Patient – Consumer Involvement in Health Care Why It Is Needed? And How Can We Do It?

1. Patient – Consumer Involvement in Health CareWhy It Is Needed?And How Can We Do It? Ted Rooney, RN, MPH Aligning Forces for Quality Project Director, Quality Counts

2. Objectives • Identify how the US health care is in a quality/cost crisis • Suggest the best path forward seems to be a primary care based system involving new and existing partners in innovative new ways • Ask for your help in involving patients and the public actively in how health care is redesigned

3. Our Quality Is Less……… BETTER 3

4. Our Costs Are MoreInternational Comparison of Spending on Health, 1980–2008 Average spending on healthper capita ($US PPP) Total expenditures on healthas percent of GDP Source: OECD Health Data 2010 (June 2010).

7. http://www.iom.edu/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America/Infographic.aspxhttp://www.iom.edu/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America/Infographic.aspx

8. Institute of Medicine - 2012

9. Problems with MisUseInstitute of Medicine Report 1999: Annual Deaths: • Medical Mistakes 44,000 - 98,000 • Motor Vehicle Accidents 43,458 • Breast Cancer 42,297 • AIDS 16,516 • Workplace Accidents 6,000 9

10. Office of Inspector GeneralDHHS, January 2012 • 2010: 13.5 %of hospitalized Medicare beneficiaries experienced adverse events during their hospital stays that resulted in prolonged hospitalization, required life-sustaining intervention, caused permanent disability, or death. • An additional 13.5 percent experienced temporary harm events that required treatment. • Maine in 2010: 61,385 Medicare patients discharged from Maine hospitals • 13.5% = 8,287 Medicare beneficiaries (23)

11. Not All Preventable • “Although an adverse or temporary harm event indicates that the care resulted in an undesirable clinical outcome and may involve medical errors, adverse events do not always involve errors, negligence, or poor quality of care and may not always be preventable.” • And Maine hospitals are among the safest in the nation…

12. Office of Inspector General Department of Health and Human Services OFFICE OF INSPECTOR GENERAL HOSPITAL INCIDENT REPORTING SYSTEMS DO NOT CAPTURE MOST PATIENT HARM Daniel R Levinson, Inspector General - January 2012 • All sampled hospitals had incident reporting systems to capture events, and administrators we interviewed rely heavily on these systems to identify problems. • Hospital staff did not report 86 percent of events to incident reporting systems.

13. Institute of Medicine

14. Not Getting the Right Care at the Right Time Problems with UnderUse 2004: Adults receive about half of recommended care 54.9% = Overall care 54.9% = Preventive care 53.5% = Acute care 56.1% = Chronic care Source: McGlynn EA, et al., “The Quality of Health Care Delivered to Adults in the United States,” New England Journal of Medicine, Vol. 348, No. 26, June 26, 2003, pp. 2635-2645

15. Problems With OverUse Hospital Outpatient Advanced Imaging Utilization / 1,000 by Hospital Service Area State Average: 44.8/1,000 15 Note: Red bars are significantly above/below the state average at the .05 level

16. Below State Average Above State Average Comparative Cost: Large Maine Hospitals

17. Comparative Cost: Small Maine Hospitals

18. WE Pay The Wrong Way! LOSE LOSE ER LOSE LOSE ?? Rests on the head… $$ of a pin $$ $$$

19. Aligning Maine’s “Forces” QC/MHMC: AF4Q Consumer Messaging/ Leadership Consumer Engagement MHMC Employee Activation Program MHMC : PTE reporting on hospitals, primary care, specialist quality Perf Meas./ Public Report MQF: reporting on hospital quality, patient experience of care (TBD) Quality Improvement MPIN, PHOs: QI support to mbr practices Quality Counts: QC Learning Community Benefit Design MHMC: Encourage employer/payer use of PTE data for steering; Value-based insurance design Hospitals/ Health Systems & Employers: Local ACO Pilots Maine PCMH Pilot Payment Reform BIW Primary Care Program Primary Care & Employers/Payers: Alternative payment models Cognitive Consultation Specialty Care: Alternative payment models Promote Health IT Adoption MEREC: Promote primary care HER adoption, meaningful use HealthInfoNet: Promote interoperable systems Bangor Beacon: promote community-wide, connected HIT

20. What Are We Trying to Achieve? And what Contributes? Univ. Wisconsin - RWJF County Health Rankings

21. Engage as a health care consumer Consumers Make healthy lifestyle choices Purchase benefits based on value Employers Design benefits based on value Insurers Help employees be better health care consumers; promote health Help members be better health care consumers; promote health Everyone Has A Role WHO RESPONSIBILITIES In Building a Value-Based Health Care System, Everyone Has a Role Improve effectiveness and affordability of health care services Doctors / Hospitals Share quality and cost information MHMC / AF4Q Produce performance reports Recommend aligned incentives 21 Based on chart developed by Puget Sound Health Alliance and the Wisconsin Health Alliance Cooperative, 2006

22. Don Berwick: “What Will Help…” • Very Strong Primary Care • Intelligent Use of Specialty and High-Tech Care (without ANY loss to patients!) • Highly Efficient Hospitals • Focus on Each Individual Patient’s Goals • Superb systems for High Cost, Socially or Medically Complex Patients • Integration of Regional Resources

23. Institute of Medicine

24. It’s About the Basics(the hard work!)

25. Professionalism Self-respect Peer respect Maine Experience: Lessons Learned Recognize different motivators – need both the “heart” and the “head”! • Efficiency • $ / financial incentives Needed to sustain change Motivators for adoption & spread of change

26. Consumers Can Drive Change

28. Pathways to Excellence – HospitalsSteering Committee Health Plans: • Aetna • Anthem • CIGNA • Harvard Pilgrim • MaineCare Employers: • Christine Burke: MEA Benefit Trust • Laurie Willamson: State Employees Hlth Comm • Tom Hopkins: Univ. of Maine System • Chris McCarthy: Bath Iron Works • Joanne Abate: Hannaford Bros. • Steve Gove: ME Mun. Employee Health Trust • Organizations: • Alex Dragatsi: Maine Quality Forum • Sandra Parker: Maine Hospital Assn. • Art Blank: ME Hosp. Assn, MDI Hosp Hospital VPMA: • Don Krause, MD: St. Joe’s Hospital • Scott Rusk, MD: Mercy Hospital • Doug Salvador, MD: Maine Med. Center • Mark Souders: Maine General Med. Center • Larry Losey, MD: Parkview Adventist Med. Center • Frank Lavoie, MD: So. Maine Med. Center • Peter Watco: St. Mary’s Regional Hospital • Roger Renfrew, MD: Redington Fairview • General Hospital • Patty Roy, RN: Central Maine Medical Center • Scott Mills, MD: Midcoast Hospital • Erik Steele, DO: Eastern Maine Healthcare • James Raczek, MD: EMMC • Vance Brown, MD: MaineHealth • Mike Swann: Franklin Memorial Hospital

29. SEHC Announce 7-07 PCP Tiering 29 29

31. Maine: 2nd biggest improvement in US

32. Physical Health Providers • Vance Brown, MD MaineHealth • Barbara Crowley MD MaineGeneral • Richard Freeman, MD EMHS • Sharron Sieleman RN, CMMC Behavioral Health Providers • Lynn Duby, Crisis & Counseling • Greg Bowers, Maine Mental Hlth Partners Health Plans • Terri Bellmore, Universal Am. • Bob Downs , Aetna • Jeff Holmstrom DO, Anthem Consumers • Jenny Rottmann • Dan L'Heureux • David White • Elizabeth Mitchell, MHMC • Michelle Probert, MaineCare • Karynlee Harrington, Dirigo Health Agency • Sandy Parker, Maine Hospital Assn • Gordon Smith, Maine Medical Assn • Debra Wigand, MaineCDC 2011: SEHC 1st Annual QC QI Award

33. Approach • We need the patients’ and public’s help (i.e. YOU) in shifting wasteful spending that does nothing to improve health, and often produces harm, to spending that actually helps improve the health of Maine people.

34. Patient & Public Involvement • Improve one’s own health / health of family • Wellness offerings • Healthy eating • Meals on wheels, etc. • Get information to make informed choices • www.GetBetterMaine • Help people access information • Articles in newsletters, etc. • Work with others to help improve their health • Living Well and Matter of Balance programs

35. Patient & Public Involvement • Work directly with health care providers to help improve the delivery, quality, experience of care • Participate in provider committees (with training) • Work with stakeholders to drive system, policy, payment changes to transform care • Community forums on quality-cost