1. What is Driving Health Care Reform and How to Use it for Success Edward O’Neil, PhD, MPA, FAAN eoneil@thecenter.ucsf.edu Director and Professor The Center for Health Professions University of California, San Francisco

2. 2 Health Care Cost and Obama Agenda Cost doubled as % of GDP in thirty years CBO is projecting double again to 30% by 2035. Increases not driven aging population Costs do not appear to contribute to quality. An enormous opportunity for the nation to rebuild health care on a more effective and responsive foundation. Source: CBO Health Fact Sheet, http://www.cbo.gov/publications/collections/health. cfm Sources of Growth in Projected Federal Spending on Medicare and Medicaid (Percentage of GDP)

3. 3 Current Drivers - Demographic - Aging Source: U.S. Census Bureau

4. 4 Current Drivers - Diversity- Disparity Source: National Center for Health Statistics, HHS, National Vital Statistics Report, August 19, 2009 http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_01.pdf White Male Black Female White Female Black Male

5. 5 Changes in Cause of Death, 1900–1999 Source: Centers for Disease Control and Prevention. Control of infectious diseases, 1900–1999. Morbidity and Mortality Weekly Report 1999; 48:621–629.

6. 6 Growing Disease Burden 6 By 2030, 171 million Americans, nearly half the population, will have one or more chronic condition Medicare spending is 12% of the federal budget and is expected to increase 8% every year from 2007 to 2016 Source: Wu, Shin-Yi and Green, Anthony. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000

7. 7 SOURCE: Health US, 2003, USHHS, CDC,NCHCS, October 2003, 56. Current Drivers - Epidemiology

8. 8 Paradigms Effective tools Make things work Provide coherence Eventually, limit what we think we can do Fail

9. 9 Current Situation- Comparative use SOURCE: Health Affairs, V 28, 5, 2009, p1311

10. 10 Changing Role Consumer choice New market entrants Price sensitive 4 of 5 bankruptcies in 08 Richer array of services Consolidated broker/integrators Consumer- Emerging View Warning: Not actual RNs

11. 11 Macro Reform: Change the Model or… Practice Model ManagePreventDiagnosisTreat Training Money Technology Consumer Great leverage Long-term Consumer driven Expensive Good models Professional role Self-help groups Oral health Dx centers Self tests Start of life Drug delivery End of life Chronic disease Practice Models

12. 12 What does it take to keep the paradigm going?

13. 13 Transition Today Acute treatment Cost unaware Professional prerogative In-patient Individual profession Traditional practice Information as record Patient passivity Tomorrow Chronic prevention and management Price competitive Consumer responsive Ambulatory – Home and Community Team Evidence based practice Information as tool Consumer engagement and accountability Strategic Success Source: Center for the Health Professions, UCSF.

14. 14 More Help At: HTTP://FUTUREHEALTH.UCSF.EDU Leadership Research Data Policy analysis Opinion