1. Its about the Region Its about the Community Its about our Friends and Neighbors

2. THE MAIN ASSUMPTION Access to adequate healthcare is a right of every American. Teddy Roosevelt proposed a national healthcare system. Lyndon Johnson led the development of Medicare and Medicaid.

3. What Do We Want From Healthcare For the Individual Improved Health Improved Quality of Life Reduced Suffering For the Employer Improved/Maintained Employee productivity For the Community Productive Community Members Overall Improved Quality of Life All members have Maximal Individual outcomes

4. Why does the Healthcare Industry have to change? Why do we as a community have to look at health differently?

5. One of the Dilemmas We have looked at the provision of healthcare in silos, because payment was based on doing things to/for people in silos. Each silo has been evaluated separately Outpatient Medical Services Inpatient Medical Services Home Care Medical Services/ Hospice Mental Health Services Medicaid Nursing Home/ Adult Family Home Services Nutrition Services Social Services Community Health/Public Health Services

6. Costs of care are increasing 2-3% faster than CPI. Commercial insurance premiums doubled from 2000-2007. Institutional care is 43% of the Medicare spend. Chronic Disease is a major contributor to cost. Diabetes, Hypertension, CAD, CHF, COPD, Depression 5% patients= 50% of Medicare cost 10% patients= 65% of Medicare cost 50% patients= 3% of Medicare cost The population is aging. In 15 years the number of Medicare beneficiaries will increase from 40-80 Million. Technology: Previously untreatable conditions are now treatable/curable. More care can be offered.

7. Quality of Care is Not Great Overall Great Care: High Quality, Low Cost, Good Patient Experience Neonatal Mortality COUNTRY PERINATAL MORTALITY (/1000) NEONATAL MORTALITY (/1000) UNITED STATES74 AUSTRALIA53 DENMARK5<1 FRANCE72 GERMANY62 GREECE33 JAPAN31 MEXICO1618 UNITED KINGDOM83 HAITI5147

8. Lifespan Vaccination Rates VACCINATIONRATES DPT-198 DPT-394 HEP B-388 HIB-388 MCV90 POLIO-394 COUNTRYLIFESPAN JAPAN83.9 AUSTRALIA81.9 CANADA81.5 SPAIN81.3 GERMANY80.2 UNITED KINGDOM80.2 UNITED STATES78.5 CUBA77.9 DOMINICAN REPUBLIC 77.4 MEXICO76.7

9. How Do We Move Forward 9 Focus on systems of care

10. Regional Systems of Care Care needs to be Evidence Based The “right care” is safest and less expensive in the long run. Local Care is Best: Where it is safe, efficient, and effective. Inpatient Care frequently requires specialty physicians/technology (most efficient with maximal use). Outpatient care is increasing, inpatient decreasing, Silos must be reduced: What is the right care, where is the right place to provide the care, when is the proper time to provide the care?

11. Regional Systems of Care Team Based Care (everyone practices at the top of their license). Specialist Physician $4/minute Primary Care Physician $2/minute Physician’s Assistant/ ARNP $1/minute RN $.35/minute CNA/CMA $.23/minute Mental Health Services Community Based Social Service Agencies Education– Schools, Community Education

12. How Can We Accomplish This The easiest would be a national strategy. This is not occurring. We need a regional or local one. We need integration of care. We can develop a regional strategy. Develop a strategy that rewards. Value (Outcomes divided by cost). Involve patients, payers (employers), and providers.

13. We Are Fortunate in NCW Geographic Isolation—Most care is in the region. High quality providers, facilities, and services already in existence and not in excess. Sized big enough to cover nearly all aspects of care and control costs locally. Small enough to make rapid changes and communicate throughout the organization and community. Committed health care providers (Physicians, Nurses, Staff, Therapists). We grew up here or like living here. This is our community, it is not just a job.

14. If We Are Successful, What Should You Expect? Easier access to the right care, at the right place, at the right time. Through Case Managers and appropriate staff. Use of all community assets Through non traditional visits—phone and intranet. More transparent business practices Overall lower healthcare costs– so business can thrive in NCW.