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Group Project #3 Data Driven Outcomes

Oakdale Physicians Group is a general medicine practice with 5 Board Certified Family Practice physicians, 1 nurse practitioner, 4 registered nurses and one practice manager and a receptionist. The practice is in an urban area of Atlanta, GA.

The practice is considering making a change from the traditional insurance (including Medicare, third party payers) reimbursement-based practice to a Direct Primary Care or Concierge Practice model. After consulting with other physician groups across the state, they find that the amount that is being charged by other groups ranges from $600 to $1500 a month.

They did some research and found a study which found that different populations respond to healthcare cost in generally different ways. The study found that people with no illnesses and disabilities, generally the young and healthy, would not spend $700 on healthcare for an entire year let alone a month, and most feel they would not waste so much money on premiums when the chance of needing expensive healthcare treatments is so small. However, the study found that older, sicker people think that $700 per month is a great deal, as most of them spend far more than this amount on healthcare. For the older population it seems like a great deal.

Before making the decision to switch to the new delivery care model, they need to gather some data because it is the data that will be the deciding factor toward the change. The outcome of their decision is driven by the data.

So now the practice must decide whether to switch to the DPC model AND how much to charge the patients each month.

1. Describe in detail four different data sets (or kinds of data or types of data) that they will need to gather to make the decisions and how having this data will influence their decision. e.g. If you were going to move to Dallas, TX , you would want to know the cost of apartments because you want to make sure that your salary will support that cost.
2. Describe how they will gather this data. In other words, what kinds of documents can be mined for the information? Where can they look for the information?

1. If the company makes this change, how might adverse selection influence their succes