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![Page 1: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/1.jpg)
Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation
in an Urban, Primary Care Telemedicine Network
Kenneth M. McConnochie, MD, MPH
* Brickley J, Smith C, Zimmerman J. The economics of organizational architecture. J Applied Corp Finance 1995;20:19-31
![Page 2: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/2.jpg)
What makes this an economic model?
Essence of economics –
• theory of values
• how individuals make choices
![Page 3: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/3.jpg)
What’s this got to do with HIT?
Primary challenge = organizational innovation
Adopting and integrating new technology requires change in individual and organizational roles and responsibilities
![Page 4: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/4.jpg)
What’s this got to do with evaluation?
Evaluation - an essential component of innovation strategy
Primary objective - to demonstrate use of model to guide evaluation strategy
![Page 5: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/5.jpg)
Health-e-Access: Health, Healthcare and Social Problems Addressed
• Marked socioeconomic disparities in childhood morbidity burden.
• More than half of US pre-school children spend time in
child care.
• Rates of common acute illness are increased in child care.
• Illness in childcare accounts for 40% of work absence for parents using child care.
• 20% - 70% of pediatric visits to the emergency department are for non-urgent problems.
![Page 6: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/6.jpg)
Short Story… about a long-running nose
1 week later
![Page 7: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/7.jpg)
Organizational Problem
Usual Healthcare• Every child has a primary care “medical home” • Physician(s) controls the organization directly
versus
Health-e-Access• Many childcare sites • Many different primary care offices • No telemedicine utility service (yet)
![Page 8: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/8.jpg)
Conceptual framework – the 3-legged stool
(1) Incentives (2) Decision rights (3) Performance evaluation
![Page 9: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/9.jpg)
Health-e-Access Stakeholders
• Parent and Child
• Private Insurance Organizations
• State and County Government, Medicaid
• Industry
• Primary Care Physicians
• Childcare Programs
![Page 10: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/10.jpg)
Stakeholders and their Decision Rights
Parent• Use of telemedicine services vs. traditional alternatives• Choice of insurance company and plan
Industry• Payment for telehealth services, if self-insured • Qualify/cover telehealth services in dependent care or
healthcare components of Flexible Spending Accounts• Negotiate health insurance premiums, covered services• Change health insurance company
![Page 11: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/11.jpg)
Decision Rights - continuedHealth Insurance organizations - Private • Coverage of telemed services (yes/no)• Type of coverage (e.g., fee-for-service, capitated)• Reimbursement rates for telemed services• Sponsorship of telemed Health Insurance organizations, Public; County & State Government• Licensing new types of healthcare workers• Administrative approval of reimbursement for new services (i.e., Medicaid
Managed Care)• Support adoption of telehealth services (vs. ignore potential)• Legislation that requires insurance reimbursement for telehealth Primary Care Physician • Provide/refuse telehealth services• Promote/obstruct adoption of telehealth services, e.g., through participation on
insurance organization committees that recommend coverage of new services
![Page 12: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/12.jpg)
Dominant Stakeholders
• Health Insurance Organizations
• Physicians
![Page 13: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/13.jpg)
Stakeholders and their Incentives
Parent and child• Improve child health and development • Increase sense of security• Increase access to healthcare • Minimize symptom severity and duration in child• Minimize disruption to usual activities/responsibilities
family from child illness • Minimize out-of-pocket costs to family• Improve financial status through steady employment and
advancement • Maintain a “medical home”
![Page 14: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/14.jpg)
Incentives - continued
Industry• Minimize work absence • Maximize employee productivity - “presenteeism”• Reduce healthcare costs
![Page 15: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/15.jpg)
Stakeholders and Performance Evaluation
• Absence due to illness
• Perceived benefits
Parent satisfaction Childcare program support
Parents, Childcare Programs, Industry
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Absence Due to Illness Before and After Health-e-Access
0
5
10
15
20
Da
ys
Ab
se
nt
Du
e t
o Il
lne
ss*
* Mean days absent per week per 100 registered child-days.
Jan
July
Dec
After
Before
Net impact :63% reduction
(Pediatrics May 2005)
![Page 17: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/17.jpg)
Parent Satisfaction%
of
fam
ilie
sBased on interviews with parent after first use of telemedicine. N = 229.
0
10
20
30
40
50
60
70
80
90
100
ED
Allowed to stay at work*
Would choose child carewith telemed over one without
Saved parent trip to:
Pri
mar
yC
are
Ph
ysic
ian
After hours
YesYes
* Estimated time saved = 4.5 hours (SD 2.2) per telemed visit
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Utilization – Preliminary Data
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Utilization Predicted by Telemed:Bivariate Analysis
![Page 20: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/20.jpg)
Utilization of Any Site for Illness: Other Determinants
• Sex
• Insurance type
• Child care site
• Primary care practice
• Child’s age
![Page 21: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/21.jpg)
Logistic Regression: Telemed Effects on Utilization
![Page 22: Economic Model of Organizational Architecture* to Guide Design and Performance Evaluation in an Urban, Primary Care Telemedicine Network Kenneth M. McConnochie,](https://reader036.fdocuments.us/reader036/viewer/2022062320/56649cf95503460f949cb0b7/html5/thumbnails/22.jpg)
Expanded Program
• 22 child sites, 8500 total children eligible– 7 current city child care programs– 5 city elementary schools– 5 suburban elementary schools– 5 suburban child care programs (SE suburbs)
• 5 urban practices• 6 suburban practices (SE suburbs)• Insurance reimbursement for demonstration
project telehealth visits