The Current State of Health Care

1. The Current State of Health Care April 16, 2014 Debra Flores, Ph.D. RHP 12 Project Manager Borrowed content from Patricia Porter 2009

2. Overview • History of health care coverage • Determinants of Health • Financial Burden on Health Care System • Payment Models • Health Care Reform • New Models of Care • Health Care Paradigm Shift • Quality/Leadership/Teamwork/Patient • Collaboration • Innovation

3. History 1930 1900 2000 1950 1970 1990 1980 1960 1920 1940 Public Broadcasting System: http://www.pbs.org/heathcarecrisis/history

4. 2014 Grover, A., Niecko-Najjum, L. (2013), Physician workforce planning in an era of health care reform. Academic Medicine, 88(12), 1822-1826.

5. Determinants of Health Status (from expert consensus; Shi; Blum) Medical Care (10%) Genetics (10%) Health Status (100%) Environment(40%) Behavior (40%) Healthy, Wealthy and Wise Physical Barriers Nutrition & Exercise Financial Lifestyle choices Education/Literacy Employment

6. Financial Burden on Health Care System • Higher patient turnover, increased hospital readmissions and development and/or exacerbation of comorbid conditions • Decreased length of stay • Unit & hospital bed closures • Increased health care provider-patient ratios Fredricks, S., Lapum, J., Schwind, Jasna, Beanlands, H., Romaniuk, D., McCay, E. (2012), Discussion of Patient Centered Care in Health Care Organizations. Quality Manage Health Care, 21(3), 127-134.

7. Payment Models Evolve! Episodic Payment Fee For Service & DRG’s Global Payment Shared Savings Owen, M., Ostrowsky, L. (2013), Who knew? Innovation and transformation within acute care case management. The Heartbeat of Case Management in Professional Case management, 18(4), 202 . Powers, L., Shepard, K., Craft, K. (2012), Payment reform and the changing landscape in medical practice-Implications for Neurologist. American Academy of Neurology (224-230).

8. Patients Experience • Lack of trust & transparency • High cost • Barriers in navigating the health care system • Isolation physically and psychologically • Hesitance to bother someone Severson, M. et al. (2011), Health reform: A community experience using design research as a guide. Mayo Foundation for Medical Education and Research, 86(10) 973-980.

9. Patients Lack • Ability to digest health care information provided • Flexibility • Insurance or ability to obtain insurance • Access • Education • Communication Severson, M. et al. (2011), Health reform: A community experience using design research as a guide. Mayo Foundation for Medical Education and Research, 86(10) 973-980

10. REFORM https://www.youtube.com/watch?v=0YGF5R9i53A Severson, M. et al. (2011), Health reform: A community experience using design research as a guide. Mayo Foundation for Medical Education and Research, 86(10) 973-980.

11. New Health Care Models • Patient Centered Medical Home • Accountable Care Organizations • Pay 4 Performance Garr, D., Margalit, R., Jameton, A., Cerra, F. (2012) Commentary: Educating the present and future health care workforce to provide care to populations. Academic Medicine, 87 (9). Severson, M. et al. (2011), Health reform: A community experience using design research as a guide. Mayo Foundation for Medical Education and Research, 86(10) 973-980. Hoying, C. et al. (2014), “On the scene”-Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio. Nursing Administration Quarterly, 38(1) 27-54.

12. Health Care Paradigm Shift • Influenced by internal & external factors • Outcome driven • Professionals practice to the full extent of their education • Value based from volume based • Care management from crisis management • Outpatient care clinics from overflowing Emergency Departments • Diverse scope of expertise to acute-centric workforce • Inpatient and outpatient in the same world • Team based approach Garcia, V., Meek, K., Wilson, K. (2011), Advancing innovation in health care leadership-A collaborative experience. Nursing Administration Quarterly, 35(3), 242-247 Herlehy, A., (2011), Nursing’s role in the transformation of health care. AORN Journal, 93(5), 519-523 .Hoying, C. et al. (2014), “On the scene”-Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio. Nursing Administration Quarterly, 38(1) 27-54.

13. Quality • Performance based • Quantify adverse effects • Quantify consistency of care • Use data to manage financial & quality improvement • Adherence to national reporting requirement Powers, L., Shepard, K., Craft, K. (2012), Payment reform and the changing landscape in medical practice-Implications for Neurologist. American Academy of Neurology (224-230). Shiparkski, L., Authier, P. (2013) Mentoring frontline managers-The vital force in stimulating innovation at the point of care. Nursing Administration Quarterly, 34(1), 28-36.

14. Leadership Entails: • Establishing and Articulating a Vision • Building relationships required to accomplish the vision • Allocating and Prioritizing Resources to enable the vision • Providing support and enthusiasm Hoying, C. et al. (2014), “On the scene”-Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio. Nursing Administration Quarterly, 38(1) 27-54.

15. Teamwork • Team Leadership • Mutual performance monitoring • Back-up behavior • Adaptability • Team orientation • Collaboration • Innovation Leasure, E. et al. (2013), There is no “I” in teamwork in the patient-centered medical home: Defining teamwork competencies for academic practice. Academic Medicine, 88, 585-592. Powers, L., Shepard, K., Craft, K. (2012), Payment reform and the changing landscape in medical practice-Implications for Neurologist. American Academy of Neurology (224-230).

16. Innovation “Cultivating ideas that have value and which can change the future” Shiparkski, L., Authier, P. (2013) Mentoring frontline managers-The vital force in stimulating innovation at the point of care. Nursing Administration Quarterly, 34(1), 28-36.

17. Innovation • Must be allowed and encouraged • Must be actively cultivated • Creates new dimensions of performance • Needs to be interdisciplinary • Shared with clear expectations and defined incentives Dzau, V., Yoediono, Z., ElLaissi, W., Cho, A., (2013), Fostering innovation in medicine and healthcare: What must academic health centers do? Academic Medicine 88(10), 1424-1429. Garcia, V., Meek, K., Wilson, K. (2011), Advancing innovation in health care leadership-A collaborative experience. Nursing Administration Quarterly, 35(3), 242-247.

18. 4 Stages of Innovation • Overcoming barriers to creativity • Providing methods for thinking “out of the box” • Addressing individual & group dynamics • Use innovative tools Dzau, V., Yoediono, Z., ElLaissi, W., Cho, A., (2013), Fostering innovation in medicine and healthcare: What must academic health centers do? Academic Medicine 88(10), 1424-1429.

19. Behaviors that Ignite Innovation • Creating culture of innovation • Collaboration that fuels diverse thinking & creativity • Using meaningfully data to drive decisions • Assessing & monitoring climate & outcomes

20. Innovation Strategies • Maintain an optimistic attitude • Live out a strong, moral code • Face fears head on • See patterns and put events in context • Manage risk • Move on! Shiparkski, L., Authier, P. (2013) Mentoring frontline managers-The vital force in stimulating innovation at the point of care. Nursing Administration Quarterly, 34(1), 28-36.

21. Accelerate Innovation • Budget • Efficient Processes • Phase out processes that make budget dollars available • Level of involvement • Selection of measures • It’s okay to fail

22. Triple Aim • Improving the experience of care-providing care that is: • Effective • Safe • Reliable • To every patient-every time • Improving the health of a population, reaching out to the communities and organizations, focusing on prevention and wellness, managing chronic conditions, etc. • Decreasing cost

23. “Simple Rules for 21st Century Health Care System

24. Summary

25. Thank You!