Health and Human Services in 2010
Fast Forward
• Systems are client-centered: active, responsible consumers have choice and control.
• All services are customized to meet the particular needs of each individual.
• Treatment and funding decisions are based on quality outcome data.
• A majority of doctor/patient interactions are conducted online.
• No direct services are provided by state. All direct services are provided by private for-profit and nonprofit sectors or local governments.
• Government’s main role is information broker and traffic cop informing and directing people to assistance needed, determining eligibility, monitoring service quality and providing electronic payments for services.
• People apply for a benefit, not to a program. (For example, one would apply for health insurance, not to Medicaid or CHIP. The state would pay the bill but the source of funding would be invisible to the recipient.)
It’s another hot, humid day in Corpus Christi, and Elaine’s asthma is worse. She contacts her personal “electronic health coach,” an expert computer system that offers a wide variety of medical information to its user through a voice-activated home computer, and sends the electronic health coach a readout from the biomonitoring device she wears on her wrist. The health coach sees that a readout of Elaine’s health status indicates a problem. It asks Elaine to send blood and urine data through her personal biochip, a device about the size of a credit card that analyzes specimens and transmits medical data online.
Elaine’s doctor and her health coach review the biochip information and the biomonitoring results. In just a few minutes, Elaine receives a computer message telling her to increase her asthma medication and add an antibiotic. Elaine heads to work wearing her wrist biomonitoring device that will alert her health coach to any further changes in her chronic condition.
Jane recently moved from Dallas to Kerrville to be closer to her elderly mother, who is in poor health. Jane’s mother needs 24-hour care, and since Jane works during the day, she is unable to care for her mother at home. Jane uses the state’s service portal to look for options for her mother’s care. She examines some nursing homes via an online virtual tour. Jane fills out an online application for her mother and submits it to the state’s eligibility office to see if her mother qualifies for state assistance. The eligibility office replies that Jane’s mother is eligible for services and sends Jane a voucher to purchase care for her mother. Instead of a nursing home, however, Jane decides on an elder day-care center in Kerrville, close to the day-care center where her two young sons go after school.
Next, Jane searches the area’s directory of physicians for a family doctor for her two boys. She wants someone who specializes in preventive medicine, since her family has a history of heart disease. She finally chooses a doctor after reviewing his medical credentials and patient ratings. The doctor’s Web site impressed Jane with its comprehensive discussion of heart disease, new medications and procedures, and interactive features for patient questions.
Dr. Klein is flying from Austin to Houston. During the trip, he opens his briefcase computer to check on some of his postsurgical patients. Mr. Young had coronary bypass surgery yesterday morning, and was released today. Dr. Klein modifies Mr. Young’s medications and increases the frequency with which his biomonitoring device will report vital signs. He also confers with the home health care workers who are caring for Mr. Young. Dr. Klein is optimistic that Mr. Young’s heart disease can be halted by new medications that melt plaque in the arteries.
The physicians at the Jefferson Critical Care Center review the workload for the next day. They update each patient’s DNA “fingerprint” to ensure that their health care records remain accurate. Meanwhile, staff members identify patients scheduled for customized gene therapy. Many of their cancer patients have elected to treat their disease through injections of genes directly into the bloodstream. The genes, contained in viral carriers, transfer corrective genetic material to each malignant cell.
It was a long night for Amelia. Her six-month old baby, Eleanor, was sick again. Amelia knew she should take Eleanor to a doctor but she did not have any health insurance and couldn’t pay for expensive doctor visits. A friend told her that she might be eligible for health insurance from the state. Amelia had never before applied for any state assistance. She went to her neighborhood center as soon as it opened and asked for help. A staff person showed her how to use the computer to find state assistance and see if she qualified to receive it.
On the state’s Web site, Amelia began a virtual tour through the list of state services. As she answered the computer’s questions, Amelia soon found that Eleanor was eligible for health insurance benefits. She completed a brief questionnaire, and her application was processed within a few minutes. Amelia received a medical insurance card and a list of phone numbers of doctors that she could choose from. She browsed a list of doctors and hospitals and their quality rankings before she made her selection.
On that day, Amelia and thousands of other Texans interacted with state government electronically. In just 10 years, state government had changed from providing services in different agencies and programs to being an information broker and a bill payer. Consumers no longer need to know which agencies provide specific services or funds for services. They can access all the available health and human services through one Web site that has links to benefits, not programs. The agency or funding source providing the health insurance is invisible to Amelia.
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