Strategies to Successfully Serve the Indigent

Hospital provider organizations around the country that that serve a large uninsured or indigent population are challenged with sustaining a viable bottom line while serving the needs of the community. These organizations are faced with inadequate yet decreasing reimbursement from Medicaid and other state funded programs for services provided to this population. In many markets the low reimbursement has eliminated or decreased the access to primary care physicians pushing more of the responsibility to Emergency Departments as the primary care provider. The Emergency Department is the most expensive and not the most effective setting for the delivery of primary care. This trend adds to the problem reducing the efficiency and effectiveness of the health system.

Strategies & Tactics for Sustainability

Most hospital providers include serving the medical needs of the community as core to the organizational mission and vision. The successful organizations that serve a large indigent population go beyond a strategy based on the profit and loss of departments or services. They look at the health needs of the community and the exisitng landscape (i.e., reimbursement, regulatory, competition, access to care, physician) and devise a devise a organizational strategy to meet the prioritized needs of the community while maintaining sustainable financial viability.
Some healthA recent articles about the success of Montefiore Health System in the Bronx, NY highlights some of the tactics.

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http://www.nysun.com/article/67885
http://www.crainsnewyork.com/apps/pbcs.dll/frontpage

Image: Steinlen, Théophile Alexandre, 1859-1923, artist

Indvidualized Medicine?

An article in the October issue of the Harvard Business Review identifies the challenges of the existing use of pharmaceuticals.

Most US physicians practice "trial and error" medicine, prescribing drugs based on the results of a studied population and not patient focused probabilities of effectiveness. As a result patients are given millions of dollars worth of pharmaceuticals that will have no benefit on their health or outcomes. One conclusion is the industry needs to develop real diagnostic capability to test an individual to determine the best course of treatment. Once the characteristics of the patient are determined a personalized treatment regimen can be developed. Additionally it could drastically change the pipeline of drugs in development. Drugs that would not make it out of testing because they only have a positive effect on a small number of people could be viable if those people could be identified before they are given the drug. With proper diagnostics those drugs would only be given to the people they benefit. This could provide more stability to a pharma company's portfolio of drugs as it provides an alternative to the blockbuster strategy.

This disruptive change could have incredible effects on pharma. It would also provide a whole new function and revenue stream for the provider that can get the delivery and integration right. Is it integrated into primary care, or would hospitals make the investment to becoming leading pharmaceutical diagnostic centers? Large health systems could integrate this into a personalized medicine service line. Another clear winner could be retail clinics. They could provide diagnosis, advanced diagnostics, prescriptions and delivery in one location.

Link to the HBR article "Realizing the Promise of Personalized Medicine": http://harvardbusinessonline.hbsp.harvard.edu/hbsp/hbr/articles/article.jsp;jsessionid=AS0Z30NYFOUCMAKRGWCB5VQBKE0YOISW?ml_action=get-article&articleID=R0710F&ml_page=1&ml_subscriber=true

Image: "DRUGS", FotoEdge. http://www.flickr.com/photos/fotoedge/214997573/