Interventions Showcase

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Transforming Healthcare in North Carolina
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Agenda for Healthcare Transformation Discussion

• Current Health Reform Proposals
• Purpose of Health Reform Discussion
• AHA Principles of Reform
• NCHAs Healthcare Transformation Portfolio and
  Lessons Learned
• Understanding the Economics of Reform
• Reform Learning Resources

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Cost and Deficit Comparisons
Source http//www.washingtonpost.com/wp-srv/speci
al/nation/health/compare-health-plans-2009/,
September 22, 2009 Kaiser Family Foundation,
side-by-side comparison
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With No Plan 54 Million Uninsured in 2019
Source http//www.washingtonpost.com/wp-srv/speci
al/nation/health/compare-health-plans-2009/,
September 22, 2009 Kaiser Family Foundation,
side-by-side comparison
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Key Provisions
Source http//www.washingtonpost.com/wp-srv/speci
al/nation/health/compare-health-plans-2009/,
September 22, 2009 Kaiser Family Foundation,
side-by-side comparison
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Key Provisions
Source http//www.washingtonpost.com/wp-srv/speci
al/nation/health/compare-health-plans-2009/,
September 22, 2009 Kaiser Family Foundation,
side-by-side comparison
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Key Provisions
Source http//www.washingtonpost.com/wp-srv/speci
al/nation/health/compare-health-plans-2009/,
September 22, 2009 Kaiser Family Foundation,
side-by-side comparison
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Key Provisions
Source http//www.washingtonpost.com/wp-srv/speci
al/nation/health/compare-health-plans-2009/,
September 22, 2009 Kaiser Family Foundation,
side-by-side comparison
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Transforming Healthcare In North Carolina
Leaders make history and not the other way
around. In periods where there is no leadership,
society stands still. Progress occurs when
courageous, skillful leaders seize the
opportunity to change things for the
better. Adapted from Harry S. Truman
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Historical Perspective

• Last two transformations in the history
• of American Medicine
• Creation of Medicare
• Corporatization of Medicine

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IOM Principles for a Healthcare System
Safe Timely Effective Efficient Equitable Patient
Centered
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AHA Principles of Healthcare Reform
Focus on Wellness Most Efficient, Affordable
Care Highest Quality Care The Best
Information Health Coverage for All, Paid for by
All
From AHA Health for Life
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National Healthcare Coalition

• Bending the Cost Curve
• Cost Reduction Principles
• Utilization of Care
• Cost of Doing Business
• Administrative Simplification
• Chronic Care

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Do not go where the path may lead, go instead
where there is no path and leave a trail. Ralph
Waldo Emerson
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North Carolina Hospital Association
Mission Promotes improved delivery of quality
health care through leadership, advocacy,
information and education Vision The highest
possible level of quality healthcare delivery
throughout North Carolina. Leadership Goals The
highest quality and safest hospitals in the
nation. The healthiest state in the nation by
2020.
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NC Center for Hospital Quality and Patient Safety
Mission The Center exists to foster a culture of
quality and safety within North Carolina
hospitals and healthcare systems. Vision The
Center will lead North Carolina hospitals and
healthcare systems to become the safest and
highest quality hospitals and healthcare systems
in the United States.
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NC Center for Hospital Quality and Patient Safety

• Values
• Leadership, Integrity, Innovation, Collaboration,
  Transparency, Good Science and Positive Focus.
• Fundamental Elements
• Culture and Teamwork
• Reliable Process Design
• Organizational Learning

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NC Healthcare Quality Alliance

• Mission
• Dedicated to improving
• the quality of health care delivered to all North
  Carolinians.
• Strategy
• Align quality measures across players to reduce
  the variation in quality measurement faced by
  providers.
• Provide feedback on performance to practices.
• Support practices throughout the quality
  improvement process using nationally-recognized
  models.

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Community Care of North Carolina

• Mission
• To bring together community providers to
  cooperatively plan for meeting the needs of the
  enrolled Medicaid population and to strengthen
  the community healthcare delivery infrastructure.
• Distinguishable Features
• Partnerships
• Population Health Management
• Approach Accountability

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Care Share Health Alliance

• Mission
• To improve the health of
• low-income, uninsured North Carolinians by
  supporting local collaborative networks of care.
• Values and Guiding Principles
• Patient-Centered
• Collaborative
• Complete continuum of integrated care
• Utilize best practices and evidence based care
• Efficient
• Accountable
• Sustainable

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Safety Net Advisory Council

• Mission
• To ensure that North Carolina
• safety net organizations have a forum in which to
  collaborate, exchange ideas, and advance their
  common mission of providing free and reduced cost
  healthcare services to NC residents.
• Goal
• To identify unmet healthcare needs and develop
  strategies to address gaps in services.

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Carolinas Lean Healthcare Roundtable

• Mission
• To be an active model spreading lean healthcare
  transformation across healthcare organizations in
  the Carolinas.
• Goals
• To achieve lean culture transformations in early
  adopter, leadership hospitals and healthcare
  organizations by 2011.
• Continue spreading lean healthcare transformation
  to other hospitals and healthcare sectors.

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NCHA Hospital Community Benefits Report

• Purpose
• To improve the accountability of hospitals to
  their communities by creating a consistent and
  defendable community benefit report.
• Goals
• Transparency of community benefit.
• Public benefit communication to community and
  legislators.
• Apples-to-apples categories and measures.
• Defensible guidelines with clear definitions and
  formulas, based on previous work.

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Community Benefit in 2008
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Community Benefit in 2008
All NC Hospitals (in millions) Charity Care
Costs 694 Bad Debt Costs 650 Total
Uncompensated 1,344 Uninsured Uncompensated
975
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Public Health Hospital Collaborative

• Vision
• The Healthiest State in the Nation by 2020
• Strategic Plan
• Developing and supporting the NC Center for
  Public Health Excellence
• Dramatically Reducing Obesity and Tobacco Use
• Coordinating Advocacy Efforts
• Supporting Local Triple Aim Partnerships

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NC Triple Aim Initiative

• Goals
• Improve quality and the
• patient experience of care.
• Improve the health of a defined population.
• Control or reduce the per capita cost of care.
• Concept Design
• Embraced by Cape Fear Valley Health System and
  CCNC partners.
• Initial focus on preventing CHF readmissions.

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Learning from NCs Transformation Portfolio
? Collaboration to plan, develop, test and
implement change. ? Clear goals and system level
aims (How Good by When). ? Small tests of change,
pilot projects and segmentation (spreading
innovation and change). ? Patient-centered and
family focused care. ? Provider based systems and
networks of care (providers, human service
agencies, communities and individuals working
together).
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Learning from NCs Transformation Portfolio
? Rural, urban and suburban models are required
(equitable and fair across settings and
communities). ? A focus on population health
improvement. ? Care systems and models driven by
quality of care, patient safety and
performance. ? Evidence-based practice and
design. ? Primary care medical homes. ? Public/pri
vate partnerships are vital. ? Transparency
stimulates improvement. ? Attention to reliable
process design leads to improved outcomes of care.
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Learning from NCs Transformation Portfolio
? Front-line staff needs to lead the improvement
efforts with support from management. ? Engagement
of senior leadership is the key to sustained
success. ? A fair and just safety culture that is
foundational to sustained, hardwired safety and
improvement processes. ? All stakeholders give
input on design, needs, what works and what does
not work. ? Networking opportunities and sharing
best practices increases the motivation to
improve. ? Success should be celebrated.
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The Economics of Healthcare Reform
A billion here, a billion there and pretty soon
you are talking real money. Senator Everett
Dirksen
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US Total Health Expenditures
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US Per Capita Health Expenditures
7,421 Annually
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NC Per Capita Health Expenditures
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US Total Health Expenditures As a Percent of
Gross Domestic Product
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Annual US Expenditures by Type (in billions)
Hospitals 697B Physician Services
479B Pharmaceutical 228B
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Annual NC Expenditures by Type (in billions)
Hospitals 16.6B Physician Services
10.2B Pharmaceutical 7.4B
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Number of US Uninsured (In Millions)
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Number of NC Uninsured (in millions)
Nearly 2 Million
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National Healthcare Reform Resources
? AHA Resources Health Reform Update and
Advocacy http//www.aha.org/aha/advocacy/health-r
eform.html Health for Life http//www.aha.org/a
ha_app/issues/Health-for-life/index.jsp
? American Medical Association
http//www.ama-assn.org/ama/pub/legislation-advo
cacy/current-topics-advocacy/health-system-
reform.html ? Mayo Clinic Health Policy Center
http//www.mayoclinic.org/healthpolicycenter/rec
ommendations.html ? Theda Care Center for
Healthcare Value http//www.createhealthcarevalu
e.com
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National Healthcare Reform Resources
? American Medical Group Association http//www.am
ga.org/Advocacy/hrp.pdf ? Medical Group
Management Association http//www.mgma.com/polic
y/default.aspx?id28690 ? Commonwealth Fund A
Roadmap to Health Insurance For
All http//www.commonwealthfund.org/Content/Publi
cations/Fund-Reports/2007/Oct/A-Roadmap-to-Health-
Insurance-for-All--Principles-for-Reform.aspx
Commission on a High Performance Healthy System
http//www.commonwealthfund.org/Content/Publicati
ons/Fund-Reports/2009/Feb/The-Path-to-a-High-Perfo
rmance-US-Health-System.aspx
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National Healthcare Reform Resources
? Business Roundtable http//www.businessroundtabl
e.org/ ? National Business Group on
Health http//www.businessgrouphealth.org/benefits
topics/et_healthcare reform.cfm ? Americas Health
Insurance Plans http//www.americanhealthsolution
.org ? NC Blue Cross Blue Shield
http//www.nchealthreform.com
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Understanding Healthcare Reform
? The Kaiser Family Foundation http//healthrefor
m.kff.org ? Commonwealth Fund http//www.commonwe
althfund.org/Health-Reform.aspx ? National Rural
Health Association http//www.ruralhealthweb.org/
go/left/policy-and-advocacy/health-reform ? Health
Affairs/RWJF Health Policy Brief
Series http//www.rwjf.org/healthreform