Presentation on theme: "Community Leaders’ Blueprint for Health Policy"— Presentation transcript:
1Community Leaders’ Blueprint for Health Policy Marcia L Comstock, MD MPHJon R ComolaWye River Group on HealthcareMarch 30, 2005
2Agenda Provide background on the ‘communities’ project Highlight the common themes that emergedDelineate consensus points around priorities for health policyShare results of a public opinion poll on health care values
3Who We Are WRGH/FAHCL: not-for-profit, non-partisan catalysts Bring diverse stakeholders togetherCreate a neutral environment to encourage honest discussion and debatePromote better understanding of different perspectives, through open dialogue that explores shared values and builds trust
4Communities Shaping a Vision for America’s 21st Century Health & Healthcare
5BackgroundBegan July 2002Involves leaders in 12 very different communities across the countryConcept for healthcare leadership roundtables or ‘listening sessions’ proposed by WRGHModel developed together with the White HousePlanning involved a broad range of sponsoring organizations and political interests
6Financial Sponsors American Assn of Health Plans American Cancer SocietyAmerican Hospital AssociationAmerican Medical Group AssociationAmerican Psychological AssociationBlue Cross Blue Shield AssociationNational Assn of Chain Drug StoreNational Chamber FoundationPhRMA
7Supporting Organizations AARPCenter for Evaluative Clinical Sciences, Dartmouth Medical SchoolNational Alliance for Hispanic HealthNational Business Coalition on HealthNational Committee for Quality Health CareProgressive Policy Institute, an affiliate of the Democratic Leadership CouncilWashington Business Group on HealthWhite House Council of Economic Advisors
8Site Selection Geographic diversity Community size Cultural diversity CompetitionRegulatory environmentRate of uninsuredMedicare costs (Dartmouth Atlas)Quality ranking (HCFA study)
9Selected Communities Salt Lake City, UT Chicago, IL Hanover, NH Portland, ORSan Diego, CASan Antonio, TXAlbuquerque, NMDurham, NCFort Lauderdale, FLJackson, MSSpokane, WAMuncie, IN
10Participants Physician leaders Hospital executives Insurance/managed care executivesPharmaceutical industry executivesLocal business leadersWhite House CEA & Democratic policy staffConsumer representativesPublic health commissioners/officialsDirectors of community health centersCivic thought leaders
11Pre-Meeting Site Visit One-on-one & small group meetings25-30 leaders in each community interviewedFocused on gaining understanding of culture, marketplace dynamics, relationshipsIdentification of ‘case studies’ of successful partnerships at the community levelBuild support for the process
12Leadership Meeting Agenda Identification of two most critical issuesDiscussion of the social contract for healthcareAttributes of a well-functioning healthcare systemAligning incentivesResource allocationCultural changeEngaging communities
13GoalsIdentify healthcare values that guide the thinking of community leaders and citizensCreate mechanisms for this thinking to inform the national policy debateIdentify replicable, collaborative community-based initiatives that address healthcare problemsUse the power of multi-sector, multi-state support to bring about public policy changes
14Process Created ‘ownership’ of results Professional writer developed ‘transcript’ of meetingA report was prepared from the transcript without attributionThe report was provided to participants for additions, correctionsChanges were incorporatedIndividual reports incorporated into the final report, along with a summary of values and principles
15FindingsCommunity leaders do not gravitate to polarized solutions advanced in WashingtonThere is much agreement at the community level & a sincere interest on the part of all stakeholders to responsibility address health system challengesUniversal sense of crisis, but not hopelessness—a ‘window of opportunity’Strong sense that healthcare leaders are more motivated than they have been to discuss problems and work together on solutions
16FindingsRecognition that core elements that need to be re-examined comprise both business & social componentsGreat understanding of the realities—where we are, how & why we got here, the serious crisis we faceAn emerging sense of what we ought to do—create a more a patient-centric systemNeed to systematically address barriers through reevaluation of organization, financing, & delivery of healthcare, & roles of different stakeholder groups
17Common ThemesNo social contract in health care that is well-articulated and broadly understoodPeople do not know what they should realistically expect from the health care system, nor do they understand their responsibility to contributeThe healthcare system has fostered unrealistic expectationsGeneral consensus that we should more explicitly define rights and responsibilities“Rather than say health care is a right, call it a privilege to which everyone should have access”Restore a sense of community interdependenceHealthcare is both a public and a private good
18Common ThemesIndividuals need to be actively involved in making key choices about health-related behaviors, and healthcare-related decisionsBut efforts to increase personal responsibility for health and health care must be linked with efforts to educate and actively reach out to patients, particularly those who are underservedWe need much more accountability in the health care system for delivering high value care and at the community level to enable people to make good choices and adopt more positive health behaviors
19Common ThemesWidespread belief that there is a serious void in leadership in the healthcare industryTrust is a critical pillar of a well-functioning healthcare system, but health care institutions have lost a great deal of credibility with the public and skepticism about motives is prevalentThere is tremendous fragmentation in healthcare, with each interest group moving forward in whatever direction they feel is appropriateSome policy and financing issues must be addressed at the federal level, but there is great faith in communities’ ability to develop creative approaches
20What Do We Do?Decide as a society what we really want from healthcare, beginning with community discussionsShift our thinking-Washington will not solve our problems‘Top down’ approaches used for 60 years have not workedReform efforts must recognize the pluralistic nature of this country and our cultureThe public needs to be involved in discussions of key choicesStart by carefully defining problems and priorities from the unique perspective of a community
21What Do We Do? Communities are the logical place for initiating change All healthcare is localPolicies determined at the community level more likely to be based on the actual conditions in a communityHealth care leaders are more likely to work together productively within their own backyardCommunity-based discussion is much more likely to pull in participation from ‘the grassroots’ and reflect a community’s values and priorities.
22What Do We Do?To restore trust the public needs to see leaders working collaboratively in their best interestHealth care leaders need to stop pointing the finger of blame at each other and cooperate on a common agendaIndustry leaders need to systematically think and plan beyond the fire at their feet, collaborativelyCollaboration will require that we address clearly mal-aligned financial incentives in our ‘non-system’Current payment polices hamper providers from focusing on prevention as the right thing to do and from collaborating to improve community health
24Blueprint Inputs Community leaders’ Advisory Board recommendations 150 representatives of diverse communities across the country and across the spectrum of health and healthcare interestsUsed a methodical combination of electronic brainstorming and facilitated discussionsCaptured 340 recommendations in 14 areasRanked and prioritized in Washington session with trade/professional association executives and policy thought leadersTop 84 framed as a series of actionable steps for this administration
25Public AwarenessWe need to increase the awareness of the public about challenges and gain broad agreement on a vision for our healthcare systemWe need a clear goal and a methodical, aggressive campaign to make healthy lifestyle decisions ‘cool’Going ‘upstream’, reaching the younger generation with messages and tools for prevention will have the most lasting impactThe President should articulate specific, measurable healthcare reform goals with timeframes and develop a national report card which shows progress against national goals
26Personal Responsibility Broad support for more individual responsibility, but must take disparities into accountSome recommend that individuals who practice good health habits should directly benefit in lower premiumsOthers feel that the prevalence of poor health habits is a societal problem, and all should share the burdenWidespread agreement on need to emphasize education on healthy lifestyles and wellnessNumerous financial incentives felt to have potential utilityNeed transparency of information on price and qualityShared decision-making can effectively engage patients in a healthy open exchangeWe should look outside the health care field to determine what works to motivate behavioral change
27IncentivesIncentives currently drive illness treatment, not better healthIncentives need to be better aligned to support primary prevention as well as ‘tertiary’ prevention and disability avoidanceEmphasis placed on rewarding evidence-based care and outcomes, not servicesShould develop models where providers, payers, and patients can share in the savings from prevention, early detection and better care management
28AccessAccess to health care is socially desirable and economically beneficial and ensuring access to health care coverage for all was cited as a top priority for the AdministrationThe problem of access encompasses cultural and logistical elements, as well as insuranceA strong and sustainable safety net is needed to provide for the medically disenfranchisedThere was considerable support for the concept of a ‘medical home’Some recommended we define a ‘baseline’ level of health care coverage; others favored emphasis on access to a ‘baseline’ of quality services irrespective of coverage standardsThere is a desire for greater flexibility in regulations, in the tax code, and with grants and waivers so communities can craft solutions that meet their unique needs
29AffordabilityThe escalating cost of health care services is a top priority, as affordability is seen as a keystone to greater access and a healthier populationRecommendations frequently focus on a segment of the cost pie, but overall system inefficiencies need to be addressedGreater transparency of information and accountability for all stakeholders were frequently cited as necessary stepsThere is broad agreement that we should focus on deriving more VALUE from whatever it is that we as a society decide to spend on healthcare
30Coordination of CareWith an eye on demographics, there was a strong emphasis on the increasing importance of better integration and coordination of servicesA greater focus is needed on prevention and primary care, public health, behavioral health, and care management for chronic illnessNumerous recommendations related to enhancing the role of allied health professionals, (e.g., advanced practice nurses, pharmacists, etc.) and to f integrating social services in a coordinated care modelHealth policy should also ensure access to a continuum of care, that includes mental and behavioral health, and oral health care services
31Information Technology Promoting and advancing IT is seen as a prerequisite to addressing many healthcare challengesThe ultimately utility of information technology will be largely determined by individual behaviorThe greatest impact of IT is in its application to electronic medical records, elimination of medical errors, inter-linking of rural areas, and reduction of administrative costsStandardization, incentives for investment and adoption, funding of pilots and demonstration projects, cultural adaptation by professionals and their institutions, and training of health professionals seen as critical steps in advancing the use of IT
32Public HealthThere is broad agreement that public health needs to move up on the national agenda; many see it as an untapped assetIOM standards on public health should be adopted as national policy and state and local governments given support and incentives to meet standardsA better definition of the appropriate role of public health in today’s society is needed with a consistency of activitiesPublic health should assume a greater role in public awareness, education, and coordination, particularly in the areas of health promotion and wellnessPublic health should serve as coordinator of population data collection and interpretation
33Role of GovernmentAgreement that an appropriately defined role for government is a critical component of a well-functioning healthcare systemFew participants advocated for a centralized single-payer approachAs purchaser government should leverage its role to promote quality, efficiency and appropriate resource allocationReward the practice of evidence based medicine, advance quality metrics and fund demonstration projectsAs public policy maker, government should carefully balance social interestsFlexibility should be a hallmark of effective governmentAs a communicator, make a healthy America synonymous with strong a America
35PurposeExamine consumer attitudes, values, and behaviors related to health careHighlight challenges for employers and policymakers in effectively motivating consumers to become more engaged in their health care, more committed to prevention and healthy lifestyles, and better informed in order to make choices based on cost and quality informationUnderstand how consumers view their role in health care decision-making and what aspects of health care they value mostClarify how they feel about making choices and possibly changing their lifestyles
36Involvement in Decision-Making Most Americans say they would be willing to become more involved in their health care decisions if the health care system were easier to navigate.Two in five Americans (40%) agree strongly and an additional quarter (24%) agree somewhat that, if the health care system were easier to navigate, they would be more involved in making health care decisions for themselves and their family.A large minority of Americans would still follow their doctor’s advice, even if it conflicted with reliable information from a knowledgeable source.More than a third (36%) agree somewhat or strongly that they would still follow their doctor’s advice even if it conflicted with reliable information from a knowledgeable source. Less than half (46%) of Americans disagree somewhat or strongly that they would follow their doctor’s advice in this situation.
37Covering Healthcare Expenses in Retirement A large majority of Americans say they would be willing work extra years to have enough money to pay for their health care in retirement.Three-quarters (74%) of Americans agree strongly or somewhat that they would be willing to work an extra two or three years in order to ensure they have enough money to pay for their health care in retirement.However, response varies with age. While nine in ten (88%) Americans age agree strongly or somewhat that they would be willing to work longer, as the age of the respondent rises, the percentage of those willing to work additional years falls. For example, fewer than eight in ten (77%)of those age 35-44, seven in ten (72%) of those age 45-54, two-thirds (67%) of those age 55-64, and half (50%) of those 65 and older would be willing to work an extra two or three years to ensure they would have enough money to pay for their health care in retirement.
38Perception of Quality & Value A large majority of Americans believe that, when getting medical care for a serious medical problem, differences in quality between health care providers may mean the difference between life and death. However, majorities are unwilling to pay more for higher-quality care and think it is unfair to require patients to pay more for better care.More than three-quarters of Americans agree that where they receive medical care for a serious medical problem can influence whether they live or die, with 53% agreeing strongly and an additional 25% agreeing somewhat.Fewer than one in five (16%)American adults would be willing to pay significantly higher premiums for a health insurance plan that provided coverage to go to hospitals and medical groups shown to provide better care.Two-thirds (64%) of Americans think it is unfair for patients to pay more to be treated by medical groups or hospitals that have been shown to provide better care.
39Do Cost or Health Plan Limitations Keep Consumers With Current Providers? If money were not an issue, only about two in five Americans would change where they receive their health care.Less than two in five (38%) Americans agree somewhat or strongly that, if they won the lottery, they would change where they get their health care. About half (51%) of Americans disagree somewhat or strongly that winning the lottery would prompt them to change where they get their health care.
40Personal Responsibility Though Americans know that a healthy lifestyle can improve and/or prevent many medical problems, they are split on whether they agree that those who practice unhealthy lifestyles should pay more.Almost all (93%) Americans agree strongly or somewhat that, by making healthy lifestyle choices - such as not smoking, exercising frequently, and controlling their weight – they can prevent or improve many serious medical problems.
41Personal Responsibility A plurality of 46% say we should not require people with unhealthy lifestyles to pay higher premiums than people with healthy lifestyles, and a virtually identical plurality (47%) feel that we should not require people with unhealthy lifestyles to pay higher deductibles or co-payments for their medical care.However, when questions are asked about different types of health risks, attitudes vary depending on the type of risk involved. Majorities believe that smokers should pay more than non-smokers (58%) and that people who do not wear seat belts should pay more than people who do wear them (53%). On the other hand, only slightly more than a quarter of Americans believe that people who are overweight (27%) or people who do not exercise regularly (also 27%) should pay more. )
42Views on Rising Healthcare Costs Americans attribute the rising costs of health care to a variety of factors, with high profits/drug companies and greed and waste in the system being cited most often.More than half of American adults feel that rising health care costs are due to high profits/drug companies (69%), greed and waste in the system (62%), the aging of the population (55%), and malpractice lawsuits (54%.) By contrast, fewer Americans attribute rising costs to the use of expensive medical technologies (46%) or the fact that consumers have little incentive to seek lower cost care (39%.)
43What is a Life Worth?On balance, Americans are not willing to put a dollar value on living another year.Only three in ten (31%) Americans agree strongly or somewhat that society should put a dollar value on living another year.About half (48%) of Americans disagree strongly or somewhat with society putting a dollar value on living another year to help decide how much money to spend on prolonging lives.The remaining 21 percent of American adults are undecided on this issue.
44Clinics as Catalysts for Collaborative Community-focused Change
45CHCs as Change AgentsClinics are in touch with everyday people and their needsClinics serve as interlocutors to other social servicesClinics are supported by and governed by local citizensClinics are a key component in this administrations strategy to address access issuesClinics are looking at the provision of services as a ‘population health’ propositionClinics have a vested interest in ensuring services are well coordinated between private and publics sector
46CHCs as Change AgentsMany CHCs are ahead of the private sector with critical elements needed to address health system weaknesses:Provide a ‘medical home’Focus on prevention and primary careExcel at community outreach through CHWs and lay educatorsAre sensitive to diverse populationsEffectively integrates medical with social services
47WRGH ReportsCommunities Shaping a Vision for America’s 21st Century Health & Healthcare:Phase I:Phase II:Community Leaders’ Blueprint for American Health Care Policy:National Study on Consumer Health Values:
48Marcia L Comstock, MD MPH Contact InformationJon R ComolaCEOMarcia L Comstock, MD MPHCOO