5A Sicker America Chronic illness is on the rise Half of Americans have one or more chronic illnesses80% of spending is linked to chronic illnessMuch of this is avoidableObesity has doubled; Diabetes is on the riseSource: Centers for Disease Control and Prevention.
6Factors Harming Health Are On the Rise A Sicker AmericaFactors Harming Health Are On the RiseBiologyHigh risk factors; family history; physical and mental health problemsPhysical environmentExposure to toxins; hazards at work or at home; air pollutionSocial environmentPoverty; lack of education; homelessness; lack of transportation; violenceBehaviorSmoking; poor eating habits; lack of exercise; drug and alcohol abuse* Adapted from Healthy People 2010, a report by The US Department of Health and Human Services
8America’s Health Must Improve Without change, America’s health care capabilities and finances will be overwhelmedAs a society we must:Provide access to education and preventive careHelp all reach their highest potential for healthReverse the trend of avoidable illnessAs individuals we must:Achieve healthier lifestylesTake responsibility for our health behaviors and choicesEach one of us must take action
10is a productive and vibrant America The BenefitsHealthy infants = healthy kidsHealthy kids = success in schoolHealthy kids = healthy adultsHealthy adults = healthy seniorsHealthy individuals = healthy families, healthy workers, healthy communities and a healthy economyA healthy Americais a productive and vibrant America
12America’s Health Care Must Improve America has what it takes to offer the best in careHighly trained doctors, nurses and other providers of careLatest technologyCutting-edge medical researchWell-equipped facilitiesFreedom of choiceBut more can and must be done now
13People are dissatisfied with the health care system America’s Health Care Must ImprovePeople are dissatisfiedwith the health care system6 in 10 Americans rate the health care system as fair or poor59% fair or poorSource: Employee Benefit Research Institute, 2006.
14America’s Health Care Must Improve Health care costs are highHighest spending per person among industrial countriesHigh costs weaken America in today’s global economyAmericans are increasingly angry about high costsDissatisfaction with health care costs grew 18 percentage points in one year33%51%Source: Employee Benefit Research Institute, 2006.
15America’s Health Care Must Improve Health care in America can bebetter and more affordableAmerica deserves care that is:Safe and free from harmProvided at the right time, when care is neededThe recommended care every timeEfficient and affordableWithout biasPersonalized and sensitive to each individual’s needsAdapted from the Institute of Medicine Crossing the Quality Chasm, 2001.
17Can We Envision a Different Future? Health and health care are basic human needs and no one goes withoutEveryone has prompt access to needed health careEveryone is treated with dignity and respectEveryone has the opportunity to reach their highest potential for healthHealth and health care is without biasImproving the health of our nation is viewed as a common good and good for our nation
18A New Vision for America Health for Life:Better health, Better health care
19What Does This Vision Mean? For America’s Health:America is #1 in health status among nationsTrend in avoidable chronic disease is reversedPeople lead healthy, balanced livesFor America’s Health Care:Health care is efficient, affordable and of high qualityEveryone has coverage and access to careCare experience exceeds expectations
21Action By All Improving America’s health is a great common cause that calls for leadership,participation and shared responsibilityEvery individualEvery employerEvery insurerEvery health care supplierEvery communityEvery state, local and the national governmentEvery doctor, hospital and all care providersNow is the time to do better
23Change Now America’s hospitals will: Improve hospital care now Create a national framework for changeIdentify essential elements of reformDevelop innovative ideas for changeUse the framework as a launching pad for collective actionEngage and involve othersBuild coalitionsCall on all America’s leaders to act now
25Focus on WellnessNot all illness is preventable. But good primary care, health education and a healthy lifestyle are essential to improving health. Costs for health coverage and health care can be controlled as health improves.GoalsHowHealthier lifestyles, better compliance with recommended care and lower rates of preventable diseasesFinancial incentives to reward healthy behaviors and compliance with care plansProvide support and coaching needed to change behaviorsAn objective, trusted source of consumer health information andeducationGuarantee access to primary careFinancially reward doctors and others who provide primary careRequire insurers to guarantee plan access to 24/7 primary careFocus on prenatal care and children’s health at an early ageA national investment in school-based health: nutrition, fitness, immunization, dental care, and school nursing
26Efficient Affordable Care America will not be satisfied unless and until the cost of health coverage and health care are affordable.GoalsHowMore informed decision makingRequire sharing by all providers, payers and suppliers of clear information on quality and pricingBetter manage chronic diseaseExplicitly fund chronic care managementEvaluate the efficacy and use of new technologies and medicinesCreate “technology assessment centers” to analyze the comparative effectiveness, costs and benefits of new technologies and medicineSpend resources on care, not paperwork and legal costsSimplify the working of public and private insuranceCreate a better alternative to today’s liability systemWell-educated workforce in sufficient numbers and with needed mix of skillsExpand educational capacity, resource and early math and science learning to meet current and future health care workforce needsDesign new roles for workers to meet future care needs
27Highest Quality CareSupport doctors, nurses, hospitals, nursing homes and others in working together in teams and with patients and families to ensure the right care is given at the right time, in the right setting.GoalsHowIncrease development and greater use of evidence-based careCreate a national investment to research the best evidence in patient care and develop practice guidelinesReward care outcomesRedesign payment to reward quality providers who follow evidence-based guidelines and recommended “best practices”Support doctors, hospitals and others in working together to coordinate care on behalf of patientsRedesign payment to give provider groups a single amount to manage the entire episode of a patient’s care and better coordinate careModernize laws and regulations to allow doctors, hospitals and others to work together in teams or “networks”Coordinate treatment of physical and behavioral health needsRedesign coverage and payment to guarantee parityIntegrate physical and mental health care deliveryIncrease availability and use of compassionate end-of-life careExpand options for end-of-life care at home and require everyone to complete an advance care plan
28Best Information Good information is the gateway to good care. Goals HowIncrease patient safetyReduce duplicative testing, unnecessary costs and patient hassleEnsure open communication between patients and providersSpeed the creation of electronic health records and personal health records by selecting “interoperable”standardsCreate a unique, confidential health information number to accurately link patients to their health recordsSpeed the adoption of health information technologyEnsure easy access for patients to their medical records and health informationEnable better care coordinationAllow providers and community collaboratives to share information technology (IT)National investment in IT for doctors and hospitals most in financial needRequire health care suppliers and insurers to enable the use of ITRequire specific IT adoption by doctors and hospitals
29Health Coverage for All… Paid for By All Health coverage for all is a shared responsibility. And everyone – individuals, business, insurers and governments – must play a role in both expanding and paying for coverage.GoalsHowHealth coverage for allIncrease access to care for allIncrease insurance efficiencyProtect against high cost health eventsReduce differences in care by race, ethnicity and other characteristicsEvery individual must have and contribute to the cost of health care coverageEvery employer must take responsibility for providing health care coverage for their employees and contribute to the costEvery insurer must guarantee access to coverage that is affordable, gives consumers the protection they need, and delivers valueGovernments must maintain their current responsibility for coverage for seniors, disabled and certain low income peopleCollective financing will be needed
30Key Opportunity Areas for Cost Savings Improve health statusReduce the burden of chronic diseaseReduce medical errorsReduce wasteImprove efficiencyReduce administrative costs
31Examples of What the Research Says GoalHealth ImpactAnnual Savings OpportunityTo Whom Savings AccrueReduce incidence of 18 types of medical injuriesJAMA 290, no. 14 (2003)2.4 million avoidable hospital days$9 billionProviders and payersReduce variation in care for 5 chronic conditionsNat’l Committee for Quality Assurance, 200521,500-52,100 deaths avoided$1 to 3 billionPayers/employersInteroperable EMR, central data repository, clinical decision supportHealth Affairs 24, no. 5 (2005)Increased efficiency, elimination of 2.2 million adverse drug events, and reduced admissions, ED visits, and lost days of work$121 billionSystem-wide (mostly payers and consumers)Benchmark performance: prenatal care1000 – 1750deaths avoided$2 millionWeight managementHealth Affairs Web Exclusive (2004)300,000 deaths attributable to obesity related conditions$177 billionExpand coverage18,000 deaths avoided$65 – 130 billion(in increased economic output)SocietyFamilies USA, 2005Reduced premium levels due to reduced cost shift$29 billion(For doctors and hospitals)Privately insured (employers and individuals)Note: Savings is not necessarily additive across studies. Savings not reflective of investment required to achieve performance level indicated.
32Measuring Progress How will we know that we are on the right path? MeasureVisionRanking of U.S. health status compared to other nations*1stFocus on Wellness: Percent of people receiving recommended prenatal, preventive and primary care100%Most Efficient Affordable Care:Percent growth in per person health spending above inflation0%Highest Quality Care:Percent of people receiving evidence-based medicine or “best practices”Best Information:Percent of people who have an electronic health recordHealth Coverage for All… Paid for By All:Percent of people with health coverage* Based on World Health OrganizationIncludes such measures as infant mortality, average life expectancy, etc.