Transcript Slide 1

A National Framework for Change
2008
The Challenge
In a country that expects the best of everything
we fail to achieve the best in health.
What must be done to meet the health and
health care challenges of our future?
• Chronic illness on the rise
• Consumer dissatisfaction
• High health care and insurance costs
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A Sicker America
Chronic illness is on the rise
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Half of Americans have one or more chronic illnesses
80% of spending is linked to chronic illness
Much of this is avoidable
Obesity has doubled; Diabetes is on the rise
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Prevalence of Obesity , U.S. Population, 1990-2002
Percentage of Population
25%
20%
Obesity
15%
10%
5%
0%
90
91
92
93
Source: Centers for Disease Control and Prevention.
94
95
96
97
98
99
00
01
02
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A Sicker America
Chronic illness is on the rise
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Half of Americans have one or more chronic illnesses
80% of spending is linked to chronic illness
Much of this is avoidable
Obesity has doubled; Diabetes is on the rise
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Prevalence of Diabetes , U.S. Population, 1990-2005
10%
9%
Percentage of Population
8%
7%
6%
Diabetes
5%
4%
3%
2%
1%
0%
90
91
92
93
94
95
Source: Centers for Disease Control and Prevention.
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97
98
99
00
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02
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A Sicker America
Factors Harming Health Are On the Rise
• Biology
High risk factors; family history; physical and mental health
problems
• Physical environment
Exposure to toxins; hazards at work or at home; air pollution
• Social environment
Poverty; lack of education; homelessness; lack of transportation;
violence
• Behavior
Smoking; poor eating habits; lack of exercise; drug and alcohol
abuse
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* Adapted from Healthy People 2010, a report by The U.S. Department of Health and Human Services
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America’s Health Must Improve
Without change, America’s health care
capabilities and finances will be overwhelmed
As a society we must:
• Provide access to education and preventive care
• Help all reach their highest potential for health
• Reverse the trend of avoidable illness
As individuals we must:
• Achieve healthier lifestyles
• Take responsibility for our health behaviors and
choices
Each one of us must take action
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The Benefits
• Healthy infants = healthy kids
• Healthy kids = success in school
• Healthy kids = healthy adults
• Healthy adults = healthy seniors
• Healthy individuals = healthy families, healthy
workers, healthy communities and a healthy
economy
A healthy America
is a productive and vibrant America
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America’s Health Care Must Improve
People are dissatisfied
with the health care system
6 in 10 Americans rate the health care system as fair or poor
Excellent
4%
Very Good
10%
Don't know
1%
Poor
29%
59%
fair or poor
Good
26%
Fair
30%
Source: Employee Benefit Research Institute, 2007.
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America’s Health Care Must Improve
Health care costs are high
• Highest spending per person among industrial countries
• High costs weaken America in today’s global economy
• Americans are increasingly angry about high costs
2005
D o n't
k no w
2%
D o n't
No
k no w e xpe rie nc e
1%
6%
E xt re m e ly
s a t is f ie d
7%
No
e xpe rie nc e
3%
E xt re m e ly
s a t is f ie d
5%
N o t a t a ll
s a t is f ie d
19 %
33%
V e ry
s a t is f ie d
2 1%
2007
V e ry
s a t is f ie d
13 %
N o t a t a ll
s a t is f ie d
30%
48%
N o t to o
s a t is f ie d
14 %
S o m e wha t
s a t is f ie d
32%
S o m e wha t
s a t is f ie d
28%
N o t to o
s a t is f ie d
18 %
Dissatisfaction with health care costs grew 15 percentage points in two years
Source: Employee Benefit Research Institute, 2007.
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America’s Health Care Must Improve
Health care in America can be
better and more affordable
America deserves care that is:
• Safe and free from harm
• Provided at the right time, when care is needed
• The recommended care every time
• Efficient and affordable
• Without bias
• Personalized and sensitive to each individual’s needs
Adapted from the Institute of Medicine Crossing the Quality Chasm, 2001.
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Can We Envision a Different Future?
• Health and health care are basic human needs and no
one goes without
• Everyone has prompt access to needed health care
• Everyone is treated with dignity and respect
• Everyone has the opportunity to reach their highest
potential for health
• Health and health care is without bias
• Improving the health of our nation is viewed as a
common good and good for our nation
A new vision for America
Health for Life
Better Health. Better Health Care.
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What Does This Vision Mean?
For America’s Health:
• America is #1 in health status among nations
• Trend in avoidable chronic disease is reversed
• People lead healthy, balanced lives
For America’s Health Care:
• Health care is efficient, affordable and of high quality
• Everyone has coverage and access to care
• Care experience exceeds expectations
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Action By All
Improving America’s health is a great
common cause that calls for leadership,
participation and shared responsibility
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Every individual
Every employer
Every insurer
Every health care supplier
Every community
Every state, local and the national government
Every doctor, hospital and all care providers
Now is the time to do better
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Opportunities for Leadership:
By Stakeholders in Coalition
• Reform will require changes in public policy at the federal and
state level
• The following public policy ideas for change were developed by
six expert advisory groups involving nearly 100 different
organizations (consumers, business, labor, insurers,
physicians, nurses, hospitals, and others)
• These ideas represent a strong consensus across the groups of
policy ideas that begin to move America in the right direction
• These ideas are intended to guide policy makers with concrete
suggestions toward a common path for creating change in
health and health care in America
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Focus on Wellness
Good health – physical, mental, and oral – is essential for a productive and
vibrant America. A focus on wellness must be integrated into the lifecycle, from
birth to death, and be encouraged in our homes, schools, workplaces and
communities.
Goals
• Healthier lifestyles, better compliance with recommended care and lower rates of preventable diseases
• Guarantee access to primary care
• Focus on prenatal care and children’s health at an early age
Public Policy Ideas for Change
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Invest in the provision of primary care services
Promote healthy pregnancies and newborns
Invest in America’s public health
Provide incentives to encourage healthy choices and behaviors
Provide a national investment in school and community-based health
Call for a national media campaign focusing on healthy lifestyles
Provide support and coaching needed to change unhealthy behaviors
Enhance health professions education to include a focus on wellness
Focus on chronic care management
Create an objective, trusted source of consumer health information and education
Go to www.aha.org for more detail.
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Efficient Affordable Care
Efficient
Affordable
Care unless and until the cost of health coverage and
America will
not be satisfied
health care are affordable.
Goals
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More informed decision making
Better manage chronic disease
Evaluate the efficacy and use of new technologies and medicines
Spend resources on care, not paperwork and legal costs
Well-educated workforce in sufficient numbers and with needed mix of skills
Public Policy Ideas for Change
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Simplify the working of public and private insurance
Focus on chronic care management
Create a better alternative to today’s liability system*
Test payment redesign to reward quality providers
who follow recommended “best practices”*
• Redefine roles for workers to meet future care needs
• Renovate the education of health care professionals
and the broader health care workforce
• Make available to consumers meaningful information
on the quality, price, use, and comparative
effectiveness of health care services
* See specific AHA proposal.
Go to www.aha.org for more detail.
• Analyze the comparative effectiveness, risks, and
benefits of new technologies, medicines, practices, and
procedures for individual conditions
• Expand educational capacity and emphasize early math
and science learning to meet current and future health
care workforce needs
• Invest in America’s public health
• Test payment redesign to give provider groups a single
amount to manage the entire episode of a patient’s care
and better coordinate care*
• Adequately fund national performance improvement
measurement*
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Highest Quality Care
Motivate doctors, nurses, hospitals, nursing homes, and others to work together
and team up with patients and families to make sure the right care is given at the
right time and in the right setting.
Goals
• Increase development and use of evidence-based care
• Reward care outcomes
• Support doctors, hospitals and others in working together to coordinate care on behalf of patients
• Coordinate treatment of physical and behavioral health needs
• Increase availability and use of compassionate end-of-life care
Public Policy Ideas for Change
• Modernize laws and regulations to allow doctors,
hospitals, and others to work together in teams or
“networks”*
• Create a national investment to research the best
evidence in patient care and effective quality
improvement strategies. Develop methods for speeding
the adoption of these methods within the field
• Clinical integration*
• Renovate the education of health care professionals
and the broader health care workforce
• Test payment redesign to reward quality providers who
follow recommended “best practices”*
• Test payment redesign to give provider groups a single
amount to manage the entire episode of a patient’s care
and better coordinate care*
• Integrate physical and mental health care delivery
* See specific AHA proposal.
Go to www.aha.org for more detail.
• Expand options for end-of-life care at home
• Require everyone to complete and providers to honor a
summary of wishes regarding life-sustaining treatment
• Adequately fund national performance improvement
measurement*
• Redesign coverage and payment to guarantee parity
• Make available to consumers meaningful information on
the quality, price, use and comparative effectiveness of
health care services
• Create a better alternative to today’s liability system*
• Analyze the comparative effectiveness, risks, and
benefits of new technologies, medicines, practices and
procedures for individual conditions
• Reduce health disparities and inequity in health care
delivery
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Best Information
Good information is the gateway to good care.
Goals
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Increase patient safety
Reduce duplicative testing, unnecessary costs and patient hassle
Ensure open communication between patients and providers
Speed the adoption of health information technology
Ensure easy access for patients to their medical records and health information
Enable better care coordination
Public Policy Ideas for Change
• Speed the creation of electronic health records and personal health records by selecting and using “interoperable”
health standards*
• Drive the secure exchange of clinical information among and across different providers of care*
• Encourage private sector creation and use of unique, confidential health information identifiers to accurately and
securely link patients to their health records
• Fundamentally reform the payment model to encourage specific IT adoption by health care professionals and
hospitals*
• Provide incentives for health care suppliers and insurers to enable the use of IT
• Conduct research and development of the market requirements and business models needed to create the next
generation systems and technologies
• Allow providers and community collaboratives to share information exchange capabilities
• Establish national models for data use that will facilitate community health improvement
• Renovate the education of health care professionals
* See specific AHA proposal.
Go to www.aha.org for more detail.
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Health Coverage for All… Paid for By All
Health coverage for all is a shared responsibility. Everyone – individuals,
business, insurers and governments – must play a role in both expanding
coverage and paying for it.
Goals
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Health coverage for all
Increase access to care for all
Increase insurance efficiency
Protect against high cost health events
Reduce differences in care by race, ethnicity and other characteristics
Public Policy Ideas for Change
• Every individual must have and contribute to the cost of health care coverage
• Every employer must take responsibility for providing health care coverage for their employees and contribute to the
cost
• Every insurer must guarantee access to coverage that is affordable, gives consumers the protection they need, and
delivers value
• Governments must maintain their current responsibility for coverage for seniors, disabled and certain low income
people
• Collective financing will be needed
Go to www.aha.org for more detail.
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Opportunities for Leadership:
By Each Stakeholder
• While some improvements will require changes in public policy,
many changes are already being made and must continue
• The nation’s hospitals and health systems commit to pursue
performance improvement in the care we provide and in
improving the health of our communities
• To improve America’s health, everyone must lead, participate
and share responsibility. We call on others – physicians,
insurers, employers, vendors, and government – to do their part
as well
• Following are examples of actions that stakeholders can take
today to improve health care in America
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Opportunities for Leadership: Hospitals
Examples of ways to reach the goal:
Safe
• Make effective use of information and clinical technology
designed to improve safety.
• Implement specific practices shown effective in improving
safety.
• Redesign care processes to eliminate defects.
• Collect and report errors in care to patient safety organizations.
• Support patients, their families, doctors and other caregivers
when patient harm occurs.
Efficient (cont.)
• Participate in payment approaches that reward efficiency and
quality.
• Track patients with chronic conditions and provide them with
effective chronic care management to avoid hospitalization.
Equitable
• Reduce emergency department wait times.
• Reduce the time between scheduling an appointment and
seeing a health care practitioner.
• Speed procedures, test results, patient diagnosis and
treatment.
• Smooth the movement of patients throughout their care
delivery experience.
• Collect patient data on race, ethnicity and language to look
more closely at hospital quality and patient satisfaction.
• Make translation services available for patients and their
families.
• Strengthen the diversity of hospital governance, management
teams and workforce.
• Provide employees training in cultural competence.
• Work with community leaders and organizations that serve
racial or ethnic minorities or other groups to reduce care
disparities.
Effective
Patient-centered
Timely
• Ensure the use of current best evidence in patient care.
• Share information with clinicians on how their clinical practice
compares to "best practices" or "benchmarks”.
• Ban unhealthy products on hospital campuses, such as
tobacco, use of trans fats, or availability of unhealthy foods.
• Promote better nutrition and fitness among our own hospital
employees and within the broader community.
• Lead community based initiatives to reduce obesity, diabetes,
HIV or other local needs.
Efficient
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Employ techniques to optimize performance.
Reduce process variation to improve reliability of care.
Manage organizational variability to streamline processes.
Adopt health information technology to eliminate duplication of
effort and reduce administrative costs.
• Encourage active patient and family involvement in care
delivery and decision-making.
• Customize care to meet each individual patient’s needs and
preferences.
• Educate patients and families on palliative care and end-of-life
care options.
• Embrace transparency in the reporting of quality and pricing
information to help people be better educated patients.
• Ensure the protection of patient privacy and the confidentiality
of medical information.
• Expand the health care literacy of communities and patients
served.
• Integrate the care delivered by physicians, nurses and others
to create a coordinated, seamless continuum of care for
patients.
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Opportunities for Leadership: Physicians
Examples of ways to reach the goal:
Safe
Efficient
• Consistently use current best evidence in
patient care.
• Publicly report both quality and pricing
measures.
• Make effective use of information technology
designed to improve safety.
• Support patients, their families, and other
caregivers when patient harm occurs.
• Eliminate duplication of tests and procedures.
Timely
Patient-centered
• Participate in providing on-call emergency
department coverage.
• Extend physician group office hours to include
evenings and weekends.
• Reduce time between scheduling an
appointment and seeing a health care
practitioner.
Effective
• Consistently use current best evidence in
patient care.
Equitable
• Achieve cultural proficiency.
• Commit to serving Medicare and Medicaid
patients.
• Commit to serving a fair share of your
community’s un- and underinsured
individuals.
• Make effective use of information technology
for patient registration and medical records.
• Use systems to remind patients of needed
follow up care and visits.
• Document all follow up care directions in
writing.
• Reduce patient waiting times.
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Opportunities for Leadership: Business/Employers
Examples of ways to reach the goal:
Safe
Efficient
• Develop healthier food product alternatives.
• Endorse and advertise marketing standards
that promote healthy behaviors.
• Agree on standardized, meaningful, accurate
and reliable measures for cost and quality
reporting.
• Support standardization of administrative
activities and costs across insurers.
• Support standardized insurance benefit
packages across insurers.
Timely
• Eliminate policies that reward workers for not
using sick leave to seek medical care.
Effective
• Use incentives to reward healthy employee
behaviors.
• Offer workplace health units for primary care
needs.
• Provide workplace wellness programs.
• Require insurers to have chronic disease
management programs.
Equitable
• Offer coverage to full-time employees.
• Offer coverage to part-time employees.
• Offer “employee and spouse” coverage in
addition to “employee and family” coverage.
Patient-centered
• Offer healthy workplace menus.
• Offer healthy vending machine selections.
• Ban smoking in or outside the workplace.
• Remove cigarette machines from the
workplace.
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Opportunities for Leadership: Insurers
Examples of ways to reach the goal:
Safe
Efficient (cont.)
• Adopt a single uniform bill across insurers.
Timely
Equitable
• Ensure provider networks include 24-7 access to
urgent care in a setting other than the emergency
department.
• Guarantee coverage policies will be issued
equally to everyone.
• Pool risk across all policy holders.
• Work with other insurers to create coverage
portability across plans and employers.
• Eliminate benefit “carve outs.”
• Eliminate lifetime caps on coverage.
• Create parity in coverage for physical and mental
health needs.
Effective
• Include coverage for prevention and wellness in
all policies.
• Collect and share outcomes data across
insurers.
• Base coverage decisions on comparative
effectiveness research.
• Share practice variation data with physicians and
hospitals.
Efficient
• Make information about insurance products,
offerings and prices transparent and easily
available to the public.
• Develop a single source for coverage
determination and claims processing across
insurers.
Patient-centered
• Give enrollees smart cards that electronically
access co-payment and deductible requirements.
• Give enrollees electronic access to claims
information so they can share it with other
providers.
• Adopt automated prescription delivery for
maintenance medications.
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Opportunities for Leadership: Vendors
Examples of ways to reach the goal:
Safe
Efficient
• Standardize device-specific numbering.
• Standardize pharmaceutical identification at
the unit dose level.
• Lead in pharmaceutical labeling that
eliminates confusion and error.
• Voluntarily join to select and implement
information technology standards to create
greater interoperability.
• Voluntarily set standards that create
compatibility among different manufacturers’
clinical technologies.
Timely
Effective
• Do not promote off label uses of medications.
• Do not facilitate unapproved device
modification.
• Voluntarily participate in the creation of
comparative effectiveness information on the
risks, benefits and costs of new technologies,
therapies and treatments.
Equitable
• Provide discounted drugs and devices to
uninsured patients of limited means.
• Ensure that pharmaceutical and device
research and testing is done with appropriate
representation of our increasingly diverse
population and be relevant to all populations.
Patient-centered
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Opportunity for Cost Savings
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Improve health status
Reduce the burden of chronic disease
Reduce medical errors
Reduce waste
Improve efficiency
Reduce administrative costs
And more…
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Examples of What the Research Says
Goal
Reduce incidence of 18 types of
medical injuries
Health Impact
2.4 million avoidable hospital days
Annual
Savings
Opportunity
$9 billion
JAMA 290, no. 14 (2003)
Reduce variation in care for 5
chronic conditions
21,500-52,100 deaths avoided
$1 to 3 billion
Nat’l Committee for Quality Assurance, 2005
Interoperable EMR, central data
repository, clinical decision
support
Health Affairs 24, no. 5 (2005)
Benchmark performance: prenatal
care
Nat’l Committee for Quality Assurance, 2005
Weight management
Health Affairs Web Exclusive (2004)
Increased efficiency, elimination of 2.2
million adverse drug events, and
reduced admissions, ED visits, and lost
days of work
1000 – 1750
deaths avoided
300,000 deaths attributable to obesity
related conditions
Expand coverage
18,000 deaths avoided
Families USA, 2005
$2 million
$177 billion
$65 – 130
billion
Providers and
payers
Payers/
employers
System-wide
(mostly payers
and consumers)
Payers/
employers
Payers/
employers
Society
(in increased
economic
output)
Health Affairs Web Exclusive (2004)
Expand coverage
$121 billion
To Whom
Savings Accrue
Reduced premium levels due to
reduced cost shift
$29 billion
(For doctors and
hospitals)
Note: Savings is not necessarily additive across studies. Savings not reflective of investment required to
achieve performance level indicated.
Privately insured
(employers and
individuals)
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Measuring Progress
How will we know that we are on the right path?
Measure
Ranking of U.S. health status compared to other nations*
Vision
1st
Focus on Wellness:
Percent of people receiving recommended prenatal,
preventive and primary care
100%
Most Efficient Affordable Care:
Percent growth in per person health spending above
inflation
0%
Highest Quality Care:
Percent of people receiving evidence-based medicine or
“best practices”
100%
Best Information:
Percent of people who have an electronic health record
100%
Health Coverage for All… Paid for By All:
Percent of people with health coverage
100%
* Based on World Health Organization
Includes such measures as infant mortality, average life expectancy, etc.
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A National Framework for Change
2008