1. © 2010 Jones and Bartlett Publishers, LLC A Practical Approach For Decision Makers SECOND EDITION EILEEN E. MORRISON

2. © 2010 Jones and Bartlett Publishers, LLC Class Six: Market Forces

3. © 2010 Jones and Bartlett Publishers, LLC Agenda Overview of general market forces and their impact Overview of general market forces and their impact Boomers exercise Boomers exercise Managed care and ethics Managed care and ethics Research reports on integrative medicine Research reports on integrative medicine General ethics issues for integrative medicine General ethics issues for integrative medicine Summary Summary

4. © 2010 Jones and Bartlett Publishers, LLC Examples of General Market Forces Everyone could be a consumer in your business. Everyone could be a consumer in your business. Children? Young adults? Older adults? Children? Young adults? Older adults? More often women than men. More often women than men. Men often more ill when they do become consumers. Men often more ill when they do become consumers.

5. © 2010 Jones and Bartlett Publishers, LLC Examples of General Market Forces Areas that impact general business also impacts health care. Areas that impact general business also impacts health care. Growth Growth Disaster planning? Disaster planning? Changes in funding sources? Changes in funding sources? Increased specialty facilities (niché markets). Increased specialty facilities (niché markets).

6. © 2010 Jones and Bartlett Publishers, LLC Money? A downturn in the economy affects health care. A downturn in the economy affects health care. Essentials are stressed. Essentials are stressed. Less interest in new projects, building, etc. Less interest in new projects, 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?

7. © 2010 Jones and Bartlett Publishers, LLC Boomers? What do you know about the boomers? What do you know about the boomers? Benefits of having the boomers in the HC system? Benefits of having the boomers in the HC system? Burdens of having the boomers in the HC system? Burdens of having the boomers in the HC system? Why do you care? Why do you care?

8. © 2010 Jones and Bartlett Publishers, LLC Managed Care and Ethics Not a new delivery option; began as an ethics issue and social movement! Not a new delivery option; began as an ethics issue and social movement! In 1970s became a way to control costs. In 1970s became a way to control costs. Has had some success through controlling access and pricing. Has had some success through controlling access and pricing.

9. © 2010 Jones and Bartlett Publishers, LLC How did they do it? Costs controlled by limiting access through gatekeeper and case management. Costs controlled by limiting access through gatekeeper and case management. Also used utilization reviews and practice profiling. Also used utilization reviews and practice profiling. Many Americans are covered by MCOs. Many Americans are covered by MCOs. Sick people are in the MCOs!!! What does this mean to cost control? Sick people are in the MCOs!!! What does this mean to cost control?.

10. © 2010 Jones and Bartlett Publishers, LLC What about the clinical staff? Physicians and others are not happy. Physicians and others are not happy. Too little time with patients and cookbook medicine. Too little time with patients and cookbook medicine. Duty to patients? Kant? Duty to patients? Kant?

11. © 2010 Jones and Bartlett Publishers, LLC What if you Work for a MCO? Market only what you can deliver. Market only what you can deliver. Make sure sales people are not making inflated claims. Make sure sales people are not making inflated claims. Clarity of coverage needs to be a priority. Clarity of coverage needs to be a priority.

12. © 2010 Jones and Bartlett Publishers, LLC What are your Responsibilities? In general: In general: Accuracy of data collected. Accuracy of data collected. Still have to worry about uninsured Still have to worry about uninsured What if providers do not want to take assignment What if providers do not want to take assignment Watch contracts!! Watch contracts!!

13. © 2010 Jones and Bartlett Publishers, LLC Where’s the Ethics Issues? Patient autonomy issues Patient autonomy issues Physician Incentive Applications and conflict of interest Physician Incentive Applications and conflict of interest Gatekeeping: Utilitarianism versus deontology Gatekeeping: Utilitarianism versus deontology Creaming or skimming Creaming or skimming What about the uninsured? What about the uninsured? Watch your marketing promises Watch your marketing promises Informed consent and disclosure can be a potential issue Informed consent and disclosure can be a potential issue

14. © 2010 Jones and Bartlett Publishers, LLC IM or CAM: Consumer-Driven Health Care Newest terminology is Integrated Medicine (IM) but Complementary/Alternative Medicine (CAM) is also used. Newest terminology is Integrated Medicine (IM) but Complementary/Alternative Medicine (CAM) is also used. National Center for Complementary and Alternative Medicine (NCCAM) has defined it. National Center for Complementary and Alternative Medicine (NCCAM) has defined it.

15. © 2010 Jones and Bartlett Publishers, LLC NCCAM Categories Whole medical systems Whole medical systems Mind/Body Areas Mind/Body Areas Biological-based Systems Biological-based Systems Manipulative Systems Manipulative Systems Energy Therapies Energy Therapies

16. © 2010 Jones and Bartlett Publishers, LLC New Trend: Medical Spa Fastest growing business side of spas Fastest growing business side of spas Medical Spa Association definition includes an onsite physician or licensed health professional as part of the practice. Medical Spa Association definition includes an onsite physician or licensed health professional as part of the practice. Includes traditional medicine plus spa services. Includes traditional medicine plus spa services.

17. © 2010 Jones and Bartlett Publishers, LLC Why the interest in medspas? Some MDs are unhappy with scope of practice. Some MDs are unhappy with scope of practice. Consumers want holistic treatment Consumers want holistic treatment Women want more than bikini medicine. Women want more than bikini medicine. Hospitals like patient focus and revenue from IM. Hospitals like patient focus and revenue from IM.

18. © 2010 Jones and Bartlett Publishers, LLC Why more interest in all areas of IM now? Consumers want more voice in their care. Consumers want more voice in their care. Consumers want prevention as well as treatment. Consumers want prevention as well as treatment. Chronic diseases are increasing among the population. Chronic diseases are increasing among the population. Consumers use both systems because they work! Consumers use both systems because they work!

19. © 2010 Jones and Bartlett Publishers, LLC What do the Traditionalist’s Say? Some say it is quackery. Some say it is quackery. Some want many double-blind, random, control group studies to support this. Some want many double-blind, random, 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 –Physician Desk Reference of Herbs –Referring patients –Offered at cancer and other centers Insurance companies are beginning to cover it. Insurance companies are beginning to cover it.

20. © 2010 Jones and Bartlett Publishers, LLC Homework 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 ideas you have learned and 1 ethics issue. When time is called present at least 5 new ideas you have learned and 1 ethics issue. Conclusions??? Conclusions???

21. © 2010 Jones and Bartlett Publishers, LLC General Ethics Issues and IM IM may be part of your business in the near future. IM may be part of your business in the near future. Patient autonomy issues Patient autonomy issues Informed consent and IM options Informed consent and IM options Revenue stream decisions Revenue stream decisions Hire competent practitioners to protect the public Hire competent practitioners to protect the public

22. © 2010 Jones and Bartlett Publishers, LLC In summary… How can you meet market challenges and still be an ethics-based health care administrator? How can you meet market challenges and still be an ethics-based health care administrator?