1. The Critical Role of School Nurses in Today’s Changing Healthcare Environment Maine School Nurse Summer Institute July 23, 2014 Bates College Lewiston, Maine Lois Skillings, RN, MS President and CEO Mid Coast Health Services Brunswick, Maine

2. Objectives: As national healthcare reform impacts the delivery and financing of healthcare, the role of school nurses is more important than ever. This presentation will highlight the goal of achieving the Triple Aim of improving healthcare, and the influence of school nurses in the transformation process.

3. Fixing Healthcare: An Economic and Social Imperative It is a whole new world out there. Aside from political views, the way we finance and deliver healthcare has to change. Our current healthcare system is not sustainable. This is the work of our generation of healthcare leaders.

4. © Copyright Orlikoff & Associates, Inc. 2014

7. The U.S. Healthcare Environment

9. Trends: Demographics and Healthcare Costs 10,000 Baby Boomers turn 65 each day. Today, the elderly population utilizes hospital services five times as often as the non-elderly. Combine this with the fact that our healthcare system is already too expensive, and we are on a collision course for collapse.

10. Trends: Maine Healthcare Scene Very high hospital quality outcomes and pretty good population health when compared nationally. Small and aging population, and poverty, makes cost shifting greater burden in Maine. All Maine hospitals are not-for-profit.

11. Per Capita Healthcare Costs 11 Source: The World Bank: Health expenditure per capita (current US$) 2012; Maine data estimated Maine needs to reduce costs by 20% just to achieve the U.S. average, and we would still be double other countries

12. Free Care & Bad Debt – Mid Coast $ 2.0 Million $ 4.4 Million $ 2.8 Million $3.3 Million $ 3.8 Million $ 5.4 Million $ 4.9 Million $ 5.1 Million $ 5.1 Million $ 5.2 Million $ 5.8 Million 20092010 2011 2012 2013 = Free Care = Bad Debt

13. Hope, Solutions and Strategies The “Triple Aim” Partnership and Collaboration Patient Centered Medical Home Critical Role of School Nurses

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15. Source: Institute for Healthcare Improvement, Cambridge, MA 15 Solutions: The Triple Aim to Accountable Care

16. Prevention and Wellness O ur vision is to become an organization that not only takes care of patients when they become sick, but also takes responsibility for the health and well-being of our community.

17. Strategic Vision for Population Health Primary Care / Patient-Centered Medical Home Community Health Employee Health / Worksite Wellness Accountable Care Integrated, Coordinated, Accountable & Aligned toward a Culture of Health and Wellness

18. © Steve Trockman 2012

19. United Way of Mid Coast Maine Success By 6: Early Childhood

20. Re-defining the “H” Today Future H HOSPITAL hER or If we are successful, the healthcare system in the future will necessarily need to look different. We can’t have it both ways (transformation and continue acute-care centric models.) Can we engage the community and employers to develop a culture of health and wellness? Can we integrate primary care, acute care, home care and elder care services to be more efficient and effective? Will all “hospitals” have inpatient beds? Can we afford as many hospitals? If we truly impact and improve the health of the population, will we need as many hospitals? We will need more community-based primary care and urgent care.

21. Patient-Centered Medical Home Coordinated care focused on prevention through Primary Care. Relationship between patient and their physician and the care TEAM. Integrated care…physical, social, spiritual, emotional.

22. Collaboration and Partnerships School Nurses are at the front line for the health of hundreds of thousands of children in our State. You have unique perspective and a critically important voice.

23. Transformation Growing, learning, improving Revolution, evolution, change, makeover Change.

24. References : The Healing of America by T.R. Reid Copyright 2010 The American Health Care Paradox: Why Spending More Is Getting Us Less by Elizabeth H. Bradley and Lauren A. Taylor Copyright 2013

25. Mid Coast Health Our Community, Our Health Brunswick, Maine