the slides. The talking points should be written as if they were going to be read word for word during the presentation while displaying the slides. You should also include information about your communitys health rankings using the U.S. News & World Reports “2018 Healthiest Communities Rankings” interactive website.
It is not necessary to provide a recorded audio narration as part of the Assignment.
Tutorials on how to create a PowerPoint presentation and add to the Speaker Notes section can be found in the University Writing Center and in the Learning Resources.
Title slide
Title of the presentation, your name, and the date.
Presentation objectives: (1 slide)
Include 2 3 SMART objectives (Specific, Measurable, Attainable, Relevant, and Timely).
Part 1: Acute Care Facilities (2 3 slides)
Provide acute care options-traditional and alternative-in your community. Categorize the care options instead of naming specific facilities or services. For example, most communities have multiple PCPs. Dont list each provider. Instead, for example, state that there are five PCPs, two hospitals, three urgent care clinics, etc.
Provide specific, useful information about each type of facility or service, including what they offer, coverage options, and accessibility.
Explain the importance of acute care facilities and services on individual and community health. Address both acute and chronic health conditions and provide examples.
Provide talking points in the Speaker Notes section of the PowerPoint.
Cite and reference content in the slides and in the Speaker Notes section.
Part 2: Long-Term Facilities (2 3 slides)
Provide the long-term care options in your community. Similar to the way you presented acute care options, categorize the care options instead of naming specific facilities or services.
Provide specific, useful information about each facility or service, including what they offer, coverage options, and accessibility.
Explain the importance of long-term care facilities and services on individual and community health. Address both acute and chronic health conditions and provide examples.
Provide talking points in the Speaker Notes section of the PowerPoint.
Cite and reference content in the slides and in the Speaker Notes section.
Part 3: Gaps in Healthcare Services and Recommendations (1 2 slides)
Describe any gaps in healthcare services in your community and then explain the impact those gaps may have on individual and community health. NOTE: If you cannot identify any gaps in your community, you still need to suggest specific healthcare services that would be beneficial to your community (see next bullet).
Suggest specific services that you think would help fill the gaps.
Include your communitys health rankings from the U.S. News & World Reports “2018 Healthiest Communities Rankings” interactive website.
Provide talking points in the Speaker Notes section of the PowerPoint.
Part 4: References
Support your content with the Learning Resources and at least one outside scholarly source.
If you use images from the Internet, you must cite and reference those as well.
All in-text citations and references must follow APA style guidelines.
By Day 7 of Week 3
Submit your Assignment.
Links for the assignment:
https://www.sciencedirect.com/science/article/abs/pii/S0091743514002187?via%3Dihub
https://www-ncbi-nlm-nih-gov.ezp.waldenulibrary.org/pmc/articles/PMC4838716/
https://www.beckershospitalreview.com/hospital-management-administration/five-factors-that-are-changing-healthcare-in-2017.html
https://www.ncsl.org/research/health/retail-health-clinics-state-legislation-and-laws.aspx
https://www.cardinalhealth.com/en/essential-insights/the-changing-culture-of-healthcare-delivery.html
https://www.usnews.com/news/healthiest-communities/rankings
https://www.jahonline.org/article/S1054-139X(16)30353-6/fulltext
http://thecaregiverfoundation.org/wp-content/uploads/2018/03/Guide-to-choosing-a-Nursing-Home-Long-Term-Care-setting.pdf
https://longtermcare.acl.gov/index.html
https://www.payingforseniorcare.com/types
https://www.ahcancal.org/Pages/Default.aspx
https://class.content.laureate.net/8ee5e67c8bb74aac7d8e41d4c08e0f2d.pdf
http://www.takingcareofmomanddad.net/nursinghomes/descriptionservices/levelsofcare.html
https://www.ahcancal.org/Pages/default.aspx
https://www.youtube.com/watch?v=LzCW4P52UmE Week 2: A Changing Healthcare Delivery System
The healthcare landscape is changing.
How we pay for healthcare is shifting from a volume-based to
a value-based payment model.
Healthcare is moving away from a hospital- and provider-centered care model to
a patient-centered care model.
Perhaps you have read or heard statements like these in the news or in one of your other courses at Walden. Or, perhaps youve had conversations with family, friends, or coworkers about one or more of these topics. So what does it all mean? How is healthcare reform impacting the way patients receive care and providers deliver care? What roles do major healthcare payers, such as the federal government and large health insurance companies, play in a changing healthcare delivery system? And, what role does healthcare policy play in all of this? Finding answers to these questions begins this week.
This week, you will examine how the delivery of healthcare is changing, including emerging alternative acute care delivery models, their impact on people with acute and chronic health issues, and how policy has driven this change. You will also begin to gather information about healthcare in your community for your first Assignment, which is due in Week 3.
Week 3: Long-Term Care
Frank and his wife, Julie, have noticed a steady decline in his mothers ability to live independently. Over the past two years, his mothers physical and mental health have declined. She requires more frequent visits to the doctor and, about 15 months ago, she fell and broke her wrist. Although she healed from the fall, Frank and Julie, who live nearby, are finding it increasingly difficult to provide her with the type of care she needs. They realize that it might be time for her to receive long-term care. To prepare for the conversation with his mother, Frank and Julie gather information about different long-term care options. Realizing that her options are limited because of financial issues, they do their best to select facilities and services that she qualifies for and/or can afford.
Franks story is not uncommon. Each day through 2029, 10,000 baby boomers turn 65 (Landau, 2017). Among those turning 65, an estimated 70% will require long-term care in their lifetime (LongTermCare.gov, 2017).
Long-term care encompasses a variety of care services, both medical and non-medical for individuals with a chronic illness or disability. Many health conditions can require long-term care, regardless of the patient’s age. However, seniors are by far the largest consumers of long-term care.
This week, you will examine how changes in policy have impacted practice in long-term care settings. You will also explore alternatives to traditional long-term care and discuss your ideal long-term care plan with your colleagues. Finally, you will put the finishing touches on your first Assignment and then submit it at the end of the week.
References:
Landau, J. (2017, October 3). Health care dilemma: 10,000 baby boomers are now retiring each day. Retrieved from https://www.cnbc.com/2017/10/03/health-care-dilemma-10000-boomers-retiring-each-day.html
LongTermCare.gov. (2017). How much care will you need? Retrieved from https://longtermcare.acl.gov/the-basics/how-much-care-will-you-need.html EDITORIAL AND COMMENT
Retail Clinics Shine a Harsh Light on the Failure of Primary Care
Access
David M. Levine, MD, MA and Jeffrey A. Linder, MD, MPH, FACP
Division of General Internal Medicine and Primary Care, Brigham and Womens Hospital and Harvard Medical School, Boston, MA, USA.
J Gen Intern Med 31(3):2602
DOI: 10.1007/s11606-015-3555-4
Society of General Internal Medicine 2015
R etail clinics, which are usually located inside retail phar-macies, provide walk-in care mainly for low-acuity prob-
lems. Retail clinics have transparent pricing and are staffed by
nurse practitioners or physician assistants. Since first opening
in the United States in 2000, retail clinic use has grown rapidly
but remains small: the proportion of families that reported
using a retail clinic in the prior year increased from 1 % in
2007 to 3 % in 2010.1 Retail clinics have obvious appeal as
low-cost, accessible sites of care.
Much has been written about the potential promises and
perils of retail clinics.24 For privately insured, healthy,
wealthy, young patients, retail clinics likely provide similar
quality and lower cost compared to primary care offices for
otitis media, pharyngitis, and urinary tract infections without
detracting from short-term preventive care.5 Antibiotic pre-
scribing is more guideline-concordant at retail clinics than in
primary care offices or emergency departments.6,7 Retail
clinics may be associated with reduced costs.8 On the other
hand, retail clinics have been found to impair continuity and to
reduce seeking care with a primary care practice when a new
problem arises.9 Little is known regarding retail clinic perfor-
mance for underserved, older, sicker patient populations.
Retail clinics strive to provide fast access for patients, and
are themselves experimenting with new models of care to
improve their service. In this issue of the Journal of General
Internal Medicine, Polinski and colleagues from CVS
MinuteClinic describe a cross-sectional quality improvement
assessment of retail clinic-based telehealth.10 Patients with
specific symptoms, mostly acute respiratory infections, who
might have to wait for an in-person practitioner for more than
20 minutes, were given the option to have their care provided
by a remote practitioner assisted by an onsite nurse.
The authors estimated that 40 to 54 % of telehealth patients
completed a post-visit survey (n=1734). Respondents were
mostly insured (80 %), female (70 %), and had a primary care
provider (59 %). For half, it was their first visit to a
MinuteClinic. Thirty-two percent of respondents expressed a
preference for receiving care via telehealth versus a
traditional in-person visit. The vast majority of users were
highly satisfied with nearly all attributes of their experience.
Respondents who lacked health insurance were significantly
more likely to prefer telehealth visits. Women, those who
believed they had a good understanding of telehealth, and
those who were satisfied with the convenience of telehealth
all had higher odds of liking telehealth. Over 70 % of respon-
dents would use telehealth again and would recommend
telehealth to someone else.
Polinski and colleagues should be congratulated for study-
ing an innovative approach to improving low-acuity care
delivery. A virtual network of clinicians who need only the
assistance of a nurse assistant and specialized internet-
connected tools could represent an improvement on an
expanding model of care.
Yet this study highlights a concern about retail clinics: they
create demand for unnecessary services. Telehealth facilitated
visits for sinusitis, upper respiratory infections, bronchitis,
allergic rhinitis, influenza, and conjunctivitis. These visits
may be unnecessary and have the potential to stimulate un-
necessary follow-up care.3 Retail clinics currently have no
incentive to discourage unnecessary care. In fact, retail clinics
may view these visits as easy, quick, and desirable and might
fear that patients would leave if kept waiting for too long.
Good continuity of care and effective pre-visit triage could
have prevented many of these visits.
In a perfect world, all patients would have a usual source of
care; be able to easily connect with their own primary care
practice; receive triage advice; and practices would provide
prompt, efficient advice and service. Comprehensive primary
care is associated with lower cost, improved health outcomes,
greater efficiency, and reduced disparities. All else being
equal, patients would choose to get care from a primary care
practice that knows them, is easily accessed, and will follow
them over time.
Clearly, we do not live in that world. Primary care is not
optimally structured or incentivized to provide accessible care.
According to the Commonwealth Fund, 73 % of Americans
responded that it was difficult to make timely doctors ap-
pointments, get phone advice, or receive after-hours care
without having to visit the emergency room. Retail clinics,
urgent care centers, and commercial online care are all under-
standable responses to primary care that is inefficient, costly,
and inaccessible. These new models of care reflect the failure
of primary care to provide access.Published online December 2, 2015
260
JGIM
http://crossmark.crossref.org/dialog/?doi=10.1007/s11606-015-3555-4&domain=pdf
Those of us in primary care should take note. CVS
MinuteClinic feels that 20 minutes is too long to wait. They
are innovating to increase access. Can primary care practices
stand the harsh light shone by this delivery innovation? Can
primary care practices learn, innovate, and radically improve
access?
Radical improvement in access must be accompanied by
radically improved efficiency. If a transaction presently takes
place on paper or over the phone, we need to automate it when
possible, switch it to the web, and optimize it for mobile. We
need to move most communication to secure, usable web
portals that are aggressively promoted and monitored. We
need to provide chronic disease management through a com-
bination of registry analytics, group visits, community health
workers, synchronous and asynchronous e-visits, and tradi-
tional in-person visits. For our high-utilizer and homebound
patients, we need to make house calls, a practice we gave up
only due to now-archaic financial and technological con-
straints. A single urgent care episode should be able to seam-
lessly and promptly be transformed, as needed, from an asyn-
chronous e-visit to a synchronous e-visit to an in-person visit
with the primary care practice or involvement of an emergency
department. Illness does not end for patients when they hang
up the phone or walk out of the office; care should not stop
when clinicians sign their notes. Practices should provide
extended and weekend hours. Improved access and efficiency
should improve the patient experience. Visits in which either
the patient thought it was a waste of time or clinicians felt
the patient didnt really need to come in for that should be
viewed as triage failures.
Primary care physicians days should look radically differ-
ent. Although there is simplicity and comfort in seeing patients
in-person, one-after-another, it is inefficient for the physician,
the practice, and the patient. We can connect with many more
of our patients if we are spending more of our time not seeing
our patients in person. There will be more structured e-visits to
review, video calls to make, teams to facilitate, and panels to
manage with proactive outreach and follow-up.
There has been progress and new resources are available.
Many health systems schedule phone visits and desktop
time. The American Medical Associations stepsforward.org
and UCSFs Center for Excellence in Primary Care both have
turn-key approaches to optimizing the busy primary care
practice. They describe pre-visit laboratory testing, synchro-
nized prescription renewal, team documentation, and panel
management techniques. Despite these and others, additional
innovation is sorely needed.
How will we pay for these changes? Health systems in-
centives to support these innovations are becoming aligned
with the passage of the Affordable Care Act and the expansion
of Accountable Care Organizations. Medicare has already
moved this direction with the Chronic Care Management
Program. Many private insurers, recognizing value and patient
demand, are moving to cover innovative care.
There will be plenty of practice innovations to implement,
research to be done, and questions to ask. Can we deliver care
that is equally effective over the internet as in-person? What is
the optimal telehealth configuration? What is the ideal level of
continuity that balances efficiency with outcomes and patient
experience? Are there subgroups of patients who benefit most
from telehealth treatment? Are there subgroups of patients
who might potentially be left behind such as the underserved,
elderly, and sickest? We need to demonstrate that new, proac-
tive methods of delivering care can benefit our most vulnera-
ble patients.
Primary care practices and clinicians should view visits to
emergency departments, retail clinics, or urgent care centers as
sentinel events. What was it about our own practice that made
seeking care away from primary care necessary? Viewed from
a more global, financial perspectiveand to paraphrase
Rushika Fernandopulle of Iora Healthprimary care accounts
for 4 % of healthcare spending in the United States; how much
of the remaining 96 % represents a failure of primary care?
What would primary care look like if it received 10 % of
spending?
Ultimately, we look forward to the implementation of
models with radically improved efficiency and access that
could realize the benefits of comprehensive primary care. We
do not begrudge the existence of retail clinics, urgent care
clinics, or online care companies. They shine a harsh light
on primary cares failings. We should look where that light
shines brightest and innovate toward doing better for patients.
Corresponding Author: Jeffrey A. Linder, MD, MPH, FACP; Division
of General Internal Medicine and Primary Care, Brigham and
Womens Hospital, 1620 Tremont Street, BC-3-2X, Boston, MA
02120, USA (e-mail: [emailprotected]).
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Retail Clinics Shine a Harsh Light on the Failure of Primary Care Access
REFERENCES
