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Shouldn’t our health care system be as responsive to our needs as our technology? After all, a phone is no longer just a phone—it’s also a calendar, a GPS, and a computer, and now you can even wear it on your wrist. A refrigerator can show you what’s inside via wireless camera so you know what to pick up at the store. And a smart thermostat realizes you’re on your way home and adjusts automatically before you walk through the door.
These innovative products help give us what we need, when and where we need it. They make daily life more convenient and comfortable. That transformation in daily life is coming to health care. Emerging health care trends are adapting medical offerings to help everyone receive the care they need, where they want it, by making the most of the specialized skills offered by advanced-practice clinicians (APCs), nurse practitioners (NPs), or physician assistants (PAs).
Supply, Demand, and Couch-Side Manner
Advanced-practice clinicians have taken a larger role in the health care system as the need for care has increased. These APCs have advanced degrees and national certifications in their area of specialty. They are able to perform an examination and order diagnostic tests to evaluate symptoms.
APCs diagnose and treat many common and chronic conditions in a variety of settings. Many of us are familiar with APCs in the physician’s office. An APC might be your primary-care provider for annual exams or chronic condition follow-up visits or take care of you when you get sick. You also might see an APC in urgent-care or retail-health clinics, emergency departments, or the hospital.
Additionally, these skilled clinicians can be the best fit to bring care to more people, in the right place, where it’s needed most. That might be the doctor’s office, but it might be a nursing home or even an exam on your cozy living-room sofa.
Advanced-practice clinicians offer comprehensive and personalized care. A visit with the APC focuses on the whole person—all of a patient’s physical, mental, and social needs—to help ensure any issues are fully addressed. The result? Health care becomes more effective, appropriate and, yes, even comfortable for more of us.
Bringing Customized Care to Home or Clinic
One clear outcome of the Affordable Care Act (ACA) is that primary-care services, including free preventive services, are available to an additional 30 million people, according to whitehouse.gov.1 Better preventive care is good for people’s health, and the idea is that prevention will save money – and lives – in the long run by catching problems early.
But what if people can’t get that care? Increasingly, our nation doesn’t have enough primary-care physicians (PCPs) to meet these needs. Reports suggest the U.S. may face a shortage of up to 90,000 PCPs nationwide in the next 10 years.2
Physicians who leverage the help of APCs can care for nearly twice as many people and focus on more complex care.3 Outside the physician’s office, APCs form a vital strand in the fabric of health care by extending medical services into underserved rural areas and the homes of seniors and people with chronic illness.
Helping People Stay Healthy
Last year, OptumCare APCs made more than a million home visits to Medicare Advantage patients—more than four times as many as in 2012. At the home visit, the APC spends up to an hour with each individual, checking health functions, educating about any concerns and helping to develop a plan of care.
The service has grown so rapidly because it works. In fact, in addition to providing a medical exam, the clinician might recommend a nutrition support program or offer a referral to a social worker if there’s a need.
The outcomes are convincing as well. A recent study by the Rand Corporation found that for Medicare members who received an OptumCare home visit, hospital admission rates decreased by as much as 14 percent, along with a 90% decrease in risk of long-term care stays.4
Of course, system innovations only matter because they enable health care providers to make a difference, one person at a time. Take the example of Paul, a Medicare member in Wisconsin, who hadn’t seen a doctor in years. At his home visit, the APC discovered a blood-pressure problem that he needed to have checked out right away. “Jenny was very persuasive,” Paul says. “She said, ‘I’m not leaving until you make a doctor’s appointment.’”
That appointment may have saved Paul’s life. The doctor found indications of lung cancer, which would have worsened quickly had it gone undetected. Instead, the cancer was treated, and Paul is back to the things he enjoys, such as time with family, friends, and his woodworking hobby.
Paul’s story demonstrates how advanced-practice clinicians can function as part of an effective, team-based model of care. APCs don’t replace physicians. In fact, the Rand study found that, in addition to reduced hospital admissions and long-term care stays, patients who received home visits actually had an increase (2-3 percent) in physician appointments after their home visit, helping seniors to receive the right care at the right place.
Clearly, being able to meet the needs of more people is good for all of us. Even better, when advanced-practice clinicians are part of an integrated health system, people can get care where they are, and the physician is kept in the loop. Now, that’s a smarter system – one that is even more practical and responsive than a Wi-Fi refrigerator.