Healthcare Coalitions, The ACA and Emergency Preparedness Capabilities

1. Healthcare Coalitions, The ACA and Emergency Preparedness Capabilities Robert Humrickhouse March 12 – 13, 2014 Little Rock, AK

2. Robert Humrickhouse, Reprint by Permission Only Through the Looking Glass

3. Robert Humrickhouse, Reprint by Permission Only Where are We at Now? • Healthcare.gov • Deadlines pushed out • Beginning implementation • System has already seen first rounds of impact • Emergency Preparedness has not been the top topic of discussion • ACA #1 • ACA #2 • ACA #3 • And so on. . .

4. Robert Humrickhouse, Reprint by Permission Only NEVER WHY?

5. Robert Humrickhouse, Reprint by Permission Only Healthcare Consumed 17.9 percent of GDP National Health Expenditures, 2010    Total = $2.3 Trillion Source: Martin A.B. et al., “Growth In US Health Spending Remained Slow in 2010; Health Share of Gross Domestic Product Was Unchanged from 2009,”Health Affairs, 2012

6. Robert Humrickhouse, Reprint by Permission Only Take another look

7. Robert Humrickhouse, Reprint by Permission Only Do Coalitions Reflect the Spend, Where Are the Trends? National Health Expenditures, 2010    Total = $2.3 Trillion Source: Martin A.B. et al., “Growth In US Health Spending Remained Slow in 2010; Health Share of Gross Domestic Product Was Unchanged from 2009,”Health Affairs, 2012

8. Robert Humrickhouse, Reprint by Permission Only Arkansas Spend $17.8 Billion Kaiser Family Foundation

9. Robert Humrickhouse, Reprint by Permission Only Cost Shifting • Payment to cost ratio • Medicare 90.9% • Medicaid 88.7% • Commercial Payers 128.3% • AHA 2010 • The financial benefit of providing coverage for the 25.3 million uninsured, most of whom will receive government-funded insurance will not be sufficient to offset to deleterious effects of the shift away from commercial health plans • Foster 2010 Nate Kaufmann

10. Robert Humrickhouse, Reprint by Permission Only Cut expenses By How Much 21% to 47% Nate Kaufmann

11. Robert Humrickhouse, Reprint by Permission Only Cut From Where Berwick

12. Robert Humrickhouse, Reprint by Permission Only The Law of Reciprocal Economics One person’s cost is another person’s revenue Nate Kaufmann

13. Robert Humrickhouse, Reprint by Permission Only What Resources are Required to be Prepared? • $$$$$$$$$ • HPP Funding • Personnel • Scope of Licensure, Specialties • Other Resources • Singular vs. Shared • Planning • Subject to Regulations • Declarations • Equipment

14. Robert Humrickhouse, Reprint by Permission Only What Does it Take? • Capability • Who best to develop • Regulatory/Standards • Legislative • Accreditation • Exercising • Large vs. Small • Micro vs. Macro

15. Robert Humrickhouse, Reprint by Permission Only Hospital Systems • Healthcare systems • Hospitals, long term care, primary care • Corporate Incident Command Structures • Number of systems crossing jurisdictional boundaries • Become greater portion of the pie when long term care is part of coalition • For profit vs. non-profit • How do these fit into NIMS • Immediate bed availability • New CMS Standards • Do not apply to outpatient providers • The very people we need to engage in coalitions

16. Robert Humrickhouse, Reprint by Permission Only Hospital Systems • Community hospitals • Over 4,500 now affiliated with system or network (2011 AHA data) • 4,300 in 2009 • Identity within community • Shelter • Primary care • Single provider • Academic medical institutions • Capabilities available at educational institution vs. hospital • Critical access hospitals • Local expertise in community needs

17. Robert Humrickhouse, Reprint by Permission Only Telemedicine • Technology ahead of implementation • Application is effective for conventional through crisis care • Specialty services available in primary care • Eliminates physical movement of equipment • Requirements at local level • Power • Credentialing • Included in emergency operation plan? • Included in COOP plan?

18. Robert Humrickhouse, Reprint by Permission Only Create Your Group • Assign capability • Take notes • Determine how the capability might need to change to lead healthcare reform • Efficiency • Care provided at most appropriate level • Technology doesn’t stand in your way • How would you ensure this capability was included in the new model of care

19. Robert Humrickhouse, Reprint by Permission Only Capabilities • Coalitions • System Preparedness • Volunteer Management • Responder Safety and Health • Emergency Operations Coordination • Medical Surge • Information Sharing

20. Robert Humrickhouse, Reprint by Permission Only Recommendations – Coalitions • Vital to survival of emergency preparedness capabilities • Consideration should be given to coalitions of coalitions to minimize impact of ACA and increase resiliency • Coalitions should give consideration to the limitation of EMS systems given the impact of ACA on hospitals • Other essential partners may not be linked to EMS

21. Robert Humrickhouse, Reprint by Permission Only Recommendations – System Preparedness • Build on coalition of coalition concept to standardize/centralize training • HVA of training needs based on necessary capabilities • Not all hospitals need the same level of training in order to create an adequate response • Collapse exercise requirements and reduce resource burden of full-scale exercises • Stretch the legs of training and TTX

22. Robert Humrickhouse, Reprint by Permission Only Recommendations – System Preparedness • Hardwire special populations into planning, exercises and response • If you can meet the needs of special populations then you can meet the needs of the general public • It’s just a matter of numbers

23. Robert Humrickhouse, Reprint by Permission Only Recommendations – Volunteer Management • DON’T CREATE A SEPARATE SYSTEM • Credentialing/privileging occurs at every hospital and TJC accredited facility in the healthcare system • Leverage current resources to create regional credential verification organizations • Providers already go through the same credentialing process for each hospital at which they provide care • Eliminates waste, reduces cost, simplifies process • Will most likely require regulatory reform

24. Robert Humrickhouse, Reprint by Permission Only Recommendations – Volunteer Management • Convene national planning group to standardize credentialing across the healthcare system • CMS • TJC, DNV, HFAP • Payers • Provides opportunity to cost shift from NDMS to insurance coverage • Will most likely require regulatory reform • Very inefficient for each coalition/state to replicate effort

25. Robert Humrickhouse, Reprint by Permission Only Recommendations – Responder Safety • Incorporate new innovations in “just-in-time” delivery into planning models • Healthcare system inventory will shrink even greater • Vendors and hospitals will consolidate and will put more pressure into the supply chain during disasters/events • Hospitals will have fewer resources to monitor and manage cache • PPE and pharmaceuticals

26. Robert Humrickhouse, Reprint by Permission Only Recommendations– Emergency Operations Coordination • Coalition, coalition, coalition • Coordination of resources • Leverage new technology for communications

27. Robert Humrickhouse, Reprint by Permission Only Recommendations – Medical Surge • Coalition must include alternate care sites, temporary care sites, field operations, etc. • Bricks and mortar healthcare system will not be able to sustain • Leverage capacity and capability with disruptive technology • Telemedicine, standardized treatment plans • Handheld devices (technology already exists • Video interpreting

28. Robert Humrickhouse, Reprint by Permission Only Recommendations – Medical Surge • Develop crisis standards of care • Crisis will happen sooner rather than later when the healthcare system has driven out 47% of cost • Conventional, Contingency, Crisis • Decontamination • Who really has to do it and how much do they have to do • Algorithms for decontamination decision making • Differentiate decon for community vs. disaster • Instant Bed Availability • Coalition based • Healthcare system based • Long term care

29. Robert Humrickhouse, Reprint by Permission Only Recommendations– Information Sharing • Streamline situational awareness processes based on coalition of coalitions that take into account hospital system and geography • Redundant communication systems require constant training and testing in an era of staff turnover and elimination • Patient Tracking – leverage evolving technology and include this capability in regional Health Information Exchanges with ability to download on national level

30. Robert Humrickhouse, Reprint by Permission Only Conclusions • Healthcare emergency preparedness capabilities are being built on a system that will require disruptive innovation in order to survive • Current funding streams and not being leveraged to create efficiencies in the healthcare system to eliminate waste and/or duplicated efforts

31. Robert Humrickhouse Healthcare Consulting Services humrob@me.com 773-550-2499 40 West Schiller Suite 1A Chicago, IL 606010