Primary Care Shortage: SolutionsMarch 21, 2012Senate HearingSacramento, CA

(1) Source: Prevent Blindness America

Population Forecast (thousands)

2000 2010 2015 2020

0 – 44 184,624 189,025 194,792 202,226

45 – 64 62,440 80,890 83,911 84,356

65+ 35,061 40,229 46,837 54,804

Total 282,125 310,234 325,540 341,386

>65 will comprise 17% CA population by 2020 additional 2 million people

California & Chronic Conditions• 70% of healthcare costs are derived from chronic

conditions• 36% of California adults report at least 1: • Diabetes, HTN, Heart Disease, Cancer, Stroke

• Current management failures exist due to:• Poor quality• Uncoordinated care• Insufficient access

• Current management failures yield:• Increased hospital & ER use• Poorer health• Death

Prevalence of Chronic Conditions• Diabetes: 7.8% • 42.3% are low income

• Hypertension: 26.1%• 32% are low income

• Children (fair to poor) health status: 6.8%• 25% of Adults with 1 chronic condition report

barriers to care:• No health insurance• No usual care provider• Communication• Access points

Growing Demand• Demographic trends and population shift will drive

increase in incidence of major ophthalmic diseases.

• 200,000 Americans develop advanced AMD each year; expected to double by 2020. (1)

• Cataract affects 1 in 6 people over age 40 (2) ; 30.1 million Americans expected to have cataracts by 2020. (1)

• Growing levels of obesity lead to increase in diabetic retinopathy; currently 4.1 million over age 40 affected, projected 7.2 million by 2020. (1)

• Glaucoma accounts for over 7 million visits to MDs each year with potential increase to over 10 million by 2020. (2)

(1)Source: “Vision Impairment and Eye Disease is a Major Public Health Problem,” National Alliance for Eye and Vision Research & National Eye Institute (2)Source: “Vision Problems in the U.S.,” Prevent Blindness America and National Eye Institute

Incidence Rates for Americans 40+ (millions)

Advanced AMD

Glaucoma Diabetic Retinopathy

Cataracts0

5

10

15

20

25

30

35

2004Est 2020

Source: National Eye Institute, 2004 Study

61% 50%79%

47%

Cataract Surgery Trends• Cataract Surgery demand to grow 29% in next 10

years• 2005 = 2.8 million• 2010 = 3.6 million• 2015 = 3.83 million• 2020 = 4.34 million

• 2011 cataract surgeries 3.7 million procedures

Source: Market Scope, Ophthalmic Market Perspective

Physician Supply Projections• Growth and aging of US population will cause a

surge in demand for physician services. • Requirements for physicians will increase 22%

from 2005 to 2020. • Requirements for ophthalmologists will increase

28% - 60% from 2005 to 2020. • Non-physician clinicians (NPC) will increase 60%

from 2005 to 2020. • NPCs will provide 40% of current physician work by 2020

Source: DHHS Physician Supply and Demand Projections to 2020

Optometry and Medical Management• Shortage of ophthalmic providers: • Patients requiring care expected to increase by 18% in

2015.(2) • Number of ophthalmologists expected to grow by 0.67%

during same timeframe.(2)

• Health Care Reform legislation designates vision care for children as an essential health benefit, how is this defined?

(1)Source: Bureau of Labor Statistics (2)Source: 2009 study conducted by Market Scope, LLC

Ophthalmology Trends

2000 2005 2010 2015 2020180001900020000210002200023000240002500026000

Expected OphRequired Oph

Source: DHHS Physician Supply and Demand Projections to 2020

Optometry in the Primary Care Team• Detect associated systemic and non-systemic

medical diseases and conditions, through retina examination and imaging and measuring visual field loss.

• Take comprehensive systemic and family health history

• Perform other tests in-office, such as measuring blood pressure and taking blood samples from diabetes suspects.

• Determine the presence of risk factors for at least 57 diseases and conditions.

See Handout for complete list of conditions.

Optometry and Healthcare $$All W/ Eye

ExamNo Eye Exam

Member Count 389 266 123Average length of stay 6.5 5.3 8.2Ave inpatient expense /member/year

$4,375 $3,589 $6,074

Ave Annual expense/member

$8,382 $7,012 $11,345

Current Practice Patterns• NCQA measures and Medical Home don’t cut it• Level 1 CHCs ONLY 35% of diabetics had a retinal exam in

12 months

• Current involvement:• EYEPACS• Excellent screening • Where do we send the patient?

• Limited CHC involvement• Health Plans: skip Primary Care directly to Tertiary

Current Provider Availability (CHCs)• 118 FQHCs in CA (444 CHCs as of late 2010)• Current FTE in the system:• Dentist 407.63• Optometrist 31.4

• Barriers:• No inclusion in National Health Service Corps• No inclusion in Public 330 funding from Congress for CHCs

Source: HRSA

$343,689,500• Potential savings by ensuring Optometrists are a

critical component of the Primary Care Team• Assumed increase of 35% in eye exams based on current

Medical Home• Additional 71,900 diabetics seen of the current 2.9 million

CHC patients• Savings of $4345 Annual expenditure/member

Barriers to Overcome• Inclusion on Health Plan Panels• Cal-Search Program • Pathway for student to resident to provider

• National Health Service Corp inclusion• 3/15/2012 bill introduced by Senator Mark Pryor, AK• Concurrent legislation running in the House

• State Funding