Transcript New Maryland Healthcare Landscape Howard County Public Forum John M. Colmers, VP, Health Care Transformation & Strategic Planning Chair, Health Services Cost Review Commission January.

New Maryland Healthcare
Landscape
Howard County Public Forum
John M. Colmers, VP, Health Care Transformation & Strategic Planning
Chair, Health Services Cost Review Commission
January 22, 2015
Health Reform
March 23, 2010
Health Reform is much
more than the
Exchanges
November 1, 2013
The Context:
Health Care System Challenges
High costs
Workforce
shortages
Coverage &
Access
Fragmentation
and variation
Health care
disparities
Aging and sicker
population
Overall
Score
64%
“D”
4
More Challenges Ahead
Changes in Demographics
and Expenditures
Minority - majority births 50.4%
Census Bureau Statistics
Debt and Health Care Spending
US
Age 60 plus by 2050
112,037,396 Administration on
Aging Projections
MD
Runaway Cost Increases
Average spending on health
per capita ($US PPP*)
Total expenditures on health
as percent of GDP
8,000
18
United States
Canada
Germany
France
Australia
United Kingdom
7,000
6,000
16
14
12
5,000
10
4,000
8
3,000
* PPP=Purchasing Power Parity.
Data: OECD Health Data 2011 (database), Version 6/2011.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2011.
2008
2006
2004
1998
1996
1994
1992
1990
1988
1986
1984
1982
2008
2006
2004
2002
2000
1998
1996
1994
1992
1990
1988
1986
0
1984
0
1982
2
1980
1,000
1980
4
2002
2,000
2000
United States
France
Germany
Canada
United Kingdom
Australia
6
Deficits in Outcomes
U.S. Comparison to Developed Nations
2011 Life
Expectancy
2008 Infant
Mortality
2011 Adult
Obesity
Bottom third
4th Highest
1st
(78.7 years
compared to Japan
at 82.6)
(6.6% compared to
average 4.6%)
(Over 1/3 of U.S.
population)
Source: OECD Health Data 2011, June 2014
Unacceptable Disparities
Mortality Amenable to Health Care by Race, State Variation, 2009-10
Overall, Howard County is a Relatively
Healthy County
•
•
The County Health Rankings measure the health of nearly every county in
the nation. Published online at countyhealthrankings.org, the Rankings help
counties understand what influences how healthy residents are and how
long they will live.
Howard County ranks at or near the top among all Maryland counties:
–
–
–
–
–
–
–
–
Quality of Life
Health Factors
Clinical Care
Social and Economic Factors
Health Outcomes
Length of Life
Health Behaviors
Physical Environment
#1 Rank
#1 Rank
#1 Rank
#1 Rank
#2 Rank
#2 Rank
#2 Rank
#7 Rank
9
Source: County Health Rankings & Roadmaps, 2014
However, there are Racial
Disparities within Howard County
•
Hospital Emergency Department Visits for Diabetes
–
–
•
African American:
White:
60.1%
78.1%
African American:
White:
11.7%
6.9%
Teen Birth Rate by Race
–
–
•
328.2 per 100,000
71.7 per 100,000
Babies with Low Birth Rate by Maternal Race
–
–
•
African American:
White:
Mothers who Receive Early Prenatal Care
–
–
•
303.0 per 100,000
112.5 per 100,000
Hospital Emergency Department Visits for Hypertension
–
–
•
African American:
White:
African American:
White:
17.5%
3.3%
Children Living Below Poverty Level
–
–
African American:
White:
8.9%
1.9%
Source: Selected disparities from Horizon Foundation’s Howard Health Counts
10
In Response, a New Culture for
Patient Care is Emerging
Fragmented
Integrated
Autonomous
Team-based
Competitive
Service-based
Proprietary
Transparent
Expert-centered
Patient-centered
Individual
Population
New Paradigm
• Improve the health of the population;
• Enhance the patient experience of care;
• Reduce the per capita cost of care.
Implications
• All this means:
– Payment moves away from fee-for service
• The more you do the more you get paid
13
Implications
• All this means:
– Payment moves away from fee-for service
• The more you do the more you get paid
• The better you do the better you get paid
– Pressure to assume more risk
– Need for integration and collaboration
• CHANGE IS HERE – CHANGE IS
EVERYWHERE
14
In Maryland…a Different Response
15
Maryland Hospitals are Paid Differently
• Maryland has set hospital rates since the mid1970s
– Health Services Cost Review Commission
• Independent 7 member Commission
• Public utility model
• Serves as watchdog and regulator
• Maryland hospitals are waived from Federal
Medicare payment methods (the Medicare
waiver)
• All payers participate
• Unique in the country
16
Value of the All Payer System





Helped hold down costs relative to elsewhere
Funds access to care
Transparency
Leader in linking quality and payment
Local access to regulators
17
New Federal Agreement
• 5 year demonstration with Medicare (CMS)
– Effective 1/1/14
• Focus on holding down costs
• More rewards for improving outcomes
• Encourages better team work among whole
health care system
Implications for Patients and their
Families
• Quality safety and satisfaction scores can account
for a significant amount of revenue
– Requires hospitals to become more patient and family
centered
• Expect greater care coordination
– Improved transitions of care between settings
• e.g., clear instructions for patients on discharge
• Expect more outreach from providers
– Particularly true for those with chronic illnesses
• Movement of care to the most appropriate setting
– Right care, right time, right place, right price
19
Concluding Thoughts
• New waiver is a call to action
• Creates a “glide path” for change
– Less disruptive than elsewhere
– Proactive not reactive
• Value is the new gold standard
–
–
–
–
–
Quality
Appropriate hospital care
New Partnerships
Cost efficiency
Population health focus
20
QUESTIONS?
21