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A National Framework for Change 2008. 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? . Chronic illness on the rise Consumer dissatisfaction
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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? • Chronic illness on the rise • Consumer dissatisfaction • High health care and insurance costs
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.
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.
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 U.S. Department of Health and Human Services
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
The Benefits • Healthy infants = healthy kids • Healthy kids = success in school • Healthy kids = healthy adults • Healthy adults = healthy seniors • Healthy individuals = healthy families, healthy workers, healthy communities and a healthy economy A healthy America is a productive and vibrant America
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, 2007.
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% 48% Dissatisfaction with health care costs grew 15 percentage points in two years Source: Employee Benefit Research Institute, 2007.
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.
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 A new vision for America Health for Life Better Health. Better Health Care.
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
Action By All Improving America’s health is a great common cause that calls for leadership, participation and shared responsibility • Every individual • Every employer • Every insurer • Every health care supplier • Every community • Every state, local and the national government • Every doctor, hospital and all care providers Now is the time to do better
Opportunities for Leadership: By Stakeholders in Coalition • Reform will require changes in public policy at the federal and state level • The following public policy ideas for change were developed by six expert advisory groups involving nearly 100 different organizations (consumers, business, labor, insurers, physicians, nurses, hospitals, and others) • These ideas represent a strong consensus across the groups of policy ideas that begin to move America in the right direction • These ideas are intended to guide policy makers with concrete suggestions toward a common path for creating change in health and health care in America
Focus on Wellness Good health – physical, mental, and oral –is essential for a productive and vibrant America. A focus on wellness must be integrated into the lifecycle, from birth to death, and be encouraged in our homes, schools, workplaces and communities. Go to www.aha.org for more detail.
Efficient Affordable Care Efficient Affordable Care America will not be satisfied unless and until the cost of health coverage and health care are affordable. * See specific AHA proposal.Go to www.aha.org for more detail.
Highest Quality Care Motivate doctors, nurses, hospitals, nursing homes, and others to work together and team up with patients and families to make sure the right care is given at the right time and in the right setting. * See specific AHA proposal.Go to www.aha.org for more detail.
Best Information Good information is the gateway to good care. * See specific AHA proposal.Go to www.aha.org for more detail.
Health Coverage for All… Paid for By All Health coverage for all is a shared responsibility. Everyone – individuals, business, insurers and governments – must play a role in both expanding coverage and paying for it. Go to www.aha.org for more detail.
Opportunities for Leadership: By Each Stakeholder • While some improvements will require changes in public policy, many changes are already being made and must continue • The nation’s hospitals and health systems commit to pursue performance improvement in the care we provide and in improving the health of our communities • To improve America’s health, everyone must lead, participate and share responsibility. We call on others – physicians, insurers, employers, vendors, and government – to do their part as well • Following are examples of actions that stakeholders can take today to improve health care in America
Opportunities for Leadership: Hospitals Examples of ways to reach the goal: Safe • Make effective use of information and clinical technology designed to improve safety. • Implement specific practices shown effective in improving safety. • Redesign care processes to eliminate defects. • Collect and report errors in care to patient safety organizations. • Support patients, their families, doctors and other caregivers when patient harm occurs. Timely • Reduce emergency department wait times. • Reduce the time between scheduling an appointment and seeing a health care practitioner. • Speed procedures, test results, patient diagnosis and treatment. • Smooth the movement of patients throughout their care delivery experience. Effective • Ensure the use of current best evidence in patient care. • Share information with clinicians on how their clinical practice compares to "best practices" or "benchmarks”. • Ban unhealthy products on hospital campuses, such as tobacco, use of trans fats, or availability of unhealthy foods. • Promote better nutrition and fitness among our own hospital employees and within the broader community. • Lead community based initiatives to reduce obesity, diabetes, HIV or other local needs. Efficient • Employ techniques to optimize performance. • Reduce process variation to improve reliability of care. • Manage organizational variability to streamline processes. • Adopt health information technology to eliminate duplication of effort and reduce administrative costs. Efficient (cont.) • Participate in payment approaches that reward efficiency and quality. • Track patients with chronic conditions and provide them with effective chronic care management to avoid hospitalization. Equitable • Collect patient data on race, ethnicity and language to look more closely at hospital quality and patient satisfaction. • Make translation services available for patients and their families. • Strengthen the diversity of hospital governance, management teams and workforce. • Provide employees training in cultural competence. • Work with community leaders and organizations that serve racial or ethnic minorities or other groups to reduce care disparities. Patient-centered • Encourage active patient and family involvement in care delivery and decision-making. • Customize care to meet each individual patient’s needs and preferences. • Educate patients and families on palliative care and end-of-life care options. • Embrace transparency in the reporting of quality and pricing information to help people be better educated patients. • Ensure the protection of patient privacy and the confidentiality of medical information. • Expand the health care literacy of communities and patients served. • Integrate the care delivered by physicians, nurses and others to create a coordinated, seamless continuum of care for patients.
Opportunities for Leadership: Physicians Examples of ways to reach the goal: Safe • Consistently use current best evidence in patient care. • Publicly report both quality and pricing measures. • Make effective use of information technology designed to improve safety. • Support patients, their families, and other caregivers when patient harm occurs. Timely • Participate in providing on-call emergency department coverage. • Extend physician group office hours to include evenings and weekends. • Reduce time between scheduling an appointment and seeing a health care practitioner. Effective • Consistently use current best evidence in patient care. Efficient • Eliminate duplication of tests and procedures. Equitable • Achieve cultural proficiency. • Commit to serving Medicare and Medicaid patients. • Commit to serving a fair share of your community’s un- and underinsured individuals. Patient-centered • Make effective use of information technology for patient registration and medical records. • Use systems to remind patients of needed follow up care and visits. • Document all follow up care directions in writing. • Reduce patient waiting times.
Opportunities for Leadership: Business/Employers Examples of ways to reach the goal: Safe • Develop healthier food product alternatives. • Endorse and advertise marketing standards that promote healthy behaviors. Timely • Eliminate policies that reward workers for not using sick leave to seek medical care. Effective • Use incentives to reward healthy employee behaviors. • Offer workplace health units for primary care needs. • Provide workplace wellness programs. • Require insurers to have chronic disease management programs. Efficient • Agree on standardized, meaningful, accurate and reliable measures for cost and quality reporting. • Support standardization of administrative activities and costs across insurers. • Support standardized insurance benefit packages across insurers. Equitable • Offer coverage to full-time employees. • Offer coverage to part-time employees. • Offer “employee and spouse” coverage in addition to “employee and family” coverage. Patient-centered • Offer healthy workplace menus. • Offer healthy vending machine selections. • Ban smoking in or outside the workplace. • Remove cigarette machines from the workplace.
Opportunities for Leadership: Insurers Examples of ways to reach the goal: Safe Timely • Ensure provider networks include 24-7 access to urgent care in a setting other than the emergency department. Effective • Include coverage for prevention and wellness in all policies. • Collect and share outcomes data across insurers. • Base coverage decisions on comparative effectiveness research. • Share practice variation data with physicians and hospitals. Efficient • Make information about insurance products, offerings and prices transparent and easily available to the public. • Develop a single source for coverage determination and claims processing across insurers. Efficient (cont.) • Adopt a single uniform bill across insurers. Equitable • Guarantee coverage policies will be issued equally to everyone. • Pool risk across all policy holders. • Work with other insurers to create coverage portability across plans and employers. • Eliminate benefit “carve outs.” • Eliminate lifetime caps on coverage. • Create parity in coverage for physical and mental health needs. Patient-centered • Give enrollees smart cards that electronically access co-payment and deductible requirements. • Give enrollees electronic access to claims information so they can share it with other providers. • Adopt automated prescription delivery for maintenance medications.
Opportunities for Leadership: Vendors Examples of ways to reach the goal: Safe • Standardize device-specific numbering. • Standardize pharmaceutical identification at the unit dose level. • Lead in pharmaceutical labeling that eliminates confusion and error. Timely Effective • Do not promote off label uses of medications. • Do not facilitate unapproved device modification. • Voluntarily participate in the creation of comparative effectiveness information on the risks, benefits and costs of new technologies, therapies and treatments. Efficient • Voluntarily join to select and implement information technology standards to create greater interoperability. • Voluntarily set standards that create compatibility among different manufacturers’ clinical technologies. Equitable • Provide discounted drugs and devices to uninsured patients of limited means. • Ensure that pharmaceutical and device research and testing is done with appropriate representation of our increasingly diverse population and be relevant to all populations. Patient-centered
Opportunity for Cost Savings • Improve health status • Reduce the burden of chronic disease • Reduce medical errors • Reduce waste • Improve efficiency • Reduce administrative costs • And more…
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.
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.
