- goal: reduce healthcare cost for the community and the individual. Involve community in health solutions be as self-sufficient as possible for reduced costs #### Costs - employed: ~$200 monthly premium + ~$2000 deductible -> ~$3500 - no income: premium and deductible subsidized by gov -> ~$100 #### community health structures - community land trust medical subsidiary - partnering with research institution to measure social determinants of health(SDOH) - community support - primary care done within community - help guide people through process - group negotiating power with local providers - collectively pay everyone's premiums - leverage federal subsidies for those with no incomes #### Professional Integrated Care injury treatment and routine health maintenance ##### Primary Care - PCP/PA: general healthcare, routine checkups, health screenings, chronic disease management, and preventive care - LPN/RN: assess patients, coordinate care, wound care, administer vaccines/meds - MA: take history, prep rooms, scheduling, and assist with basic tests and documentation - procedures - comprehensive health checkup: physical exams, medical history updates, and setting personalized care plans - minor wound care: - wound care: | Service | Duration (minutes) | Appointments per Year | Hours per Year | Roles that Can Perform | Notes/Details | | ------------------------------ | ------------------ | --------------------- | -------------- | --------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Annual Health Assessment | 30 | 1000 | 500 | PCP, NP, RN, MA | Comprehensive health checkup including physical exam, medical history updates, and personalized care plans. May include basic screenings (e.g., blood pressure, cholesterol). | | Chronic Disease Management | 15 | 300 | 75 | PCP, NP, RN, Dietitian, Physical Therapist | For patients with conditions like diabetes, hypertension, heart disease, obesity. Regular follow-ups for monitoring, medication adjustment, and lifestyle support. | | Routine Health Screenings | 15 | 1000 | 250 | RN, MA, Dietitian, PCP | Includes cancer screenings (e.g., mammograms, colonoscopies), cholesterol and diabetes screening, mental health assessments, vision/hearing checks. | | Minor Injury Care | 15 | 500 | 125 | RN, NP, PCP, PA | Treatment for cuts, abrasions, sprains, minor infections. May involve wound cleaning, dressing, bandaging, and suturing. | | Urgent Care/Minor Injuries | 15 | 500 | 125 | NP, PA, RN, PCP | Includes sprains, muscle injuries, fever, minor fractures, stitches, wound care. Tetanus shots may be included. | | Chronic Disease Checkups | 15 | 300 | 75 | PCP, NP, RN | Regular follow-up for conditions like diabetes, hypertension, COPD, and asthma. Includes vitals checks, medication management, lifestyle counseling. | | Mental Health Screening | 20 | 1000 | 333 | NP, PCP, RN, Mental Health Professional | Includes screenings for depression, anxiety, and stress management. Referrals to counseling or medication may follow. | | Health Education/Support | 30 | 300 | 150 | RN, Dietitian, Social Worker, Health Educator | Group or individual sessions on nutrition, exercise, smoking cessation, mental health, weight management, and other preventive care. | | Physical Therapy (Follow-up) | 20 | 150 | 50 | Physical Therapist, RN | Follow-up appointments for rehabilitation, mobility support, and chronic pain management for injuries or surgeries. | | Dietary Counseling (Follow-up) | 20 | 150 | 50 | Dietitian, RN | Regular follow-up appointments for weight management, chronic disease management, and lifestyle education. | | Role | Hours per Year | | | ----------------------------- | ------------------------------------------ | --- | | PCP | 500 + 75 + 75 = 650 hours | | | NP | 500 + 75 + 125 + 333.3 = 1033.3 hours | | | RN | 250 + 125 + 75 + 333.3 + 150 = 933.3 hours | | | MA | 500 + 250 = 750 hours | | | PA | 125 + 125 = 250 hours | | | Dietitian | 75 + 50 = 125 hours | | | Physical Therapist | 50 = 50 hours | | | Social Worker/Health Educator | 150 = 150 hours | | ##### pharmacy - pharmacy tech can do a lot!!! ##### Dental | Service | Duration (minutes) | Appointments per Year | Hours per Year | Roles that Can Perform | Notes/Details | | -------------------------- | ------------------ | --------------------- | -------------- | -------------------------------------- | ------------------------------------------------------------------------------------------------------- | | Annual Dental Exam | 30 | 1000 | 500 | General Dentist, Dental Hygienist | Comprehensive exam including oral cancer screening, cavities check, gum health, and bite evaluation. | | Routine Cleaning | 45 | 1000 | 750 | Dental Hygienist, Dental Assistant | Includes scaling, debridement, polishing, and fluoride treatment. | | Fillings | 30 | 500 | 250 | General Dentist, Dental Assistant | Treatment for cavities, tooth decay; material choices may include silver amalgam, resin, or gold. | | Root Canal Treatment | 60 | 200 | 200 | General Dentist | Removal of infected pulp, cleaning, sealing, and possible crown placement. | | Tooth Extraction | 45 | 150 | 112.5 | General Dentist, Dental Assistant | Removal of damaged or decayed teeth; may require local anesthesia or sedation. | | X-rays | 15 | 1000 | 250 | General Dentist, Dental Assistant | Includes bitewing, panoramic, and full-mouth radiographs to diagnose issues beyond visible symptoms. | | Preventive Education | 15 | 500 | 125 | Dental Hygienist, General Dentist | Discuss oral health practices, brushing/flossing techniques, and dietary habits for optimal dental care. | | Role | Hours per Year | | ----------------------------- | --------------------------------------- | | General Dentist | 500 + 250 + 200 = 950 hours | | Dental Hygienist | 750 + 125 = 875 hours | | Dental Assistant | 250 + 112.5 = 362.5 hours | | Dental Technician | 50 = 50 hours | ##### Vision - Optometrist (OD): Vision exams, prescribing corrective lenses, diagnosing eye conditions, managing non-surgical treatment for eye diseases - Ophthalmologist (MD): Medical doctors for more advanced conditions requiring surgery or specialized treatment - Optician: Fitting and dispensing glasses or contact lenses based on prescriptions | Service | Duration (minutes) | Appointments per Year | Hours per Year | Roles that Can Perform | Notes/Details | | ----------------------------- | --------------------------------------- | --------------------- | -------------- | -------------------------------------- | --------------------------------------------------------------------------------------------------------- | | Annual Eye Exam | 30 | 1000 | 500 | Optometrist, Ophthalmologist | Comprehensive vision exam, refraction test for glasses prescription, screening for common eye conditions. | | Routine Screening | 15 | 1000 | 250 | Optometrist, Ophthalmologist | Screening for glaucoma, cataracts, macular degeneration, and other eye conditions. | | Contact Lens Fitting | 30 | 500 | 250 | Optometrist, Optician | Fitting and instruction on care for contact lenses, including measurements for proper fit. | | Glasses Prescription | 15 | 500 | 125 | Optometrist, Optician | Prescription for glasses, including updating vision correction needs based on changes in vision. | | Glaucoma Test | 20 | 500 | 166.7 | Optometrist, Ophthalmologist | Eye pressure tests, optic nerve health checks, and visual field tests to screen for glaucoma. | | Cataract Screening | 20 | 500 | 166.7 | Ophthalmologist, Optometrist | Screening for early signs of cataracts, usually for older populations or those at risk. | | Laser Vision Correction | 90 | 200 | 300 | Ophthalmologist | LASIK or other laser procedures to correct refractive errors like nearsightedness or farsightedness. | | Low Vision Aids Counseling | 30 | 100 | 50 | Optometrist, Rehabilitation Specialist | Advice and guidance on adaptive tools and techniques for people with low vision or blindness. | | Role | Hours per Year | | ----------------------------- | --------------------------------------- | | Optometrist | 500 + 250 + 125 = 875 hours | | Ophthalmologist | 166.7 + 166.7 + 300 = 633.4 hours | | Optician | 250 + 125 = 375 hours | | Rehabilitation Specialist | 50 = 50 hours | ##### Mental | Service | Duration (minutes) | Appointments per Year | Hours per Year | Roles that Can Perform | Notes/Details | | ------------------------------ | ---------------------- | ------------------------- | ------------------ | ------------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Annual Mental Health Screening | 20 | 1000 | 333.3 | NP, PCP, RN, Mental Health Professional | Screenings for depression, anxiety, stress, and overall mental health. Referrals to counseling or medication may follow. | | Mental Health Education/Support | 30 | 300 | 150 | RN, Social Worker Therapist | Group or individual sessions focusing on coping strategies, stress management, and mental wellness practices. | | Therapeutic Counseling (Follow-up) | 60 | 150 | 150 | Therapist, Counselor | Regular counseling sessions for those dealing with anxiety, depression, trauma, or other mental health concerns. | | Crisis Intervention | 60 | 100 | 100 | Therapist, Mental Health Professional | Immediate care for those in crisis situations (e.g., suicidal thoughts, panic attacks, emotional distress). | | Mental Health Checkup | 15 | 300 | 75 | NP, PCP, RN | Regular check-ins for individuals with ongoing mental health conditions, ensuring medication management, coping strategies, and referrals for further care. | | Support Groups | 90 | 100 | 150 | Social Worker, Therapist | Group support for specific issues like grief, addiction, parenting, etc. Facilitated by professionals. | | Community Mental Health Events | 60 | 50 | 50 | Social Worker, Therapist | Community-led events aimed at destigmatizing mental health issues, increasing awareness, and providing tools for mental wellness. | | Emergency Mental Health Response | 30 | 50 | 25 | Mental Health Professional | Immediate support for individuals who need urgent mental health intervention (e.g., following traumatic events or crises). | | Role | Hours per Year | | ------------------------------- | -------------------------------------------- | | Mental Health Professional | 333.3 + 100 + 50 + 150 = 633.3 hours | | Therapist | 150 + 150 = 300 hours | | Social Worker | 150 + 50 = 200 hours | ##### Therapeutic I see! You want a breakdown of therapeutic services more focused on physical therapy and other non-mental health-related therapies. Here's a table for those types of services within a 1,000-person community, which includes the duration of treatments, the professionals who can perform them, and the hours allocated for each service. | Service | Duration (minutes) | Appointments per Year | Hours per Year | Roles that Can Perform | Notes/Details | | --------------------------------------- | ---------------------- | ------------------------- | ------------------ | ----------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------ | | Physical Therapy (Follow-up) | 20 | 150 | 50 | Physical Therapist, RN | Regular follow-up appointments for rehabilitation, mobility support, and chronic pain management after injuries or surgeries. | | Post-Surgical Rehabilitation | 30 | 100 | 50 | Physical Therapist | Focus on rehabilitation after surgeries, helping individuals regain movement, strength, and mobility. | | Sports Injury Rehabilitation | 30 | 150 | 75 | Physical Therapist | Specialized therapy for recovering from sports-related injuries such as sprains, strains, and fractures. | | Joint Mobilization and Manipulation | 30 | 50 | 25 | Physical Therapist | Manual therapy used to improve joint function and reduce pain, typically after injuries or in cases of chronic pain conditions. | | Massage Therapy | 60 | 200 | 200 | Massage Therapist, Physical Therapist | Therapeutic massage techniques to relieve muscle tension, improve circulation, and manage pain or stress. | | Chronic Pain Management Therapy | 30 | 200 | 100 | Physical Therapist, Occupational Therapist | Therapy for individuals suffering from chronic pain conditions such as arthritis, fibromyalgia, or lower back pain. | | Occupational Therapy (Follow-up) | 30 | 100 | 50 | Occupational Therapist | Therapy aimed at helping individuals regain their ability to perform daily activities, especially after injury or surgery. | | Balance and Fall Prevention Therapy | 30 | 100 | 50 | Physical Therapist, Occupational Therapist | Focus on improving balance and preventing falls in older adults or those recovering from injury or surgery. | | Role | Hours per Year | | ------------------------------------- | ----------------------------------------------------- | | Physical Therapist | 50 + 75 + 25 + 200 + 50 + 50 = 450 hours | | Massage Therapist | 200 hours | | Occupational Therapist | 50 + 50 = 100 hours | ##### Staffing Breakdown for Healthcare Needs (Annual Hours) | Role | Hours per Year | Number of Roles | Hours per Week (approx.) | | ----------------------------- | -------------- | ---------------- | ------------------------ | | Primary Care Provider (PCP)| 650 | 1 | 12.5 | | Nurse Practitioner (NP) | 1033.3 | 2 | 20.0 | | Registered Nurse (RN) | 933.3 | 2 | 18.0 | | Medical Assistant (MA) | 750 | 2 | 14.5 | | Physician Assistant (PA) | 250 | 1 | 5.0 | | Dietitian | 125 | 1 | 2.4 | | Physical Therapist | 50 | 1 | 1.0 | | Social Worker/Health Educator| 150 | 1 | 2.9 | | General Dentist | 950 | 1 | 18.3 | | Dental Hygienist | 875 | 1 | 16.8 | | Dental Assistant | 362.5 | 1 | 7.0 | | Optometrist | 875 | 1 | 16.8 | | Ophthalmologist | 633.4 | 1 | 12.2 | | Optician | 375 | 1 | 7.2 | | Mental Health Professional| 633.3 | 2 | 12.2 | | Therapist | 300 | 1 | 5.8 | | Massage Therapist | 200 | 1 | 3.8 | | Occupational Therapist | 100 | 1 | 1.9 | ##### Summary Costs Per Person Initial Infrastructure Cost: $580,000 / 1000 people = $580 per person Amortized Infrastructure (20 year average): $29 per person per year Annual Operating Costs: $196,000 / 1000 people = $196 per person per year Total Annual Cost Per Person: $225 ##### Initial Infrastructure Requirements ###### Primary Care / Urgent Care Space | Item | Sustainable Approach | Initial Cost | Annual Operating Cost | Lifespan | | ----------------------- | ------------------------------------------------------------- | ------------ | --------------------- | -------- | | Basic Exam Rooms (4) | Modular design with natural lighting, passive heating/cooling | $80,000 | $2,000 | 30 years | | Diagnostic Equipment | Energy efficient models, shared equipment plans | $150,000 | $7,500 | 10 years | | Lab Equipment | Energy-efficient, minimal chemical waste | $75,000 | $15,000 | 7 years | | Sterilization Equipment | Steam-based, energy efficient | $15,000 | $1,000 | 10 years | | Storage Systems | Reusable containers, minimal packaging | $10,000 | $500 | 15 years | ###### Dental Care Space | Item | Sustainable Approach | Initial Cost | Annual Operating Cost | Lifespan | | -------------------- | ---------------------------------- | ------------ | --------------------- | -------- | | Dental Chairs (2) | Energy efficient, water conserving | $40,000 | $2,000 | 10 years | | X-ray Equipment | Digital system, minimal radiation | $35,000 | $1,500 | 7 years | | Sterilization System | Integrated with primary care | $5,000 | $500 | 10 years | | Dental Tools | High quality, repairable | $25,000 | $2,500 | 5 years | ###### Vision Care | Item | Sustainable Approach | Initial Cost | Annual Operating Cost | Lifespan | |------|---------------------|--------------|----------------------|-----------| | Basic Eye Exam Equipment | Energy efficient models | $45,000 | $2,000 | 10 years | | Diagnostic Tools | Shared with primary care where possible | $30,000 | $1,500 | 7 years | | Frame/Lens Inventory | Focus on durable, repairable options | $20,000 | $5,000 | Ongoing | ###### Therapy/Rehabilitation Space | Item | Sustainable Approach | Initial Cost | Annual Operating Cost | Lifespan | |------|---------------------|--------------|----------------------|-----------| | Exercise Equipment | Manual/minimal power needs | $25,000 | $1,000 | 10 years | | Treatment Tables | Durable, repairable | $10,000 | $500 | 15 years | | Therapy Tools | Reusable, minimal waste | $15,000 | $1,500 | 5 years | ##### Annual Supply Costs (1000 person community) ###### Basic Medical Supplies | Category | Sustainable Approach | Annual Cost | |----------|---------------------|--------------| | Disposable Items | Focus on reusable alternatives where possible | $25,000 | | Medications | Bulk purchasing, proper storage | $50,000 | | Lab Supplies | Minimal waste protocols | $20,000 | | Emergency Supplies | Regular rotation, minimal waste | $15,000 | ###### Dental Supplies | Category | Sustainable Approach | Annual Cost | |----------|---------------------|--------------| | Disposable Items | Sterilizable alternatives where possible | $15,000 | | Materials | Bulk purchasing, proper storage | $20,000 | | Preventive Care | Focus on education and prevention | $10,000 | ###### Vision Care Supplies | Category | Sustainable Approach | Annual Cost | |----------|---------------------|--------------| | Basic Supplies | Minimal waste, bulk purchasing | $10,000 | | Frames/Lenses | Repair-focused inventory | $25,000 | ###### Therapy Supplies | Category | Sustainable Approach | Annual Cost | |----------|---------------------|--------------| | Treatment Supplies | Reusable options preferred | $10,000 | | Educational Materials | Digital where possible | $5,000 | #### Legality - community land trust medical subsidiary - Certification: a formal recognition of someone's competence in a specific area. does not grant legal authority to administer healthcare. credential, demonstrating that the person has met certain standards and can competently perform specific tasks - Licensing: grants permission for someone to practice medicine or healthcare independently - procedures that break the skin for administer medicine require license medical professionals #### First Aid first aid addresses symptoms to stabilize - can suggest certain over-the-counter medications for `self-administration` (like aspirin, antihistamines, etc.) | Certification | Requirements | Duration | Typical Cost | Common Actions | Limitations | | --------------------------------- | -------------------------------------------------- | ----------- | ------------ | ------------------------------------------------------------------------------------------------ | ------------------------------------------------------------------------------------------ | | Basic First Aid (Level 1) | Age 16+, no prerequisites | 4-6 hours | $50-100 | Minor wound care, basic bandaging, calling emergency services, scene safety | Cannot administer medications, perform any invasive procedures | | Standard First Aid (Level 2) | Age 16+, Basic First Aid recommended | 8-12 hours | $100-175 | All Basic plus: fracture care, spinal injury management, heat/cold emergencies, triage | Cannot give medications, suture, reduce dislocations | | Advanced First Aid (Level 3) | Age 18+, Standard First Aid required | 24-40 hours | $200-400 | All Standard plus: oxygen administration, blood pressure monitoring, detailed patient assessment | Cannot start IVs, give prescription medications, perform advanced medical procedures | | Pediatric First Aid | Age 16+, no prerequisites | 6-8 hours | $75-150 | Child/infant CPR, choking response, seizure management, allergic reactions in children | Cannot administer medications without parent/guardian consent, perform invasive procedures | | CPR/AED | Age 16+, no prerequisites | 3-4 hours | $30-80 | Chest compressions, rescue breaths, AED operation, choking response | Cannot perform tracheotomy, intubation, or give emergency medications | | Wilderness First Aid | Basic First Aid certification, age 16+ | 16-20 hours | $200-350 | Extended care, improvised splints/stretchers, environmental emergency response | Cannot perform suturing, give prescription medications, or reduce major dislocations | | Emergency Medical Responder (EMR) | Age 16+, high school diploma/GED, background check | 40-60 hours | $450-800 | Patient assessment, oxygen administration, spinal immobilization, basic airway management | Cannot start IVs, give medications, or perform advanced airway procedures | | Professional Rescuer | Healthcare provider BLS, age 18+ | 8-12 hours | $150-250 | Two-rescuer CPR, bag-valve-mask ventilation, supplemental oxygen delivery | Cannot perform advanced cardiac life support or give emergency medications | | Certification Level | Instructor Requirements | Instructor Course Duration | Renewal Period | | ----------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- | -------------------------- | -------------- | | Basic/Standard First Aid Instructor | - Current Level 3/Advanced First Aid certification<br>- 2+ years field experience<br>- Completion of Instructor Development Course<br>- Pass teaching evaluation | 24-40 hours | 2-3 years | | CPR/AED Instructor | - Current CPR/AED certification<br>- Completion of CPR Instructor course<br>- Minimum of 1 year experience<br>- Teaching demonstration | 16-20 hours | 2 years | | Wilderness First Aid Instructor | - Current WFA certification<br>- Extensive outdoor/wilderness experience (3+ years)<br>- Advanced First Aid or EMT certification<br>- Teaching experience | 40-60 hours | 2 years | | EMR Instructor | - Current EMT or Paramedic license<br>- 5+ years field experience<br>- College-level teaching experience preferred<br>- Additional state requirements may apply | 40-80 hours | 2-3 years | | Pediatric First Aid Instructor | - Current Pediatric First Aid certification<br>- Healthcare or childcare background preferred<br>- Teaching experience with child-specific content<br>- Pass evaluation | 24-32 hours | 2 years |