Finding The Opportunities In National And NYS Healthcare Reform

Finding The Opportunities In National And New York State Healthcare ReformDale Jarvis206-613-3339dale@djconsult.net

1Three Simple TopicsThe ProblemThe Fix New Yorks Opportunity and Challenge

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2The Problem

Page 33The U.S. Quality and Cost Problems

110 Preventable Deathsper 100,000$7,285 Per Capita Health Expenditure44 Page 44The U.S. has a Sick Care Systemnot a Health Care SystemHalf of Americans have one or more chronic health conditions (155+ million)Over half of these people receive their care from 3 or more physiciansIn total, treating chronic health conditions consumes 75%+ of the $2.5 trillion we spend on healthcare each year in the U.S.In large part due to the fact that money doesnt start flowing in the US healthcare system until after you become sick

Page 5"Chronic conditions in childhood are common and dynamic, underscoring the benefits of continuous, comprehensive health services for all children to adjust treatment of chronic conditions, promote remission, and prevent onset of new conditions. Future research should examine etiological differences between persistent and remitted cases," the authors conclude.(JAMA2010;303[7]:623-630. Available pre-embargo to the media atwww.jamamedia.org)5Americans with a Serious Mental Illness die, on the average, at age 53The high prevalence of persons with these disorders, combined with high cost, directly affect the quality and cost problemsThe Two-Part Problem is Closely Linked to a Third Problem

Page 66The FixBetter Health for the PopulationBetter Care for IndividualsReduced Costs through Improvement (not rationing)

Page 77Follow the Money (Deep Throat quote from Bob Woodwards account of Watergate)Prevention Activities must be funded and widely deployedPrimary Care must become a desirable occupation andMental Health and Substance Use Disorder Assessment & Treatment for all must become the Standard of CareIn order to Decrease Demand in the Specialty and Acute Care Systems

Page 8Specialists:High performingRetireDecide to become PCPsLess opportunities available as med students think about their specialtiesPCPsMore NPs & PAsSpecialist conversionsMore med students going into primary care

8We Already Know How to Flip the Resource Triangle(Medical Homes, Accountable Care Organizations, supported by Payment Reform)In Denmark, over the last few decades, the number of hospitals has dropped from 155 to 89 today, a 42% drop. (Sources: Paul Grundy, Director of Healthcare, Technology and Strategic Initiatives for IBM Global Wellbeing Services and Wikipedia)And in the US: Pilots in the U.S. include Geisinger's, which Grundy says has been remarkably successful, yielding a 12% reduction in ER utilization, a 20% reduction in hospitalization, and a 48% reduction in rehospitalization. (excerpt from David Harlows Health Care Law Blog 9/15/2009)

Page 9Specialists:High performingRetireDecide to become PCPsLess opportunities available as med students think about their specialtiesPCPsMore NPs & PAsSpecialist conversionsMore med students going into primary care

9Vermont Blueprint for HealthThe Healthcare System of the Future?Key Ingredients:Medical HomesCommunity Health TeamsMental Health ProvidersPublic Health PreventionAccountable Care Organizations

10 Page 1010Accountable Care Organizations (ACOs) the homes for medical homesACOs are provider groups that accept responsibility for the cost and quality of care delivered to a group of patients that are cared for by ACO cliniciansWith Medical Homes/Healthcare Homes at the center

Page 11114/10/2011Harold Miller, Center for Healthcare Quality and Payment Reform, How to Create Accountable Care Organizations, www.chqpr.org

Why Accountable Care Organizations?It takes more than a high performing Healthcare Home to improve quality and bend the cost curve Page 124/10/201112But what about At-Risk, Vulnerable Populations?Social Determinants of HealthThere is a distinct relationship between an individuals health status and the social and environmental conditions in which he or she lives

Page 1313But what about At-Risk, Vulnerable Populations?For many children, families, and adults in the safety net, good healthcare is not enoughConsider a mom with depression and diabetesAdd to this scenario the facts that she is the head of household of a family of three, has lost her job, is experiencing domestic violence and she and her children are on the brink of homelessness

Page 1414Goal: Create The Healthcare Neighborhood, The Next Generation Safety Net Healthcare SystemThe Fulton County Georgia (Atlanta area) Neighborhood Union Primary Care Partnerships One Stop Shopping:Well patient careSick-patient careOB/GYN servicesTravel immunization servicesCommunicable disease interventionWIC/nutrition educationOral health servicesBehavioral health servicesA day center for parents receiving services Employment assistanceDisability and vocation rehabilitation servicesForeclosure prevention servicesHousing assistanceA reading room/information center that offers ESL classesA farmers marketA community gardenA walking trail

Page 1515Which requires the Customization of the Accountable Care Organization

Page 1616Emerging Idea: Community Care Organizations (ACOs for the Safety Net)A Community Care Organization is an ACO that is designed to focus on the needs of the safety net population in a community, with a special emphasis on addressing the social determinants of health such as poverty, unemployment, homelessness, poor housing, neighborhood violence, etc. Designed by a broad cross-section of community residents and community partners, the core of the CCO is made up of existing community service agencies.

Page 1717The List IncludesFederally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs)Community Mental Health and Substance Use Disorder Treatment ProvidersRecovery, Peer and Wellness OrganizationsPublic Health DepartmentsHospitalsSocial Service AgenciesChild Welfare Providers and Family Resource CentersHousing and Homeless Services ProvidersOral Health ProvidersPre-Schools and SchoolsJob Training and Employment Support Organizations Page 1818The Purpose of a CCOis to organize a Healthcare Neighborhood that will help all community members move toward the Triple Aim of:Better health for the population, Better care for individuals and Reduced costs. A core objective of the CCO is to develop an integrated network of community groups that see themselves as hospital and institution prevention organizations; Helping prevent admission and readmission to acute care and psychiatric hospitals; nursing homes; youth residential treatment facilities; jails prisons, and juvenile justice facilities; and other restrictive, high cost, non-community based institutions. Page 1919One important measure of successwill be the creation of the cycle of resilience and recovery in communities

From Comas, a Scottish community development organization working to promote recovery and resilience amongst individuals and communities Page 2020New Yorks Opportunity And Challenge

Page 2121A Compressed Period of ChangeUS timeline compared with China

Other States timeline compared with NY

Page 2222We Know How To Fix The Healthcare System But How Will It Unfold Across The Country?Some states will fight ObamaCare at the risk of destroying their economies Some states will leverage many of the healthcare reform tools but be tone deaf to the importance of the healthcare neighborhood for the safety netOther states willget it and set thepace for the restof the country

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