HO

Health Care Industry Overview: Growth, Policy, and Patient Safety

Health Care Industry: Key Points

  • Guest speaker session planned next week with two speakers from CMA and CNA; scheduling depends on their time, will cover health care industry and your role.
  • Objectives: list four benefits of working in health care.
  • Health care employs about 10\% of all American workers.
  • Job opportunities in health care are excellent now and in the future; health care is one of the fastest growing sectors in the US economy.
  • Health care offers diverse employment opportunities and pathways to advance through earned advanced degrees and digital professional certifications; opportunities to move up in original discipline or branch of knowledge; transferable skills that can train in a different discipline; ability to advance into leadership, teaching, sales, or research jobs.
  • Working in health care offers the opportunity to improve the quality of people’s lives; people seek health care during vulnerable times; your skills enhance relationships, job performance, and career prospects.
  • Distinctive qualities include patterns of behavior and attitudes; soft skills relate more to who you are than what you know; employers screen, hire, pay, and promote for soft skills.
  • Soft skills are part of personality and harder to acquire/change; there are many occupations in health care; this book emphasizes soft skills needed for success in health care (working with patients, customer service, professionalism, personal life, practical experience, employment, and career advancement).
  • To be viewed as a health care professional, be aware of industry trends: population trends and the additional services people need; primary care doctors act as gatekeepers who monitor actions and control access to services.
  • Efforts to control rising costs include:
    • Encouraging preventative services to avoid contracting conditions.
    • Providing care in the least expensive setting.
    • Avoiding unnecessary tests and treatments.
    • Coordinating services among providers to ensure continuity of care.
  • Accessibility issues: Millions of Americans lack health insurance or a primary care doctor; patients may go without medical care, prescriptions, or prenatal care.
  • Access impact examples: prenatal care and preventative services are essential for pregnant patients; concerns arise about being unable to pay medical bills and the resulting write-offs by providers, which can raise costs for insured patients.
  • Rural and underserved urban areas face lack of doctors and facilities, limiting access; many doctors prefer urban areas, complicating recruitment in rural regions.
  • Demographics: the older population is growing rapidly due to aging baby boomers; 78\,000\,000 people born 1946–1964; the 65+ population will almost double in coming years; the first baby boomer reached age 64 in 2010; it will take about 21 more years for the last one to reach a similar milestone.
  • Economic and spending patterns: minorities possess 75\% of the nation’s disposable income; 70\% of baby boomers subscribe to complementary or alternative medicine; they are projected to live longer than predecessors.
  • End-of-life care: more than 25\% of total health care spending for each patient occurs in the final years of life.
  • By 2030, 0.4 (four out of ten) adult visits to the doctor will be by baby boomers.
  • Health care reform and the Affordable Care Act (ACA): patient protection and Affordable Care Act; ACA passed in Feb 2010; goals include expanding access to affordable quality health insurance and reducing rising costs; restrictions on insurer practices (cancellation of policies, preexisting conditions).
  • ACA essentials (illustrative list from transcript):
    • All qualified plans must offer the ACA’s ten potential medical benefits; includes annual checkups, immunizations, preventive testing, and no out-of-pocket expense.
    • Prohibits charging more based on gender or health status.
    • Prohibits plans with annual or lifetime dollar limits on benefits.
    • Individual mandate; allows parents to keep children on their health insurance until age 26.
  • Medicare vs Medicaid: Medicare is for people aged 65+; Medicaid is state-based for low income; Medicare coverage nuances: anecdote from clinic noted Medicare often pays for yearly exams only every two years (example from practice); TeenCare (teen health coverage) may extend to age 21 if still in school.
  • Patient-centered medical homes: organizations that provide comprehensive, coordinated care to patients who are members.
  • Accountable Care Organizations (ACOs): networks of providers that work together and share responsibility for a large group of patients.
  • Quality improvement approach: PDSA cycle (Plan-Do-Study-Act)
    • Plan: creating a plan or test to see how a different approach would work.
    • Do: implementing the plan and seeing what happens.
    • Study: reviewing results to determine what was learned.
    • Act: taking action based on what was learned.
  • Understanding the current situation: compare statistics with outcome data after a change to examine impact and results.
  • Quality improvement and staffing: adequate staffing is tied to quality and patient safety; cutbacks can lead to more falls, bed errors, and wrong tests.
  • Lean Sigma: combines Lean and Six Sigma; Lean aims to streamline processes, reduce waste, and increase speed; Six Sigma reduces variation and defects to improve quality and reduce costs; about half of health care organizations have Lean Sigma projects.
  • Patient safety: the third leading cause of death in the US is preventable medical mistakes; culture should encourage nurses and health care workers to speak up when they see mistakes; caregivers must feel empowered (given authority, enablement, or commitment) to put patient interests first.
  • Terminology: a centennial event is a preventable incident involving death or serious injury; patient safety goals include: identify patients correctly; improve staff communication; use medicines safely; use alarms safely; prevent infections; identify patient safety risks; prevent surgical mistakes.
  • Medication safety basics (the five rights): five rights of giving medicines are discussed; explicitly mentions the Rights: Right patient, Right dose; reference to age considerations as well.
  • Workforce projections and practice changes:
    • In a given clinic, three more doctors joined the staff along with three medical assistants, and five new advanced practice providers joined.
    • Practice hours were expanded to accommodate increased patient load.
    • Emphasis on patient–provider interaction and ongoing learning; someone named Perfection’s interaction with health care providers; started a blog to share best practices with colleagues in other states.
  • Education and career development example: Carla completed prerequisites at a local community college and decided to pursue a BS degree in health care management and supervision; she attended workshops to advance.
  • Summary implication: with ongoing changes, the health care industry requires awareness of trends, continual skills development, and engagement with policy, quality, and technology to deliver effective patient care.

Key Concepts and Terminology

  • Primary care doctors as gatekeepers; monitoring and access control role.
  • Preventative care as cost-containment strategy.
  • Health care workforce categories: clinicians (doctors, nurses, allied health), IT professionals (EMR/EHR), administrators, researchers.
  • Soft skills vs hard skills:
    • Soft skills: communication, empathy, professionalism, teamwork, adaptability; harder to teach, essential for patient-centered care.
    • Hard skills: technical competencies, hands-on clinical skills, procedures, data entry, medical knowledge.
  • Population health concepts:
    • Aging population and demand for services.
    • Disparities in access to care between urban and rural areas.
  • Health policy concepts:
    • ACA provisions and intended impacts on access and affordability.
    • Essential health benefits and protections against discriminatory practices.
  • Quality improvement methodologies:
    • PDSA: Plan-Do-Study-Act cycle for testing changes.
    • Lean Sigma: process optimization and defect reduction.
  • Patient safety framework:
    • National Patient Safety Goals: patient identification, communication, safe medication practices, alarm safety, infection prevention, risk identification, and surgical safety.
  • Health information technology:
    • EMR vs EHR; data sharing; interoperability challenges; penalties for non-use of electronic records; advantages include up-to-date patient information and accessibility across settings.
  • End-of-life care and cost drivers:
    • End-of-life spending and its impact on overall health care costs.
    • Projections of spending and visit patterns by baby boomers.
  • Career development paths:
    • Advanced degrees, professional certifications, and transferable skills enabling movement across disciplines.
    • Role of additional training: workshops and degree programs in health care management and supervision.

Demographics, Access, and Costs

  • Baby boomer demographics:
    • Birth cohort: 1946\text{–}1964; 78\,000\,000 people; aging will increase demand for health care services.
    • The 65+ population is expected to almost double in coming years.
    • First baby boomer reached age 64 in 2010; last will reach 65 in about 2031 (approx. 21 years from 2010).
  • Minority economics:
    • Minorities possess 75\% of disposable income; baby boomers show significant engagement with complementary/alternative medicine (approximately 70\%).
  • Health care spending patterns:
    • More than 25\% of total health care spending occurs in the final years of life.
  • Insurance coverage landscape:
    • Millions lack health insurance or a primary care doctor, leading to delayed or foregone care.
  • Access disparities:
    • Rural shortages and unattractive urban areas contribute to insufficient labor supply in some regions.

Policy, Reform, and Coverage Details

  • ACA goals and provisions (overview):
    • Expand access to affordable, quality health insurance; reduce rising costs.
    • Prohibit insurers from canceling policies or denying coverage for preexisting conditions.
    • Require plans to cover essential benefits and limit cost-sharing for preventive services.
  • ACA essential benefits (illustrative):
    • Annual checkups, immunizations, preventive testing; no out-of-pocket expense for these services.
    • Prohibitions on gender- and health-status-based premium adjustments; no annual or lifetime limits.
    • Individual mandate; dependent coverage up to age 26.
  • Medicare and Medicaid overview:
    • Medicare: federally funded program for people 65 and older.
    • Medicaid: state-based program for low-income individuals.
    • Anecdote: some Medicare-covered services may have frequency limitations (e.g., annual exams every two years in certain clinics).
  • TeenCare concept:
    • Eligibility extended up to age 21 if a student.
  • Health care delivery reforms:
    • Patient-centered medical homes delivering coordinated care.
    • Accountable Care Organizations (ACOs) as networks sharing accountability for a large patient population.

Quality Improvement, Safety, and Care Delivery

  • PDSA framework details:
    • Plan: devise a plan or test to try a different approach.
    • Do: implement the plan and observe results.
    • Study: review outcomes to determine what was learned.
    • Act: take action based on what was learned to improve.
  • Current state assessment:
    • Compare statistics with outcome data after changes to evaluate impact.
  • Staffing and quality link:
    • Inadequate staffing can lead to poorer quality of care: more patient falls, bed errors, and incorrect tests.
  • Lean Sigma in health care:
    • Lean: streamline processes, reduce waste, increase speed.
    • Six Sigma: reduce variation and defects to improve quality and reduce costs.
    • Adoption: approximately half of health care organizations have Lean Sigma projects.
  • Patient safety goals and culture:
    • The third leading cause of death in the US is preventable medical mistakes.
    • Empower health care workers to speak up about errors; align culture to prioritize patient safety.
    • Goals include: identify patients correctly; improve staff communication; use medications safely; use alarms safely; prevent infection; identify patient safety risks; prevent surgical errors.
  • Medication safety basics (five rights):
    • Five rights discussed: Right patient; Right dose; (implied others); contextual note mentions age considerations in practice.

Technology, Data, and Information Sharing

  • Health information technology (IT) workforce trends:
    • IT employment in health care expected to rise by 20\% by the year 2000 (as cited in transcript);
    • Use of electronic health records (EHRs) and electronic medical records (EMRs) in hospitals, clinics, and physician offices;
    • EMRs are commonly used locally; EHRs enable broader data sharing across providers and settings to improve access to up-to-date patient information; some systems may interact poorly due to lack of universal interoperability.
  • Benefits and challenges of EHRs/EMRs:
    • Benefits: immediate access to comprehensive, up-to-date patient information; better coordination of care.
    • Disadvantages: system incompatibility; lack of universal EHR; interoperability issues.
  • Patient engagement and empowerment:
    • Patients must become more directly involved in their health and care; redesigning the death and dying experience for Americans.
  • Personal and professional identity in health care:
    • You wear at least three hats as a patient, a taxpayer, and a health care professional; each hat changes perspective.

Case Examples and Personal Trajectories

  • Practice expansion example:
    • Three more doctors joined the staff; three medical assistants; five new advanced practice providers joined.
    • Practice hours expanded to accommodate increased patient load.
    • Enhanced patient interactions with providers; one professional started a blog to share best practices with colleagues in other states.
  • Education and career development example:
    • Carla completed prerequisite coursework at a local community college and pursued a BS degree in health care management and supervision.
    • She took advantage of workshops to develop professionally.

Practical Implications for Exam and Real World

  • Understand how demographic shifts influence demand for health care services and policy responses.
  • Recognize how policy, technology, and quality improvement intersect to shape daily practice and patient outcomes.
  • Be aware of the balance between cost containment, access to care, and quality of care in a complex health system.
  • Appreciate the importance of soft skills in addition to technical competencies for professional success in health care.
  • Reflect on ethical considerations around access, affordability, end-of-life care, and the distribution of resources in a diverse population.

Connections to Foundational Principles

  • Population health and prevention reduce long-term costs and improve outcomes.
  • Interprofessional collaboration and communication are essential for safety and quality.
  • Data-driven decision making (PDSA, Lean Sigma) enables continuous improvement and accountability.
  • Patient autonomy and engagement are central to modern health care delivery.
  • Policy and economics shape access, affordability, and the structure of health care systems.

Health Care Industry Overview

  • Employs around 10\% of American workers; one of the fastest-growing sectors with diverse job opportunities and career advancement pathways.
  • Benefits include improving lives and developing transferable soft skills (e.g., communication, professionalism) essential for employment.

Key Trends and Challenges

  • Demographics: Rapidly aging baby boomer population (78\,000\,000 born 1946\text{–}1964) drives increased demand for services; minorities hold 75\% of disposable income.
  • Costs: Efforts to control rising costs via preventative services, care in least expensive settings, and avoiding unnecessary treatments. Over 25\% of spending occurs in the final years of life.
  • Access: Millions lack health insurance or primary care, leading to delayed care; rural and underserved urban areas face doctor shortages.

Policy and Reform

  • Affordable Care Act (ACA): Passed in 2010 to expand access to affordable quality health insurance and reduce costs. Prohibits denying coverage for preexisting conditions and requires essential health benefits.
  • Medicare vs. Medicaid: Medicare covers those aged 65+; Medicaid is state-based for low-income individuals. Anecdotes suggest frequency limitations (e.g., Medicare annual exams every two years in some clinics).

Care Delivery Models

  • Patient-centered medical homes (PCMHs): Provide comprehensive, coordinated care.
  • Accountable Care Organizations (ACOs): Networks of providers sharing responsibility for patient groups.

Quality Improvement and Safety

  • Quality Improvement Approaches: Includes PDSA (Plan-Do-Study-Act) cycle for testing changes and Lean Sigma for streamlining processes, reducing waste, and minimizing defects.
  • Patient Safety: Preventable medical mistakes are the third leading cause of death. Culture should empower staff to report errors. Goals include correct patient identification, improved communication, safe medication use, and preventing infections.
  • Medication Safety: Adherence to the five rights (Right patient, Right dose, etc.) is crucial.

Technology and Workforce

  • Health Information Technology (HIT): Growing field with the use of EMRs (local) and EHRs (broader data sharing), improving access to patient information but facing interoperability challenges.
  • Workforce Projections: Practice expansion and increased staffing (doctors, MAs, advanced practice providers) are common, requiring ongoing learning and skill development.