Optimizing Health Care Delivery by Integrating Workplaces, Homes, and Communities

Abstract

EXECUTIVE SUMMARY In recent years, the health care reform discussion in the United States has focused increasingly on the dual goals of cost-effective delivery and better patient outcomes. A number of new conceptual models for health care have been advanced to achieve these goals, including two that are well along in terms of practical development and implementation—the patient-centered medical home (PCMH) and accountable care organizations (ACOs). At the core of these two emerging concepts is a new emphasis on encouraging physicians, hospitals, and other health care stakeholders to work more closely together to better coordinate patient care through integrated goals and data sharing and to create team-based approaches that give a greater role to patients in health care decision-making. This approach aims to achieve better health outcomes at lower cost. The PCMH model emphasizes the central role of primary care and facilitation of partnerships between patient, physician, family, and other caregivers, and integrates this care along a spectrum that includes hospitals, specialty care, and nursing homes. Accountable care organizations make physicians and hospitals more accountable in the care system, emphasizing organizational integration and efficiencies coupled with outcome-oriented, performance-based medical strategies to improve the health of populations. The ACO model is meant to improve the value of health care services, controlling costs while improving quality as defined by outcomes, safety, and patient experience. This document urges adoption of the PCMH model and ACOs, but argues that in order for these new paradigms to succeed in the long term, all sectors with a stake in health care will need to become better aligned with them—including the employer community, which remains heavily invested in the health outcomes of millions of Americans. At present, ACOs are largely being developed as a part of the Medicare and Medicaid systems, and the PCMH model is still gathering momentum and evolving among physicians. But, the potential exists for implementation of both of these concepts across a much broader community of patients. By extending the well-conceived integrative concepts of the PCMH model and ACOs into the workforce via occupational and environmental medicine (OEM) physicians, the power of these concepts would be significantly enhanced. Occupational and environmental medicine provides a well-established infrastructure and parallel strategies that could serve as a force multiplier in achieving the fundamental goals of the PCMH model and ACOs. In this paradigm, the workplace—where millions of Americans spend a major portion of their daily lives—becomes an essential element, next to communities and homes, in an integrated system of health anchored by the PCMH and ACO concepts. To be successful, OEM physicians will need to think and work innovatively about how they can provide today's employer health services—ranging from primary care and preventive care to workers' compensation and disability management—within tomorrow's PCMH and ACO models. INTRODUCTION AND BACKGROUND Today, the American health care system faces enormous and growing challenges. Health care costs in the United States, already highest in the world, continue to spiral upward. An estimated 50 million Americans are uninsured and Medicare and Medicaid face huge financial issues that threaten their long-term stability. Chronic health conditions are on the rise across all age groups, with more than 50% of Americans having at least one chronic health condition.1 Millions of baby boomers are retiring, placing new strains on the nation's health care infrastructure at a time when the shortage of physicians in the United States is projected to reach 62,000 by 2015 and 130,000 by 2025.2 Those workers who remain in the system, increasingly beset by chronic disease, have a greater likelihood of needing to access social security disability and Medicare before retirement age, potentially weakening the nation's work capacity even more. In response to the dual problems of increased costs and the growth of the nation's uninsured population, Congress passed and the President signed into law in 2010 the Affordable Care Act (ACA), a massive federal bill with wide-ranging mandates.3 Although much of the law has the practical intent of simply extending insurance coverage to those who are currently uninsured, it also has a number of provisions intended to fundamentally transform the way care is are for to the adoption of health and to more these strategies is a new emphasis on encouraging physicians, hospitals, and other health system stakeholders to work together in new to better coordinate care, a more team-based approach to health This approach aims to achieve better health outcomes at lower cost. models of care, in are the The a that emphasizes the central role of primary care and facilitation of partnerships between patient, physician, family, and other caregivers, is on a that care integrated across all of the health care system and hospitals, care and nursing with a community care in a that is and in which their health care and are well A number of organizations have been of the including the American of American of American of and American Accountable Care a care model that physicians and hospitals more accountable in the care system, emphasizing organizational integration and efficiencies coupled with outcome-oriented, performance-based medical strategies to improve the health of is meant to improve the value of health care services, controlling costs while improving quality as defined by outcomes, safety, and patient experience. the medical home as a central in a spectrum of health care approaches in among organizations that the of the for the development of ACOs the Medicare system have been by the federal to their The between PCMH and ACOs is a that integration and of health care services, with a new emphasis on care value and a in health in the two concepts is with into the A new for Medicare and Medicaid has been and is with PCMH and ACO are and of the major health have PCMH The of and have both a approach to in PCMH and ACOs to and a new discussion is emerging about how a model for care could be more and In order for the model to succeed in the long term, all sectors with a stake in health care will need to become better aligned with from the medical community to and these one of the it can be the of the is the employer to the of the is by health of million The health care of these are closely with their and in recent have become increasingly as of and at their A growing of an between the health of the workforce and the of the and are in to and health by a spectrum of health care they are a more and more part of the health care the is on the of a approach to the an The is to the home and to the communities in which the of their health on the when they for work as they the of their when they Health across and be health in the health at and health in communities are health are to the health and strategies that are a fundamental of PCMH and ACOs. 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The nation's community of OEM is at the of the and between ACOs, the PCMH and the nation's on and health the OEM community can the integration of health between the community, and which is essential to the implementation of ACOs and the PCMH the to for ACOs, and health organizations the PCMH the role of the health community be integrated into these