1. HSA 3111: The Future of Health Services Delivery 1 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Topics Trends Insurance Public Programs Healthcare Reform Wellness & Prevention Chronic Conditions Long-Term Care Infectious Diseases Public Health Hospitals The HC Workforce Other Trends “Any attempts to project the future of health care provoke more questions than answers.” Text, p. 562

2. HSA 3111: The Future of Health Services Delivery 2 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Trends The semester has been a historical review of the HC delivery system in the US (with a peek at other countries along the way) What have been the major trends we have seen? –Technical and knowledge advances –HC worker education and training –Changes in organizations offering HC –Changes in insurance and other payers –Changes in the roles of governments –Changes in public (and voter) attitudes –Demand for healthcare

3. HSA 3111: The Future of Health Services Delivery 3 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Trends (cont.) What elements of the US HC System are currently in a state of flux? –Which elements have major transitions in progress at the current time? Technical and knowledge advances HC worker education and training Changes in organizations offering HC Changes in insurance and other payers Changes in the roles of governments Changes in public (and voter) attitudes Demand for healthcare

4. HSA 3111: The Future of Health Services Delivery 4 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Trends (cont.) What new and existing trends do we expect to see in the future? How do we expect these trends to affect us… –…personally? –…professionally? Technical and knowledge advances HC worker education and training Changes in organizations offering HC Changes in insurance and other payers Changes in the roles of governments Changes in public (and voter) attitudes Demand for healthcare

5. HSA 3111: The Future of Health Services Delivery 5 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Insurance What is the 900 lb gorilla facing payers of insurance programs today? What was the economic condition that gave rise to employer-sponsored health insurance? –What economic changes have we seen to this situation? –What are the reduced or changed employee insurance benefits that have resulted? –What changes might we expect in the future?

6. HSA 3111: The Future of Health Services Delivery 6 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Insurance (cont.) How do the following initiatives affect participants and why were they implemented? –High-deductable health plans (> $1,000 individual or > $2,000 family) –Health Reimbursement Arrangement –Health Savings Account –Defined contribution plans (vs. defined benefit) Parallel with retirement plans

7. HSA 3111: The Future of Health Services Delivery 7 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Public Programs What changes have we seen to Medicaid and Medicare and how are they responsive to ongoing trends? –Managed care –Prescription benefits –Medicaid eligibility –SCHIP and similar programs What is the 900 lb gorilla for Medicare?

8. HSA 3111: The Future of Health Services Delivery 8 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Healthcare Reform Note that the book was written before passage of the Patient Protection and Affordable Care Act of 2010 and even before the 2007 presidential election Which of the three approaches to HC reform was incorporated into the PPACA? –Single Payer –Managed Competition –Play-or-Pay –Employer Mandate

9. HSA 3111: The Future of Health Services Delivery 9 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Healthcare Reform (cont.) What are the provisions of the PPACA of 2010? You should be able to look at almost any provision of this Act and… –…Identify the problem it was designed to address –…Identify who will benefit from the provision –…Identify who will pay for the provision Cover non-monetary ‘costs’ or impacts –…Identify other impacts of the provision

10. HSA 3111: The Future of Health Services Delivery 10 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Wellness and Prevention Why are wellness and prevention so important in future HC policy? What are the fundamental problems with addressing HC costs through wellness and prevention programs?

11. HSA 3111: The Future of Health Services Delivery 11 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Chronic Conditions What is the perverse result of improved HC on the prevalence (and cost) of chronic conditions? What is the role of existing coverage for those with chronic conditions? Are there coverage gaps which suggest big impacts for targeted policy or coverage changes?

12. HSA 3111: The Future of Health Services Delivery 12 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Long-Term Care Issues The Baby Boom dominates the long-term care landscape –Increasing demand for services –Declining labor force to provide services What are the financing issues that dominate the LT Care field? –What are the incentives to change existing programs? –Why is LT care financing tilted toward institutional care?

13. HSA 3111: The Future of Health Services Delivery 13 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Infectious Diseases New diseases and new (more virulent) strains of existing diseases continue to emerge Managing Widespread infections (epidemics) and prevention goes well beyond the resources and coordinating ability of individual providers Increasingly global travel and trade make disease control problematic –Responses include diplomatic efforts in addition to medical planning and action

14. HSA 3111: The Future of Health Services Delivery 14 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Public Health Most HC plans and programs focus on individuals and groups. Public health policy focuses on geography –Parallels private and government activities at the local, state, and federal level –Addresses local issues Environment Trends Performance Lifestyle change Provider of last resort Monitoring Emergency response

15. HSA 3111: The Future of Health Services Delivery 15 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Hospitals What are the trends we have seen in the ownership, financing, structure, and operation of hospitals? How do we expect other trends to affect them? –Demographic shifts –Cost control pressures –Healthcare policy –The “supply chain” of patients and providers

16. HSA 3111: The Future of Health Services Delivery 16 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest The Healthcare Workforce Physicians –Increasing supply of physicians… –…offset by increasing demand… –…for a projected shortage by 2020 –Specialty and geographic maldistributions expected to continue Shortages of primary care physicians

17. HSA 3111: The Future of Health Services Delivery 17 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest The Healthcare Workforce (cont.) Nurses –Nursing shortages are typically cyclical –Current shortage is the longest we have seen Are there differences with this one? Increasing demand Stagnant supply from slowly increasing training programs –What policy responses might we expect to see?

18. HSA 3111: The Future of Health Services Delivery 18 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest The Healthcare Workforce (cont.) What trends from other topics we have seen will affect the HC workforce? –Hours worked –Employment models –Specialty selections –Work conditions Team approaches Changing hospital business models Shift to preventive care Managed care pressures

19. HSA 3111: The Future of Health Services Delivery 19 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Other Trends Customer service focus based on two healthcare worlds –Customers with the ability to pay and discrimination regarding quality of service Convenience Atmosphere Ambiance –Customers seeking any provider available

20. HSA 3111: The Future of Health Services Delivery 20 Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida http://systems.cohpa.ucf.edu/lwest Other Trends New technology will not stop –See eight trends in the chapter –Some are massively exciting the way the first use of anesthesia or antiseptics were Evidence-based medicine –Various pressures affect HC efficiency and quality management –Managed care pressures –Publicized differences in outcomes –EBM requires physicians to be aware of and willing to follow evidence-based guidelines