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1 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,

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Presentation on theme: "1 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,"— Presentation transcript:

1 1 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

2 2 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

3 3 3 Our Quality Is Less……… 3 BETTER

4 4 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 Source: OECD Health Data 2010 (June 2010).

5 5 5

6 6 6

7 7 America/Infographic.aspx

8 8 Institute of Medicine

9 9 9 9 Problems with MisUse Institute of Medicine Report 1999: Annual Deaths: Medical Mistakes44, ,000 Motor Vehicle Accidents 43,458 Breast Cancer42,297 AIDS16,516 Workplace Accidents6,000

10 10 Office of Inspector General DHHS, January : 13.5 %of hospitalized Medicare beneficiaries experienced adverse events during their hospital stays that resulted in prolonged hospitalization, required life- sustaining 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)

11 11 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… 11

12 12 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. 12

13 13 Institute of Medicine

14 14 Problems with UnderUse 2004: Adults receive about half of recommended care 54.9% = Overall care 54.9% = Preventive care 53.5% = Acute care 56.1% = Chronic care Not Getting the Right Care at the Right Time Source: McGlynn EA, et al., “The Quality of Health Care Delivered to Adults in the United States,” New England Journal of Medicine, Vol. 348, No. 26, June 26, 2003, pp

15 15 Problems With OverUse State Average: 44.8/1,000 Note: Red bars are significantly above/below the state average at the.05 level Hospital Outpatient Advanced Imaging Utilization / 1,000 by Hospital Service Area

16 16 Comparative Cost: Large Maine Hospitals Above State AverageBelow State Average

17 17 Comparative Cost: Small Maine Hospitals

18 18 WE Pay The Wrong Way! Rests on the head… of a pin ER LOSE ?? LOSE $$ $$$

19 Aligning Maine’s “Forces” Consumer Engagement Quality Improvement Payment Reform Benefit Design Promote Health IT Adoption QC/MHMC: AF4Q Consumer Messaging/ Leadership MHMC Employee Activation Program MHMC : PTE reporting on hospitals, primary care, specialist quality MPIN, PHOs: QI support to mbr practices Hospitals/ Health Systems & Employers: Local ACO Pilots Primary Care & Employers/Payers: Alternative payment models Maine PCMH Pilot BIW Primary Care Program Specialty Care: Alternative payment models Cognitive Consultation MEREC: Promote primary care HER adoption, meaningful use HealthInfoNet: Promote interoperable systems Bangor Beacon: promote community-wide, connected HIT MHMC: Encourage employer/payer use of PTE data for steering; Value-based insurance design Perf Meas./ Public Report MQF: reporting on hospital quality, patient experience of care (TBD) Quality Counts: QC Learning Community

20 What Are We Trying to Achieve? And what Contributes? Univ. Wisconsin - RWJF County Health Rankings

21 21 Everyone Has A Role WHO RESPONSIBILITIES In Building a Value-Based Health Care System, Everyone Has a Role Based on chart developed by Puget Sound Health Alliance and the Wisconsin Health Alliance Cooperative, 2006 Doctors / Hospitals Share quality and cost information Improve effectiveness and affordability of health care services Help employees be better health care consumers; promote health Purchase benefits based on value EmployersConsumers Make healthy lifestyle choices Engage as a health care consumer Design benefits based on value Insurers Help members be better health care consumers; promote health Produce performance reports MHMC / AF4Q Recommend aligned incentives

22 22 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

23 23 Institute of Medicine

24 24 It’s About the Basics (the hard work!)

25 25 Maine Experience: Lessons Learned Professionalism Self-respect Peer respect Motivators for adoption & spread of change Needed to sustain change Efficiency $ / financial incentives Recognize different motivators – need both the “heart” and the “head”!

26 26 Consumers Can Drive Change LABOR MEMBERS: 13 Brett Hoskins, Co-Chair (MainePERS) Carl Parker (MSEA-Admin) Cheryl Moreau (MSEA-Courts) Freeman Wood (Retiree-MAR) John Bloemendaal (MEA-MCCS) John Leavitt (MSLEA-Law Enf) Kandi Jenkins (MSEA-Pro Tech) Michael Mitchell (MSTA) Acting Richard Hodgdon (Retiree-MSEA) Scott Kilcollins (MSEA-Supv) Steve Moore (MSEA-OMS) Tom Hayden (MSEA-MTA) Will Towers (AFSCME) MANAGEMENT MEMBERS: 9 (Exec-DHHS) - VACANT Alicia Kellogg, Co-Chair (Exec-DAFS) Becky Greene (Exec-MDOT) Carol Harris (MainePERS) Ed Mouradian (Exec-AG) Frank Johnson (Ex-Officio, EH&B) Jan Lachapelle (MCCS) Kimberly Proffitt (Judicial) Lauren Carrier (MTA) Tanya Plante (Staff-EH&B)

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28 28 Pathways to Excellence – Hospitals Steering Committee 28 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 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 Organizations: Alex Dragatsi: Maine Quality Forum Sandra Parker: Maine Hospital Assn. Art Blank: ME Hosp. Assn, MDI Hosp

29 29 SEHC Announce 7-07 PCP Tiering

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31 31 Maine: 2nd biggest improvement in US

32 32 Physical Health Providers Vance Brown, MD MaineHealth Barbara Crowley MD MaineGeneral Richard Freeman, MD EMHS Sharron Sieleman RN, CMMC Behavioral Health Providers Lynn Duby, Crisis & Counseling Greg Bowers, Maine Mental Hlth Partners Health Plans Terri Bellmore, Universal Am. Bob Downs, Aetna Jeff Holmstrom DO, Anthem Consumers Jenny Rottmann Dan L'Heureux David White Elizabeth Mitchell, MHMC Michelle Probert, MaineCare Karynlee Harrington, Dirigo Health Agency Sandy Parker, Maine Hospital Assn Gordon Smith, Maine Medical Assn Debra Wigand, MaineCDC : SEHC 1 st Annual QC QI Award

33 33 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.

34 34 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

35 35 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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