Change is Inevitable…Are we Ready?The Impact of National
Health Care ReformPresentation to:
20th Annual Education Session
Health Care Quality Institute
Marco Island, FL
June 27, 2014
Pause Listen Think Pray Go
Presentation Objectives• Discuss the impact national health care reform is having
on care delivery models, patient experience, and public health financing;
• Share strategies for addressing the rapid change and uncertainty health care; and
• Address the need to bring more value at a lower cost without jeopardizing quality.
ABOUT AHS
http://itvs.org/films/waiting-room
Our Mission
Caring, Healing, Teaching, Serving All
Excellence for All
Safety Net Provider
Alameda Health System
Integrated Regional Network
Our Vision
AHS is recognized as a world-class
patient and family centered system of care that promotes
wellness, eliminates disparities and
optimizes the health of our diverse communities
… 2012Assess and Plan
2013-2017Build, Adapt, Transform
2022…Sustain system & manage pop
H
E
W
FJ
Organizational Overview1864 Alameda County Infirmary opened on the Fairmont Campus
1927 Highland Hospital opened in Oakland
1960s Ambulatory health care services launched
1992 John George Psychiatric Pavilion opened
1990s Alameda County Medical Center (ACMC) was formed by merging Fairmont Hospital with Highland Hospital and John George Psychiatric
1998 Alameda County Hospital Authority was created
2012 Adopted 10 year Financial Plan and 5 year Strategic Plan
2013 ACMC renamed and rebranded to Alameda Health System (AHS) Expanded Ambulatory – Same Day Services; San Leandro Hospital acquired
2014 Alameda Hospital affiliation completed
Organizational Overview849 licensed beds, 4,545 employees, 1000+ MDs, 5 acute hospitals, 3 SNFs and 4 Wellness centers
Average Daily Census: 411; Discharges: 20,461, ED Visits: 146,932
OP Clinic Visits 312,465 ; Surgeries: 9,176; Births: 1,080; Operating budget: $805M
Emergency Medicine, General Surgery, Internal Medicine, Orthopedics, Oral Maxillofacial Surgery, Podiatry
Nurses, allied health professionals, pre-doctoral psychology interns
Nationally recognized public health system
Training tomorrow’s doctors (160/year)
Training students/providers
Market Presence
Alameda Hospital
Highland Hospital & Wellness Eastmont Wellness
John George Psych Hospital
Newark Wellness
San Leandro Hospital
Hayward Wellness
Fairmont Hospital
ChangeHard
InevitableUnavoidable
The nation is experiencing the most significant TRANSFORMATION of the health care delivery system since the launch of Medicare.
• Successful transformation is dependent on our ability to CHANGE.
HITEC PPACA PCMH ACO HBE VBP
2009 2010 2011 2012 2013 2014
Transformation
Patient Protection and Affordable Care Act
• Guaranteed Issue – Pre-existing condition clause
• Minimum health insurance standards
• Individual mandate• Health Insurance Exchange
• Federal Subsidies for individuals, families, and small employers
• Medicaid expansion• Medicare shift from FFS to
bundled payments• Employer mandate
January 1, 2014 Changes
Alameda Health System
ACCESS
Market competitive standard for access in the communities we serve that supports organizational growth
51
SUSTAINABILITY
Financial sustainability that supports growth and reinvestment to sustainour mission
2
INTEGRATION
Effective physician and hospital partnership that supports clinical integration leading to improved quality and experience for patients
3
EXPERIENCE
Patients feel valued, cared for and continue to choose us as their medical home/provider of care
4
NETWORK
Community engagement and external partnerships that align resources necessary for a sustainable clinically integrated network of care
5
WORKFORCE
Culture of excellence in the workforce that empowers staff to embrace and lead transformation to a high performance health system
6
Strategic Goals
2010 Federal Spending: $3.5T
Defense;
20%
Social Security; 20%
Medicare, Medicaid, CHIP; 21%
Safety-Net; 14%
National Debt; 6%
Employee Benefits; 7%Research; 2%Transport; 3% Education; 3% Other; 3%
Federal goal is to shrink that number year after year after year
14%
Patient Experience
National Health Care Reform• Accountable Care Organizations
• Medicare Innovation Projects
• Administrative Simplification
• Anti-Discrimination
• Provider Profiling
ChangeHard
InevitableUnavoidable
Implementing a Turn Around
Financial Focus
Board Alignment
Goal
Alignment
Build Excellence
Focus on Culture
Performance Improvement
1: Recognize MegaForces
• Demographic Shifts• Technology Changes• Workforce Shortages• Economy• Accountable Care• Payment Reform• Health Care Consumerism• ICD-10• Changing Regulations/Compliance
2: Prepare and Empower
3: Don’t Wait
4: Plan, Do, Check, Act
5: Influence Consumer Decision Making
The Consumer Decision Model
Access
Sustainability
Experience
Changing the Face of Health Care
Looking to the Future
The Four Agreements: Miguel Ruiz
Don’t make assumptions
Don’t take anything personally
Be impeccable with your word
Always do your best
Issues Before Us!COMPETITION
Clinical Integration
Medical Homes
Resid
ual U
nin
suredPopulation Mgmt
Legacy Costs
Pri
mar
y C
are
Acc
ess
Val
ue-
bas
ed p
urc
has
ing
FQHCs
Community MDsMediCal
Covered CA
LEANEHR
Technology Use
Safety Culture
Workforce SupplyAre We Ready?
THANK YOU!
Carladenise A. Edwards, Ph.D.CHIEF STRATEGY OFFICER