I'm writing to summarize the approach that I suggested in our phone conversation.
The project we discussed will help to develop an initial, shared understanding of the problems concerning access to health care in Whatcom County. Merely listing the problems and their components is not enough. In examining these problems, we will use elements of the System Dynamics approach to understand the interrelationship of:
· the availability of physicians and other care providers,
· payment patterns and rates,
· the nature and volume of care delivered,
· consequences of that care for the health of the population,
· impact of health status on future demand for care,
· efforts to solve the problems such as physician recruiting, provision of alternative sources of care, demand reduction strategies, and changes in the nature of care that is delivered, and
· effects of all of the above on residents, providers, payors, and employers and responses of each of these groups to the problems.
A System Dynamics approach should be especially helpful because the situation in Whatcom County is not likely to remain static. These interrelationships have the potential for making problems worse over time and for thwarting attempts at solving the problems. For example, delays in receiving care because of limited physician availability may lead to patients having more serious health problems that increase the demand for care, create additional costs that stress individuals, employers, and payors, make existing health care resources even less adequate, and potentially drive overworked providers out of the community. Attempts to solve these problems such as recruiting more physicians may not succeed unless they are coordinated with changes in payment mechanisms and rates and the manner and efficiency with which care is delivered.
Jack Homer and I will work with a group of health care providers and other stakeholders to identify the nature of the problem and its key indicators. We will use System Dynamics diagramming techniques with the group to map causal factors that:
· Create and maintain the problems
· Produce consequences for community health status and costs to residents and employers
· Can help to provide remedies for the problems, and
· Potentially work against those remedies succeeding.
With the group and in analyses afterwards, we will use these maps to:
· Enumerate potential impacts of the problems on various stakeholders
· Identify data required for more extensive analysis and richer set of policy questions to be explored
· Identify potential remedies for the problems including some that might not have been apparent without taking this systemic view, and
· Examine how these remedies might interact and combinations likely to be most effective.
We would meet with the group one additional time to discuss and expand on these analyses and help think through next steps for the community. At this point, we will also be in a better position to determine the value of going further with the System Dynamics approach which could include the development of a simulation model to project the impact of various sets of remedies. The effort we are now proposing would be limited to mapping the causal factors and analyzing the implications of these maps as described above. The results will be preliminary in nature and provide a good context for further analysis and action.
We will limit the costs by "piggybacking" travel on work we are already doing in Bellingham on chronic illness. We will also be alert for potential overlaps between this project and the chronic illness effort in order to avoid any duplication. We estimate that the cost of the project I have outlined above would be in the range of $10,000-15,000 for consulting fees plus any extra travel costs such as extra meals and hotel nights and possibly a share of our air fare.
Please let me know if you have any questions or would like to discuss any aspects of the proposal further.
Sincerely yours, Gary Hirsch [gbhirsch@attbi.com]
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