Exploring Innovative, Alternative Healthcare Models in the US

2020 ◽  
pp. 21-42
Author(s):  
Raj Selladurai ◽  
Roshini Isabell Selladurai ◽  
George VandeWerken
Keyword(s):  
Primary Care ◽  
Healthcare Cost ◽  
Primary Care Physicians ◽  
Healthcare Services ◽  
Wellness Program ◽  
Faith Based ◽  
Partnership Model ◽  
The Us ◽  
Direct Primary ◽  
Patient Retention

This chapter explores, discusses, analyzes, and presents some recommendations for new, innovative alternative healthcare models to the traditional insurance and healthcare models that currently exist. These include a revised and enhanced hybrid model of healthcare; healthcare cost-sharing faith-based model; healthcare cost-reduction corporate partnership model (for example, Amazon, Berkshire Hathaway, and JPMorgan Chase partnership); direct primary care model; and wellness program model including subscription type payment services, concierge medicine services, networks of primary care physicians providing patient retention, personalized medicine, and preventive care (MD VIP for example). Significant outcomes such as lowering healthcare costs, enhancing the quality and delivery of healthcare services, improving patient satisfaction, and promoting overall sustainability are addressed, including their implications for various stakeholders.

scholarly journals Practices and perspectives of primary care physicians in Japan and the United States about diagnosing dementia: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M. Abe ◽  
S. Tsunawaki ◽  
M. Dejonckheere ◽  
C. T. Cigolle ◽  
K. Phillips ◽  
...  
Keyword(s):  
Primary Care ◽  
Early Intervention ◽  
Advance Directives ◽  
Primary Care Physicians ◽  
Long Term Care ◽  
Term Care ◽  
Care Services ◽  
The Us ◽  
Diagnosis Of Dementia

Abstract Background While dementia is a common problem in Japan and the US, primary care physicians' practices and perspectives about diagnosing dementia in these different healthcare systems are unknown. Methods Qualitative research was conducted in an ethnographic tradition using semi-structured interviews and thematic analysis in primary care settings across Japan and in the Midwest State of Michigan, US. Participants were a total of 48 primary care physicians, 24 each from Japan and the US participated. Both groups contained a mixture of geographic areas (rural/urban), gender, age, and years of experience as primary care physicians. Results Participants in Japan and the US voiced similar practices for making the diagnosis of dementia and held similar views about the desired benefits of diagnosing dementia. Differences were found in attitudes about the appropriate timing of formally diagnosing dementia. Japanese physicians tended to make a formal diagnosis when problems that would benefit from long-term care services emerged for family members. US physicians were more proactive in diagnosing dementia in the early stages by screening for dementia in health check-ups and promoting advance directives when the patients were still capable of decision-making. Views about appropriate timing of diagnostic testing for dementia in the two systems reflect what medical or nursing care services physicians can use to support dementia patients and caregivers. Conclusions Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US. Testing to establish an early diagnosis of dementia by primary care physicians only partly relates to testing and treatment options available. Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US.

Significant decline in cancer diagnostic testing in U.S. CMS population during the COVID-19 pandemic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6536-6536
Author(s):  
Dave Smart ◽  
Peter Riccelli ◽  
Keith Kerr ◽  
Jordan Clark ◽  
Susanne Munksted Fosvig ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Diagnosis ◽  
Primary Care Physicians ◽  
Diagnostic Testing ◽  
Delayed Diagnosis ◽  
Cancer Control ◽  
Unintended Consequences ◽  
Initial Diagnosis ◽  
Test Volume ◽  
The Us

6536 Background: The COVID-19 pandemic has caused >400,000 infection related deaths in the US to January 2021. Actions taken to limit COVID-19 infection and mortality could potentially lead to unintended consequences, precipitating excess mortality due to other causes. One such cause is delayed cancer diagnosis. Significant decreases in presentation for cancer diagnosis at the primary care level have been noted in the UK. This study aimed to look for evidence of a similar effect in the US. Methods: CMS claims data from JAN18-JUN20 associated with primary diagnosis across 11 cancers (bladder, breast, cervical, colorectal, endometrial, lung, ovarian, pancreatic, prostate, sarcoma and thyroid) were analyzed for use of surgical pathology (SP), a procedure associated with initial diagnosis, and immunohistochemistry (IHC). Test volumes varied widely by test and cancer so were normalized to enable comparison across indications. This was done by dividing the month-on-month difference for the period JAN19-JUN19 vs JAN20-JUN20 by the median monthly test volume for the period JAN18-DEC19 (“pre-COVID period”). Extent and duration of declines in test rates and number of missing patients as the sum of these declines were then determined. The ratio of IHC to SP testing was taken to determine any decline in likely post-initial diagnosis testing. Results: There were significant (>10%) declines in test volumes for SP for all 11 cancers at some time in Q1-Q2 2020. Table. Extent, duration and return to pre-COVID levels for SP testing across 11 cancers Median extent and duration of the decline was 56% (range 41.1%-80.4%) and 2 months (range 1- >4). This equates to 32,192 missing diagnoses across all cancers. SP test volumes for all cancers except lung and breast had returned to around pre-COVID levels by JUN20. There was no significant (>10%) increase in normalized SP test volume after the COVID dip for any cancer. While SP showed decreased test volumes across all cancers at some point during the first half of 2020, test volume ratios of IHC to SP showed increases for most cancers in the same time period. Conclusions: These data highlight that the decline in patients presenting to their primary care physicians with suspicion of cancer for diagnostic investigation was linked to COVID-19 prevention strategies. No evidence for increased, “catch up” testing to address presentational/diagnostic backlog was observed. Thus, it is predicted that these patients may subsequently present with a more advanced cancer. Potential excess morbidity, mortality and cost associated with absent or delayed diagnosis should be factored into cancer control programs going forward.[Table: see text]

scholarly journals Screening Colonoscopy in the US: Attitudes and Practices of Primary Care Physicians

2012 ◽  
Vol 27 (9) ◽  
pp. 1150-1158 ◽  
Author(s):  
Jane Zapka ◽  
Carrie N. Klabunde ◽  
Stephen Taplin ◽  
Gigi Yuan ◽  
David Ransohoff ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Screening Colonoscopy ◽  
Attitudes And Practices ◽  
The Us

scholarly journals Work stress of primary care physicians in the US, UK and German health care systems

2010 ◽  
Vol 71 (2) ◽  
pp. 298-304 ◽  
Author(s):  
Johannes Siegrist ◽  
Rebecca Shackelton ◽  
Carol Link ◽  
Lisa Marceau ◽  
Olaf von dem Knesebeck ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Work Stress ◽  
Primary Care Physicians ◽  
Health Care Systems ◽  
German Health ◽  
The Us ◽  
Care Systems

scholarly journals Perspectives and Approaches of Primary Care Physicians on Diagnosing Dementia– a Qualitative Japan – United States Comparison Study

2021 ◽  
Author(s):  
Michiko Abe ◽  
Shinji Tsunawaki ◽  
Melissa DeJonckheere ◽  
Christine T. Cigolle ◽  
Kristin Phillips ◽  
...  
Keyword(s):  
Primary Care ◽  
Advance Directives ◽  
Primary Care Physicians ◽  
Long Term Care ◽  
Qualitative Comparison ◽  
Term Care ◽  
Care Services ◽  
The Us ◽  
Diagnosis Of Dementia

Abstract Background: To explore the perspectives and approaches of primary care physicians in Japan and the US on diagnosing dementia.Methods: Qualitative comparison conducted in ethnographic tradition using semi-structured interviews and thematic analysis. Primary care settings across Japan and in the Midwest State of Michigan, US. Participants were a total of 48 primary care physicians, 24 each from Japan and the US participated. Both groups contained a mixture of the practice area (rural/urban), gender, age, and years of experience as a primary care physician. Results: Participants in Japan and the US voiced similar approaches for making the diagnosis of dementia and held similar views about the desire benefits of diagnosing dementia. Differences were found in attitudes about the appropriate timing of formally diagnosing dementia. Japanese physicians tended to make a formal diagnosis when problems that would benefit from long-term care services emerged for family members. US physicians were more proactive in diagnosing dementia in the early stages by screening for dementia in health check-ups and promoting advance directives when the patients were still capable of decision-making. Views about appropriate timing of diagnostic testing for dementia in the two systems reflect what medical or nursing care services physicians can use to support dementia patients and caregivers.Conclusions: Testing to establish an early diagnosis of dementia by primary care physicians only partly relates to testing options available. Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US.

scholarly journals The provision of promotive and preventative healthcare services by private primary care physicians in the era of the national health insurance program

2017 ◽  
Vol 5 (2) ◽  
pp. 140
Author(s):  
Ketut Ary Diana Artha ◽  
Ketut Suarjana ◽  
Pande Putu Januraga
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Primary Care Physicians ◽  
Healthcare Services ◽  
Qualitative Approaches ◽  
Inhibiting Factors ◽  
Preventative Healthcare ◽  
Preventative Services

Background and purpose: In addition to their duties in addressing the curative and rehabilitative needs of the community, private primary care physicians (PCP) play an important role in providing promotive and preventative healthcare services. This study aims to determine the behaviours, enabling and inhibiting factors involved with the provision of promotive and preventative services by PCP in the era of national health insurance (JKN) implementation.Methods: This research is a mix method study using a combination of quantitative and qualitative approaches. Quantitative surveys were conducted with all PCPs already in working collaboration with the Social Security Administering Agency (BPJS) in the Denpasar City area (61 people). Data analysis techniques used descriptive techniques in order to explore the kinds of promotion and preventative services provided by PCPs. Qualitative research was conducted through in-depth interviews of 8 informants selected by purposive sampling and analyzed thematically to discover the enabling and inhibiting factors of the provision of promotive and preventative services by PCPs.Results: The results showed that 91.8% of PCPs did perform promotive and preventative services in their practice site. PCPs who did not carry out promotive and preventative services demonstrate perceptions, beliefs and motivations categorized as low and weak as well as attitudes that do not support the implementation of such services. Enabling factors of promotion and preventative services by PCPs, include among others, quality of facilities and infrastructure, the receipt of awards from BPJS and capitation systems that benefit physicians financially. Inhibiting factors include a low willingness of the patient to carry out doctor's advice, limitations in the PCPs work time and limited funds to perform preventative/promotive services.Conclusions: Promotive and preventative services are not being optimally carried out by PCPs in Denpasar. This is due to the low willingness of the patients, the limited time of the doctor, and the limited allocated funds for promotive and preventative services and low capitation.

scholarly journals US Primary Care in 2029: A Delphi Survey on the Impact of Machine Learning

2020 ◽  
Author(s):  
Charlotte Blease ◽  
Anna Kharko ◽  
Cosima Locher ◽  
Catherine M. DesRoches ◽  
Kenneth D. Mandl
Keyword(s):  
Primary Care ◽  
Health Informatics ◽  
Primary Care Physicians ◽  
Response Rate ◽  
Digital Health ◽  
Training Requirements ◽  
Modified Delphi ◽  
Primary Care Workforce ◽  
The Us ◽  
The Impact

AbstractObjectiveTo solicit leading health informaticians’ predictions about the impact of AI/ML on primary care in the US in 2029.DesignA three-round online modified Delphi poll.ParticipantsTwenty-nine leading health informaticians.MethodsIn September 2019, health informatics experts were selected by the research team, and invited to participate the Delphi poll. Participation in each round was anonymous, and panelists were given between 4-8 weeks to respond to each round. In Round 1 open-ended questions solicited forecasts on the impact of AI/ML on: (1) patient care, (2) access to care, (3) the primary care workforce, (4) technological breakthroughs, and (5) the long-future for primary care physicians. Responses were coded to produce itemized statements. In Round 2, participants were invited to rate their agreement with each item along 7-point Likert scales. Responses were analyzed for consensus which was set at a predetermined interquartile range of ≤ 1. In Round 3 items that did not reach consensus were redistributed.ResultsA total of 16 experts participated in Round 1 (16/29, 55%). Of these experts 13/16 (response rate, 81%), and 13/13 (response rate, 100%), responded to Rounds 2 and 3, respectively. As a result of developments in AI/ML by 2029 experts anticipated workplace changes including incursions into the disintermediation of physician expertise, and increased AI/ML training requirements for medical students. Informaticians also forecast that by 2029 AI/ML will increase diagnostic accuracy especially among those with limited access to experts, minorities and those with rare diseases. Expert panelists also predicted that AI/ML-tools would improve access to expert doctor knowledge.ConclusionsThis study presents timely information on informaticians’ consensus views about the impact of AI/ML on US primary care in 2029. Preparation for the near-future of primary care will require improved levels of digital health literacy among patients and physicians.

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