© 2010 jones and bartlett publishers, llc a practical approach for decision makers second edition...

© 2010 Jones and Bartlett Publishers, LLC© 2010 Jones and Bartlett Publishers, LLC

A Practical Approach

For Decision MakersSECOND EDITION

EILEEN E. MORRISON


Class Six:Class Six:

Market ForcesMarket Forces


Agenda Agenda

Overview of general market forces and Overview of general market forces and their impacttheir impact

Boomers exerciseBoomers exercise Managed care and ethicsManaged care and ethics Research reports on integrative medicineResearch reports on integrative medicine General ethics issues for integrative General ethics issues for integrative

medicinemedicine SummarySummary


Examples of General Market Examples of General Market Forces Forces

Everyone could be a consumer in Everyone could be a consumer in your business. your business.

Children? Young adults? Older Children? Young adults? Older adults?adults?

More often women than men.More often women than men. Men often more ill when they do Men often more ill when they do

become consumers.become consumers.


Examples of General Market Examples of General Market Forces Forces

Areas that impact general business also Areas that impact general business also impacts health care. impacts health care.

Growth Growth Disaster planning?Disaster planning? Changes in funding sources? Changes in funding sources? Increased specialty facilities (nichIncreased specialty facilities (niché é

marketsmarkets).).


Money?Money?

A downturn in the economy affects A downturn in the economy affects health care.health care.

Essentials are stressed.Essentials are stressed. Less interest in new projects, Less interest in new projects,

building, etc. building, etc. Do more with less (staff, money, etc.)Do more with less (staff, money, etc.) How does the affect you?How does the affect you?


Boomers?Boomers?

What do you know about the boomers?What do you know about the boomers? Benefits of having the boomers in the HC Benefits of having the boomers in the HC

system?system? Burdens of having the boomers in the HC Burdens of having the boomers in the HC

system?system? Why do you care?Why do you care?


Managed Care and EthicsManaged Care and Ethics

Not a new delivery option; began as Not a new delivery option; began as an ethics issue and social movement! an ethics issue and social movement!

In 1970s became a way to control In 1970s became a way to control costs. costs.

Has had some success through Has had some success through controlling access and pricing. controlling access and pricing.


How did they do it?How did they do it?

Costs controlled by limiting access Costs controlled by limiting access through gatekeeper and case through gatekeeper and case management.management.

Also used utilization reviews and Also used utilization reviews and practice profiling. practice profiling.

Many Americans are covered by MCOs.Many Americans are covered by MCOs. Sick people are in the MCOs!!! What Sick people are in the MCOs!!! What

does this mean to cost control?does this mean to cost control?

. .


What about the clinical What about the clinical staff?staff?

Physicians and others are not happy.Physicians and others are not happy. Too little time with patients and Too little time with patients and

cookbook medicine.cookbook medicine. Duty to patients? Kant? Duty to patients? Kant?


What if you Work for a What if you Work for a MCO?MCO?

Market only what you can deliver.Market only what you can deliver. Make sure sales people are not Make sure sales people are not

making inflated claims.making inflated claims. Clarity of coverage needs to be a Clarity of coverage needs to be a

priority.priority.


What are your What are your Responsibilities?Responsibilities?

In general:In general: Accuracy of data collected.Accuracy of data collected. Still have to worry about uninsuredStill have to worry about uninsured What if providers do not want to take What if providers do not want to take

assignmentassignment Watch contracts!!Watch contracts!!


Where’s the Ethics Issues?Where’s the Ethics Issues?

Patient autonomy issues Patient autonomy issues Physician Incentive Applications and conflict Physician Incentive Applications and conflict

of interest of interest Gatekeeping: Utilitarianism versus Gatekeeping: Utilitarianism versus

deontologydeontology Creaming or skimming Creaming or skimming What about the uninsured?What about the uninsured? Watch your marketing promisesWatch your marketing promises Informed consent and disclosure can be a Informed consent and disclosure can be a

potential issue potential issue


IM or CAM: Consumer-Driven IM or CAM: Consumer-Driven Health Care Health Care

Newest terminology is Integrated Medicine Newest terminology is Integrated Medicine (IM) but Complementary/Alternative (IM) but Complementary/Alternative Medicine (CAM) is also used.Medicine (CAM) is also used.

National Center for Complementary and National Center for Complementary and Alternative Medicine (NCCAM) has defined Alternative Medicine (NCCAM) has defined it.it.


NCCAM Categories NCCAM Categories

Whole medical systems Whole medical systems Mind/Body AreasMind/Body Areas Biological-based Systems Biological-based Systems Manipulative SystemsManipulative Systems Energy TherapiesEnergy Therapies


New Trend: Medical SpaNew Trend: Medical Spa

Fastest growing business side of spasFastest growing business side of spas Medical Spa Association definition includes Medical Spa Association definition includes

an onsite physician or licensed health an onsite physician or licensed health professional as part of the practice.professional as part of the practice.

Includes traditional medicine plus spa Includes traditional medicine plus spa services.services.


Why the interest in Why the interest in medspas?medspas?

Some MDs are unhappy with scope of Some MDs are unhappy with scope of practice.practice.

Consumers want holistic treatmentConsumers want holistic treatment Women want more than bikini medicine.Women want more than bikini medicine. Hospitals like patient focus and revenue Hospitals like patient focus and revenue

from IM. from IM.


Why more interest in all areas Why more interest in all areas of IM now?of IM now?

Consumers want more voice in their Consumers want more voice in their care.care.

Consumers want prevention as well Consumers want prevention as well as treatment.as treatment.

Chronic diseases are increasing Chronic diseases are increasing among the population.among the population.

Consumers use both systems Consumers use both systems because they work!because they work!


What do the Traditionalist’s What do the Traditionalist’s Say?Say?

Some say it is quackery.Some say it is quackery. Some want many double-blind, random, Some want many double-blind, random,

control group studies to support this. control group studies to support this. Some think it is only the placebo effect. Some think it is only the placebo effect. Some are beginning to support it Some are beginning to support it

– NIH Research NIH Research – Physician Desk Reference of HerbsPhysician Desk Reference of Herbs– Referring patients Referring patients – Offered at cancer and other centers Offered at cancer and other centers

Insurance companies are beginning to Insurance companies are beginning to cover it.cover it.


Homework SynthesisHomework Synthesis

Discuss findings in your group.Discuss findings in your group. Aquinas: Acupuncture; Aquinas: Acupuncture; Kant: Massage;Kant: Massage; Mill: Herbal Medicine;Mill: Herbal Medicine; Rawls: Naturopathy. Rawls: Naturopathy. When time is called present at least 5 new When time is called present at least 5 new

ideas you have learned and 1 ethics issue.ideas you have learned and 1 ethics issue. Conclusions??? Conclusions???


General Ethics Issues and IM General Ethics Issues and IM

IM may be part of your business in IM may be part of your business in the near future.the near future.

Patient autonomy issuesPatient autonomy issues Informed consent and IM optionsInformed consent and IM options Revenue stream decisionsRevenue stream decisions Hire competent practitioners to Hire competent practitioners to

protect the public protect the public


In summary…In summary…

How can you meet market How can you meet market challenges and still be an ethics-challenges and still be an ethics-based health care administrator?based health care administrator?

© 2010 jones and bartlett publishers, llc a practical approach for decision makers second edition...

Documents

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llc boomers

llc managed care

ethics managed care

health care

general business

llc money

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