Student Discussion Leaders (2Ëš): You will be leading a short class discussion on PCMH vs IPUs. The articles in the Dell Modules are a few years behind, so you are tasked with finding updated information on these models. We have included some articles as a jumping off point and expect you to look for additional articles to prepare yourself to lead a discussion. To assist you, the course leaders can distribute some discussion questions to asked of the class.
Opt: Reflecting on Hotspotting and Value Stewardship
Optionally review the two other Atul Gawande pieces mentioned (and heavily critiqued) in the article, What the Healthcare Debate Still Gets Wrong. Facilitators can choose to assign all or some of these articles and decide whether to compare/contrast the arguments made by Gawande vs. Gaffney. Essentially, Gawande's articles discuss how "overdiagnosis and overtesting" (argued in OverKill & Cost Conundrum) and "super utilizers," (argued in The Hot Spotters) are huge contributors to healthcare waste and gross overspending in the U.S. whereas Gaffney, in review of Uwe Reinhardt's book, suggests that healthcare pricing and policy are principally responsible. By the way, a recent NYT piece (also included) highlights how recent research into hotspotting programs shows they are not as effective at reducing healthcare costs as everyone hoped.
Facilitators can decide which society guidelines to recommend to students. In the May 2020 elective's Thursday discussion section, UNC students heard from Dr. Alice Ma (renowned hematologist), so we chose hematology society guidelines (also because she contributed to their development). In her talk, she discussed the innovative, IPU-like Bleeding Disorders clinic that she helps run at UNC. It is an affiliate clinic with the Foundation for Women & Girls with Bleeding Disorders, and multiple institutions across the country boast such institutions. Further reading has been provided, as well as the link to Dr. Ma's talk.