The Concept

Quality Healthcare

Cost Savings

Easy Access

New Model That Works

Drop In Clinic
By Phone

Overview

Convergence

Flow Chart

Trend Charts

FAQ

Challenges Solutions

Case Studies

Advisory Board

Cost Effective Quality Health Care

A major problem and an unmet need in the United States health care system today is the lack of easy access to timely medical decision support and continuity of decision support and care. Our model provides 24/7 quality decision support with one stop shopping This is achieved thru an adaptation of a multispecialty clinic without walls. An expert- talking with patient on phone- can quickly make most diagnoses without tests or treatment. Then best direction can be selected by patient and local provider.. Open access by telephone conferencing and other methods is provided to patients and providers. Synchronous and asynchronous scheduling is made available. This helps decrease fragmentation problems in healthcare delivery.

The patient-consumer must be actively involved. Potentially costly and chronic conditions can frequently be identified (and diagnosed) at first healthcare provider contact with phone conferencing and other methods. We combine accepted best practices with live and scheduled phone conferencing between patient, local provider and expert. This is made cost effective by efficient use of developed techniques of screening , virtual offices, call centers eic -modified in our model.. The cascade of wastes is thus markedly reduced. Arrangements for continuity and timely corrective feedback assure reliable outcome studies of results- health and economic. Waste now accounts for more than half the healthcare budget .Incorporating assured and repeated rewards for patient and provider -the motivation for change is present .. This results in lower costs to all payers- corporate, health insurers, individual, and government .Some behavior changes will be necessary to implement this solution. A proactive case manager using a grand-rounds approach is one of many innovations to integrate.

Case examples

A lady in her 30s with recurrent abdominal cramps, vomiting over several years, had upper GI, barium enema, various oral medications, ten office visits to internist and seven to a psychiatrist (stress reaction diagnosis). Symptoms continued. With our system, an initial, brief screening history done at her doctor's office and then an examination was followed with interactive FAX screening questionnaires from gastroenterologist. This identified possible lactose intolerance promptly. She responded to dietary restrictions.

A 50-year old lady with two-year history of mild left sided weakness and chest pressure. Three hospitalizations in intensive care and coronary care units with extensive evaluations over a total of 18 days. No cardiac disease found. Symptoms of periodic dizziness, depression and passing out, persisted. MRI of the head revealed small, old stroke. Two years after onset, with our methodology electroencephalogram revealed seizure activity and she improved promptly with seizure medication treatment. With our system, phone conferencing with a neurologist, internist and patient would have led to diagnosis before or at first hospital admission.

Corporate and public interest identified

We have met with the benefit managers of Cisco Systems, SBC, Charles Schwab, public leaders and people in many walks of life. All are very interested and would like to participate in a pilot program. The insurance companies also indicated interest-if the demand comes from one or more major self insured corporations. The provider
multispecialty clinic groups indicated great interest and recognized this model would provide better quality care at less cost. Individuals and public leaders requested this model and couldn't understand -why it isn't available now. Some government leaders also think the model should be started by private industry- then adopted by others.. The military- Walter Reed leaders- are hung up on asynchronous communication.

Why hasn't model been adopted-concerns expressed.

Many of each group agree with our model. The challenge is integration and collaboration.
An experienced large organization is needed to work with the political, social and economic issues. Most of the fragmented efforts at change are programmed for failure.

Providers:-individual and large multispecialty clinic. No provisions for adequate pay for time for phone-conferencing , e-mail etc. Individuals fear loss of control of care.
Self -insured corporations: decision makers do not understand value of this approach and have deferred to health insurance carriers to provide a pilot and savings projections
Health insurance companies senior staff-some do not understand model- others project a shift of budget and control away from them when this model becomes implemented Therefore give other excuses not to test program Junior staff are overwhelmed with issues of HIPPA ( govt. regulations), coding for payment, legal hurdles and fear of job loss when criticizing policy. Academics are concerned about shift of power and control of resources to public and other changes taking place in healthcare.

Value to large organizations
Have staff with the ability to understand the total picture and its components -national and local, the competing forces, conflicting and fragmented programs. Then the staff can assist in the adaptation of our model to local and corporate needs .An experienced management group is needed to achieve this application.
:
1) Help package the ideas for good communication -better blending of technology and brain power--for prompt access and diagnosis. This value added benefit (defined contribution) salable to corporate groups or individuals. Ex.-help network individuals, hospital or clinic group grand rounds with participating providers .Adapt model for better ways of using call centers and web based consultation. We have some solutions to the legal issues posed.
2) Guide collaboration and team building to assist with linkages between individuals, community and corporate groups .to share resources.
3) Provide a neutral coordinating and even handed management to links between self -insured corporations and health insurers.
4) Program -benefits -can be available locally and as needed at distant sites. Help decrease health related loss of work time.
5) Analyze costs -before and after of using this model

The value to large organization is in adding to it's portfolio of solutions

1)Lead group could take a percentage of savings from self-insured corporations and health insurers.
2) Revenue flow will come from information-exchange technology in the system (participants, digital persona, human coordinators, virtual offices, government healthcare budgets and educational components.)
3) Employees of initiating group- will receive better benefits using this model

My interest and role in implementing this model

1) Genuine interest and satisfaction in helping fellow man
2) Conviction that this model makes sense and will be useful
3) Request role in implementing model to try and assure value to public
4) Request consulting fees for work I do.

PILOT STUDY - fast, low-cost

These are a few of the specifics we can include in an action plan developed with the corporate group or health plan involved. This approach will demonstrate improved quality care, better use of resources, savings, as well as improved satisfaction of patients and providers. Some detail follows.

Piggy back on existing infrastructure which is adapted to needs of pilot at low cost.
Select a group of patients who have demonstrated high costs, have wound up in litigation or arbitration, or a group who have complex, controversial, and chronic problems. Examples include: 1. Patients who have industrial accidents with the following cluster - low-back symptoms - depression - litigation. 2. Patients with seizure problems.
3. Patients with endocrine problems. Then using the health plan or corporate groups database we can identify ways of easily and proactively screening and identifying such patients before they get into extended and unneeded diagnostic and treatment cycles.

It is possible using a flow-chart model as illustrated to apply approach.

The providers participating should be assisted in being accessed without the frequent unreasonable delays of hospital switchboards and some answering services.(one quick call to call center)We can arrange a 24/7 call center.

Providers limited to those who want to participate in pilot. The providers would be asked to indicate scheduled times as well as urgent response times that they will be available within fifteen minutes. The "voluntarily participating healthcare providers" would have a reasonable reimbursement schedule guaranteed. As much of the participating providers time could be scheduled to coincide with their regular work activities - one does not have to incur major increased additional start-up salaries and fees.

It is important that the participating providers be involved in the initial planning. Also, to the extent possible the patients and local providers retain control and utilize the usual referral patterns.

Many other details are available and these include ways of using minimal data sets, rules of thumb, simple patient and provider scored health trend charts, clinical guidelines, web-based technology, etc.