Jeff is a 48-year-old welder who works for a pipeline service company in Houston. He is obese, smokes one pack per day, has medication-controlled diabetes (DM) and hypertension (HTN) and is prone to diabetic foot infections (INF) and chronic headaches (HA). He has a primary care provider (PCP) and employer-provided insurance. Jan Annual physical examination with PCP $50 Refills medications for DM and HTN $25 Feb Seen ED with headaches (DM? HTN?) discharged with neurologist referral $1,750 Neurologist orders CT $2,250 CT is negative Mar PCP send to dermatologist for chronic right foot infection $50 Dermatologist orders cutting edge antibiotics, urged to stop smoking $450 Unable to fill antibiotics due to cost Apr ED visit with infected foot, 5-day admission $38,000 Follows up with PCP $50 Has MRI for headache evaluation (not EBM, no ins coverage)  negative $1,500 May Cleared by neurologist for headache $750 Neurologist concerned about HTN and sends back to PCP Jun PCP changes medications, notes chronic unexplained hearing loss $50 Loss of consciousness at work  taken to ED, given IV fluids, sent home $2,500 New PCP finds taking two BP medications, DM uncontrolled, to Derm for foot $75 Jul Misses Derm appt due to lack of transportation In ED because cannot walk  admitted  emerg surgical debridement, 8 day admit $81,000 Begins three times/week rehab  misses 1/2 of visits due to transport issues $18,000 Aug Let go from work because unable to do light duty Difficulty finding work because of leg infection Begins paperwork for county healthcare system Apartment files eviction claim Sep Seen County ED after passed out  possible alcohol/drugs (drug screen pos for narcotics and anxiety meds)  given referral for County Health (2 month waiting list) $3400 Oct Seen in County Clinic, all meds changed to generics, advised to lose weight $50 Nov Foot worse, was delay in getting derm clinic visit, diagnosed with gangrene, admitted County Hospital - admit amputation R foot, dced to rehab, advised to quit smoking $46,000 Dec Admitted County Hospital with wound infection, uncontrolled DM and ETOH abuse $29,000 Questions : Review the Jeff case study. Assume you are the Chief Operating Office of a large county-wide hospital and clinic system. 1. Briefly describe a healthcare system design that would use clinic visits and data analytics to improve the quality and cost of care for a given population of 1000 patients with similar medical problems and life circumstances to Jeff. 2. Assume the predictive analytics project and monitoring hardware/software/staffing cost $500,000 per year for a program involving 1000 patients at risk for complications like Jeff. Can you justify the implementation of such a project on a qualitative basis? Can you justify the implementation on a quantitative cost benefit? 3. Do you think a system of clinic visits and data analytics would be sufficient to care for patients like Jeff?