ASHHRA LEADERSHIP CONFERENCE

1. ASHHRA LEADERSHIP CONFERENCE

2. The Challenge In a country that expects the best of everything we fail to achieve the best in health. What must be done to meet the health and health care challenges of our future?

3. A Sicker America Chronic illness is on the rise • Half of Americans have one or more chronic illnesses • 80% of spending is linked to chronic illness • Much of this is avoidable • Obesity has doubled; Diabetes is on the rise Source: Centers for Disease Control and Prevention.

4. Factors Harming Health Are On the Rise A Sicker America • Biology High risk factors; family history; physical and mental health problems • Physical environment Exposure to toxins; hazards at work or at home; air pollution • Social environment Poverty; lack of education; homelessness; lack of transportation; violence • Behavior Smoking; 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

5. America’s Health Must Improve Without change, America’s health care capabilities and finances will be overwhelmed As a society we must: • Provide access to education and preventive care • Help all reach their highest potential for health • Reverse the trend of avoidable illness As individuals we must: • Achieve healthier lifestyles • Take responsibility for our health behaviors and choices Each one of us must take action

6. America’s Health Care Must Improve America has what it takes to offer the best in care • Highly trained doctors, nurses and other providers of care • Latest technology • Cutting-edge medical research • Well-equipped facilities • Freedom of choice But more can and must be done now

7. America’s Health Care Must Improve • 6 in 10 Americans rate the health care system as fair or poor People are dissatisfied with the health care system 59% fair or poor Source: Employee Benefit Research Institute, 2006.

8. America’s Health Care Must Improve • Health care costs are high • Highest spending per person among industrial countries • High costs weaken America in today’s global economy • Americans are increasingly angry about high costs 33% 51% Dissatisfaction with health care costs grew 18 percentage points in one year Source: Employee Benefit Research Institute, 2006.

9. America’s Health Care Must Improve Health care in America can be better and more affordable America deserves care that is: • Safe and free from harm • Provided at the right time, when care is needed • The recommended care every time • Efficient and affordable • Without bias • Personalized and sensitive to each individual’s needs Adapted from the Institute of Medicine Crossing the Quality Chasm, 2001.

10. Can We Envision a Different Future? • Health and health care are basic human needs and no one goes without • Everyone has prompt access to needed health care • Everyone is treated with dignity and respect • Everyone has the opportunity to reach their highest potential for health • Health and health care is without bias • Improving the health of our nation is viewed as a common good and good for our nation

11. A New Vision for America Health for Life: Better health, Better health care

12. What Does This Vision Mean? For America’s Health: • America is #1 in health status among nations • Trend in avoidable chronic disease is reversed • People lead healthy, balanced lives For America’s Health Care: • Health care is efficient, affordable and of high quality • Everyone has coverage and access to care • Care experience exceeds expectations

13. Health Reform 200? A Campaign or a Caravan?

14. Outside game • Making issue a priority • Forcing candidates to address issue • Multiple coalitions around principles • Ensure that candidate elected has mandate for change • Inside game • Ideas and specifics Current Situation

15. Lessons fromthe Past • Invest public in vision • Invest the insured…and give them a stake in solutions that focus on: • affordability • improving care to chronically ill • Included all stakeholders from the start • Avoid “taking out” industries • Bipartisan • Develop a plan of incremental steps toward major change • Keep it simple

18. Examples of What the Research Says Note: Savings is not necessarily additive across studies. Savings not reflective of investment required to achieve performance level indicated.

19. Measuring Progress How will we know that we are on the right path? * Based on World Health Organization Includes such measures as infant mortality, average life expectancy, etc.

20. What’s Different? • Not an AHA plan…seek to build coalitions • Lesson from 1992 • Addresses more than coverage • Public and policymakers skeptical of providers advocating for only expanded coverage • Public and policymakers need confidence that expansion of the system will be accompanied by greater value • Develop details (with coalition partners) from framework that can be applied to incrementally • Quality and patient safety • Pay for performance • Chronic care management • Clinical integration • Evidence base medicine • IT standards • Transparency • Alternative liability approaches • Technology assessment

21. Key Stakeholder Outreach Meetings With Outside Stakeholders: • Already complete • Center for Health Transformation • Commonwealth Fund • Families USA • National Association of Manufacturers • National Business Group on Health • National Federation of Independent Business • National Medical Association • Robert Wood Johnson Foundation • U.S. Chamber of Commerce • VHA • AMA • Catholic Health Association • ACS • AARP • AFL-CIO • AHIP • American Academy of Family Physicians • American Academy of Pediatricians • American Nurses Association • American Public Health Association • American Society of Health-System Pharmacists • Association of American Medical Colleges • BCBSA • Business Roundtable

22. Key Stakeholder Outreach Issue Advisory Groups: • Focus on Wellness • Most Efficient Affordable Care • Chronic Care Management • Highest Quality Care • Clinical Integration • Best Information

23. On The Road To Change…. • Reduce Our Vulnerabilities • Community Benefit • Billing and Collection • Charity Care • Transparency • Infection Control • Our People

24. TRUST

25. “… if you'd like me to know what you've been through with your insurance company, or what it's been like to have no insurance at all, or how the hospitals and doctors wouldn't treat you (or if they did, how they sent you into poverty trying to pay their crazy bills) …”

26. Hospitals and Public Trust

28. “To Help Hospitals Reaffirm Their Rightful Place as Vital and Valued Community Resources That Merit Broad Public Support”

30. In Pursuit of ExcellenceOperationalizing Across AHA