Transcript Document

Patient – Consumer
Involvement in Health Care
Why It Is Needed?
And How Can We Do It?
Ted Rooney, RN, MPH
• Aligning Forces for Quality Project
Director, Quality Counts
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Objectives
• Identify how the US health care is in a
quality/cost crisis
• Suggest the best path forward seems to
be a primary care based system involving
new and existing partners in innovative
new ways
• Ask for your help in involving patients and
the public actively in how health care is
redesigned
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Our Quality Is Less………
BETTER
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Our Costs Are More
International Comparison of Spending on Health, 1980–2008
Average spending on health
per capita ($US PPP)
Total expenditures on health
as percent of GDP
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8000
7000
6000
5000
4000
United States
Norway
Switzerland
Canada
Netherlands
Germany
France
Denmark
Australia
Sweden
United Kingdom
New Zealand
14
12
10
8
2000
4
1000
2
0
0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Source: OECD Health Data 2010 (June 2010).
United States
France
Switzerland
Germany
Canada
Netherlands
New Zealand
Denmark
Sweden
United Kingdom
Norway
Australia
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
3000
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http://www.iom.edu/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-inAmerica/Infographic.aspx
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Institute of Medicine - 2012
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Problems with MisUse
Institute of Medicine Report 1999:
Annual Deaths:
• Medical Mistakes
44,000 - 98,000
• Motor Vehicle Accidents
43,458
• Breast Cancer
42,297
• AIDS
16,516
• Workplace Accidents
6,000
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Office of Inspector General
DHHS, January 2012
• 2010: 13.5 %of hospitalized Medicare
beneficiaries experienced adverse events
during their hospital stays that resulted in
prolonged hospitalization, required lifesustaining intervention, caused permanent
disability, or death.
• An additional 13.5 percent experienced
temporary harm events that required
treatment.
• Maine in 2010: 61,385 Medicare patients
discharged from Maine hospitals
• 13.5% = 8,287 Medicare beneficiaries
(23)
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Not All Preventable
• “Although an adverse or temporary harm
event indicates that the care resulted in an
undesirable clinical outcome and may
involve medical errors, adverse events do
not always involve errors, negligence, or
poor quality of care and may not always
be preventable.”
• And Maine hospitals are among the safest
in the nation…
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Office of Inspector General
Department of Health and Human Services OFFICE OF
INSPECTOR GENERAL
HOSPITAL INCIDENT REPORTING SYSTEMS DO NOT
CAPTURE MOST PATIENT HARM
Daniel R Levinson, Inspector General - January
2012
• All sampled hospitals had incident reporting
systems to capture events, and
administrators we interviewed rely heavily on
these systems to identify problems.
• Hospital staff did not report 86 percent of
events to incident reporting systems.
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Institute of Medicine
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Problems with UnderUse
Adherence to Quality Indicators
Breast Cancer
2004: Adults receive
about half of
recommended care
75.7%
Prenatal Care
73.0%
Low Back Pain
68.5%
Coronary Artery Disease
68.0%
Hypertension
64.7%
Congestive Heart Failure
63.9%
Depression
57.7%
Orthopedic Conditions
57.2%
Colorectal Cancer
53.9%
Asthma
53.5%
Benign Prostatic Hyperplasia
53.0%
Hyperlipidemia
54.9% = Overall care
54.9% = Preventive care
53.5% = Acute care
56.1% = Chronic care
48.6%
Diabetes Mellitus
45.4%
Headache
45.2%
Urinary Tract Infection
Not Getting
the Right
Care at the
Right Time
40.7%
Ulcers
32.7%
Hip Fracture
22.8%
Alcohol Dependence
10.5%
0%
20%
40%
60%
80%
100%
Percentage of Recommended Care Received
Source: McGlynn EA, et al., “The Quality of Health Care Delivered to Adults in the United States,” New England Journal of Medicine,
Vol.14
348, No. 26, June 26, 2003, pp. 2635-2645
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Fo
Problems With OverUse
110
100
90
Hospital Outpatient Advanced Imaging
Utilization / 1,000 by Hospital Service Area
80
70
60
State Average:
44.8/1,000
50
40
30
20
10
0
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Note: Red bars are significantly above/below the state average at the .05 level
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Comparative Cost: Large Maine Hospitals
Below State Average
Above State Average
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Comparative Cost: Small Maine Hospitals
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WE Pay The Wrong Way!
Population Health for 20,000 People
LOSE
Primary Care
LOSE
Psych Clinic, Home Health,
EMS, Nursing Home, Etc.
Rests on
the
head…
LOSE
Inpatient Beds
LOSE
Lab and Other
Ancillaries
??
Imaging
$$
Surgical and
other
Procedures
of a pin
$$
$$$
Total
Joints
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ER
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Aligning Maine’s “Forces”
Consumer
Engagement
Perf Meas./
Public Report
Quality
Improvement
Benefit
Design
Payment
Reform
QC/MHMC: AF4Q Consumer Messaging/
Leadership
MHMC Employee Activation Program
MHMC : PTE reporting on hospitals,
primary care, specialist quality
MQF: reporting on hospital quality, patient
experience of care (TBD)
MPIN, PHOs: QI support to mbr practices
Quality Counts: QC Learning Community
MHMC: Encourage employer/payer use of PTE
data for steering;
Value-based insurance design
Hospitals/ Health Systems &
Employers: Local ACO Pilots
Primary Care & Employers/Payers:
Alternative payment models
Promote
Health IT
Adoption
Specialty Care:
Alternative payment models
Maine PCMH
Pilot
BIW Primary
Care Program
Cognitive
Consultation
MEREC: Promote primary care HER adoption, meaningful use
HealthInfoNet: Promote interoperable systems
Bangor Beacon: promote community-wide, connected HIT
What Are We
Trying to
Achieve?
And what
Contributes?
Univ. Wisconsin - RWJF
County Health Rankings
Everyone Has A Role
WHO
RESPONSIBILITIES
Engage as a health care consumer
Consumers
Make healthy lifestyle choices
In Building a
Value-Based
Health Care
System,
Doctors /
Hospitals
Improve effectiveness and
affordability of health care services
Share quality and cost information
Purchase benefits based on value
Employers
Help employees be better health
care consumers; promote health
Everyone
Has a Role
Design benefits based on value
Insurers
MHMC /
AF4Q
Based on chart developed by Puget Sound Health Alliance and the Wisconsin 21
Health
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Alliance Cooperative, 2006
Help members be better health care
consumers; promote health
Produce performance reports
Recommend aligned incentives
Don Berwick: “What Will Help…”
• Very Strong Primary Care
• Intelligent Use of Specialty and High-Tech
Care (without ANY loss to patients!)
• Highly Efficient Hospitals
• Focus on Each Individual Patient’s Goals
• Superb systems for High Cost, Socially or
Medically Complex Patients
• Integration of Regional Resources
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Institute of Medicine
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It’s About the Basics
(the hard work!)
Amb
• Advanced Primary
Care/PCMH (New workforce: Practice
• Bundled Payments
RN Care Managers)
• Community Care Teams for
Comm
• Partial Capitation
High-Cost/High-Risk Patients
(New workforce: CCT staff)
• Enhanced Care Transitions
Comm
• Global Capitation
(New workforce: Hospital + Communitybased Care Transition Coaches)
Healthcare
Delivery
System
Change
Payment
Reform
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System
Transformation
Maine Experience: Lessons Learned
Recognize different motivators – need both the
“heart” and the “head”!
• Professionalism
• Self-respect
• Peer respect
• Efficiency
• $ / financial
incentives
Needed to
sustain
change
Motivators for
adoption & spread of
change
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Consumers Can Drive Change
LABOR MEMBERS: 13
Brett Hoskins, Co-Chair (MainePERS)
Carl Parker (MSEA-Admin)
MANAGEMENT MEMBERS: 9
(Exec-DHHS) - VACANT
Cheryl Moreau (MSEA-Courts)
Alicia Kellogg, Co-Chair (Exec-DAFS)
Freeman Wood (Retiree-MAR)
Becky Greene (Exec-MDOT)
John Bloemendaal (MEA-MCCS)
Carol Harris (MainePERS)
John Leavitt (MSLEA-Law Enf)
Kandi Jenkins (MSEA-Pro Tech)
Michael Mitchell (MSTA) Acting
Ed Mouradian (Exec-AG)
Frank Johnson (Ex-Officio, EH&B)
Richard Hodgdon (Retiree-MSEA)
Jan Lachapelle (MCCS)
Scott Kilcollins (MSEA-Supv)
Kimberly Proffitt (Judicial)
Steve Moore (MSEA-OMS)
Lauren Carrier (MTA)
Tom Hayden (MSEA-MTA)
Will Towers (AFSCME)
Tanya Plante (Staff-EH&B)
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Pathways to Excellence – Hospitals
Steering Committee
Hospital VPMA:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Don Krause, MD: St. Joe’s Hospital
Scott Rusk, MD: Mercy Hospital
Doug Salvador, MD: Maine Med. Center
Mark Souders: Maine General Med. Center
Larry Losey, MD: Parkview Adventist Med.
Center
Frank Lavoie, MD: So. Maine Med. Center
Peter Watco: St. Mary’s Regional Hospital
Roger Renfrew, MD: Redington Fairview
General Hospital
Patty Roy, RN: Central Maine Medical
Center
Scott Mills, MD: Midcoast Hospital
Erik Steele, DO: Eastern Maine Healthcare
James Raczek, MD: EMMC
Vance Brown, MD: MaineHealth
Mike Swann: Franklin Memorial Hospital
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Health Plans:
• Aetna
• Anthem
• CIGNA
• Harvard Pilgrim
• MaineCare
Employers:
• Christine Burke: MEA Benefit Trust
• Laurie Willamson: State Employees
Hlth Comm
• Tom Hopkins: Univ. of Maine System
• Chris McCarthy: Bath Iron Works
• Joanne Abate: Hannaford Bros.
• Steve Gove: ME Mun. Employee
Health Trust
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Organizations:
Alex Dragatsi: Maine Quality Forum
Sandra Parker: Maine Hospital Assn.
Art Blank: ME Hosp. Assn, MDI Hosp
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SEHC Announce 7-07 PCP Tiering
2929
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Medication Survey Results
2005-2009 (as of 8-09)
2005
2006
2005 Pie
Total
Total
2006
Pie
2007
TOTAL
2007
PIE
2009
2008
2008 PIE TOTAL 2009 PIE
TOTAL
SCORE
Bridgton Hospital
24
24
62
73
73
Franklin Memorial
0
29
56
50
72
Midcoast Hospital
32
35
70
74
71
MaineGeneral Medical Center
28
35
63
68
71
Sebasticook Valley
0
26
60
70
71
The Aroostook Medical Center
5
6
63
70
71
Northern Maine Medical Center
0
36
74
73
70
St. Mary's R.M.C.
23
23
44
54
68
St. Joseph Hospital
9
28
59
57
67
Inland Hospital
0
21
59
66
66
Penobscot Valley Hospital
14
31
42
57
66
Goodall Hospital
9
14
67
57
58
Calais Regional Hospital
31
38
61
54
57
Redington Fairview
18
17
36
32
52
Millinocket Hospital
0
27
52
43
52
Houlton Regional
7
12
24
25
52
CA Dean
1
1
1
34
47
Waldo County General Hospital
0
10
48
43
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Maine: 2nd biggest
improvement in US
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Physical Health Providers
• Vance Brown, MD MaineHealth
• Barbara Crowley MD MaineGeneral
• Richard Freeman, MD EMHS
• Sharron Sieleman RN, CMMC
Consumers
• Jenny Rottmann
• Dan L'Heureux
• David White
Behavioral Health Providers
• Lynn Duby, Crisis & Counseling
• Greg Bowers, Maine Mental Hlth
Partners
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Health Plans
• Terri Bellmore, Universal Am.
• Bob Downs , Aetna
• Jeff Holmstrom DO, Anthem
•
•
•
Elizabeth Mitchell, MHMC
Michelle Probert, MaineCare
Karynlee Harrington, Dirigo Health
Agency
Sandy Parker, Maine Hospital Assn
Gordon Smith, Maine Medical Assn
Debra Wigand, MaineCDC
2011: SEHC 1st Annual QC QI Award
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Approach
• We need the patients’ and public’s
help (i.e. YOU) in shifting wasteful
spending that does nothing to
improve health, and often
produces harm, to spending that
actually helps improve the health
of Maine people.
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Patient & Public Involvement
1. Improve one’s own health / health of family
–
–
–
Wellness offerings
Healthy eating
Meals on wheels, etc.
2. Get information to make informed choices
–
–
–
www.GetBetterMaine
Help people access information
Articles in newsletters, etc.
3. Work with others to help improve their health
– Living Well and Matter of Balance programs
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Patient & Public Involvement
4. Work directly with health care providers to
help improve the delivery, quality,
experience of care
– Participate in provider committees (with
training)
5. Work with stakeholders to drive system,
policy, payment changes to transform
care
– Community forums on quality-cost
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