George Hernandez, PresidentCEO University Health System San Antonio, Texas

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George Hernandez, President/CEOUniversity Health
SystemSan Antonio, Texas November 7, 2008
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Texas Departmentof Insurance Report

• Texas Health Insurance Market Insuring the
  Uninsured
• Dianne Longley, Director Research and Analysis,
  Life, Health and Licensing, Texas Department of
  Insurance
• From Presentation to Senate Finance Committee
  August 19, 2008

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Texans Insurance Status - 2006
Source US Census Bureau, Current Population
Survey, 2007
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History of Uninsured Rates
Source US Census Bureau, Current Population
Survey
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Uninsured Rates by Age - 2006
Source US Census Bureau, March 2007 Current
Population Survey (Texas Sample)
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Uninsured Rates by Gender - 2006
Source US Census Bureau, March 2007 Current
Population Survey (Texas Sample)
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Uninsured Rates by Race/Ethnicity - 2006
Source US Census Bureau, March 2007 Current
Population Survey (Texas Sample)
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Federal Poverty Levels for 2007 and 2008
Source US Department of Health and Human Services
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Uninsured Ratesby Poverty Level - 2006
Source US Census Bureau, March 2007, Current
Population Survey (Texas Sample) Number for
which poverty status information is available
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Uninsured Childrenby Poverty Level - 2006
Source US Census Bureau, March 2007, Current
Population Survey (Texas Sample) Number for
which poverty status information is available
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Texas Uninsured Rates by Citizenship - 2006
Source US Census Bureau, March 2007 Current
Population Survey (Texas Sample)
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Uninsured Rates by Employment Status for Persons
Age 18 and Older - 2006
Source US Census Bureau, March 2007 Current
Population Survey (Texas Sample)
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Uninsured Rates for Adults by Company Size - 2006
Source US Census Bureau, March 2007 Current
Population Survey (Texas Sample)
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Summary Characteristics of the Uninsured

• Age 40.8 of young adults 18-24 and 37.3 of
  25-34 year olds are uninsured
• Ethnicity 58.8 of uninsured are Hispanic
• Income 71.6 of uninsured adults are under 250
  FPL
• Citizenship 73.6 of uninsured are US citizens
• Employment 68.3 of uninsured adults are
  employed 82 of uninsured live in families with
  at least one adult that works full-time
• 25.2 work at firms with 500 or more employees

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Consequences

• Poorer Health status
• Negatively affects educational attainment and
  work status
• Damage to community resources such as hospitals
  and emergency rooms
• Family disruptions including bankruptcies
• Higher health care costs borne by those who have
  insurance
• Rising tax burdens and less attractive business
  environment

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Shared Responsibilities

• The Task Force concluded that solutions to the
  challenge of the uninsured must arise out of a
  shared responsibility to address the problem by a
  broad diversity of participants.
• Additional resources and the more efficient and
  effective use of resources are necessary to
  provide appropriate services to the uninsured.

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Findings

• Texas has not taken full advantage of available
  federal matching funds to reduce the burden of
  providing health care for the uninsured.
• The current county-based approach to delivery of
  health care in Texas is inadequate and
  inequitable.
• There is a significant shortage of health care
  professionals in Texasprofessionals that could
  reduce the cost of health care delivery to all
  Texans.

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Findings

• Care for people with mental illnesses and access
  to dental care remain major problems for Texas
• Providing health care to all Texans will require
  aggressively controlling health care costs
  through efforts such as disease management
  programs, the use of electronic health records,
  and experiments in cost-effective health care
  delivery

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Overall Conclusions

• The long-term economic vitality and security of
  Texas depends critically upon the health of all
  of its people so that they may learn and work
  successfully. This responsibility must be broadly
  shared by individuals, families, communities, and
  the public and private sectors
• The long-term economic vitality and security of
  Texas depends on the health of its children and
  their parents, who must learn and be prepared to
  join the workforce

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Code Red

• Recommendations
• 2008

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1. Access to Health Care

• Texas should adopt the principle that all
  individuals living in Texas should have access to
  adequate levels of health care
• -The strength and productivity of the Texas
  workforce and student population depends on the
  good health of all of its residents.

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2. Patient-Centered Health Homes

• All Texans, including the uninsured, should have
  access to individualized patient-centered health
  homes
• A patient-centered health home offers patients
  access to coordinated, comprehensive care
• Comment Through partnerships over 95 of
  CareLink members have a medical home/primary care
  physician

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3. Population Health

• Texas must increase its investment in the health
  of various populations in disease prevention and
  in public health programs at the state and local
  level
• Disease management based health homes must
  include preventative measures.
• School-based educational programs in health and
  local public health programs must also be
  strengthened.

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Bexar County Example

• UHS will integrate the following services
• prenatal care
• family planning
• well-child screenings
• senior health screenings
• refugee health services

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Benefits to the Community

• Seamless patient services across the continuum of
  care
• Prevention
• Primary care
• Specialty care
• Hospital Services
• More efficient and effective patient care
• Coordinated care among physicians
• Single electronic medical record

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4. Federal Funds

• Texas should continue its efforts to obtain
  additional federal funds in support of health
  care and prevention
• 1115 waiver Three share programs
• Medicaid for the medically needy
• Insurance coverage must provide a meaningful
  basic benefits package for Medicaid recipients.

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5. Increase Ambulatory Care and Disease
Management

• Increase community-based ambulatory care,
  disease management and forms of health care
  delivery that improve the quality of patient care
  while decreasing its cost.

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(UHS Case Management Example)
5. Increase Ambulatory Care and Disease
Management
(n105) 2FTEs
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6. Availability of Health Insurance and Health
Benefit Plans

• The Task Force strongly encourages vigorous
  efforts by the public and private sectors to
  improve the availability and affordability of
  health coverage through small employers using
  health insurance or health benefit plans. This
  includes
• Authorizing the Texas Department of Insurance to
  conduct innovative pilot projects to expand
  access to health insurance or health benefit
  plans. Such projects should be approved by the
  Commissioner of Insurance and include appropriate
  methods of evaluation. The Commissioners
  approval is required, in part, so the pilot
  projects are appropriately focused and limited in
  scope.

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7. Educate Health Professionals

• Texas must continue to increase its investment in
  the education of health professionals who will
  provide a significant amount of care to the
  uninsured and underinsured, including
• 600 more medical residents per biennium over a
  10-year period.
• 2,000 more nursing students annually and 200
  additional nursing faculty.
• Additional general revenue for formula funding to
  increase nursing students and faculty.
• Increase the number of physicians annually
  graduating from its medical schools by 25 percent
  over the next decade.
• Increase the number of dentists annually
  graduating in Texas by 20 percent over the next
  10 years.

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8. Frew Settlement

• Aggressively support improving the health of
  children enrolled in Medicaid through the Frew
  Settlement.
• Implement sustainable strategic initiatives to
  develop integrated systems of care for children
  covered by Medicaid.
• A program should include the creation of
  patient-centered integrated and comprehensive
  health homes for children including medical,
  dental, behavioral health, substance abuse, and
  preventative services, with initiatives in mental
  health
• Provide for education loan repayment for primary
  care providers.

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9. Health Information Technology

• Develop and apply health information technology
  to allow for standardization, connectivity, and
  improved health provider/patient communication.
• KLAS 2007 CPOE Digest - CPOE in use in 6.8 of
  U.S. hospitals. Only 4 of U.S. hospitals are
  entering 50 of their orders in the system
• 2008 HIMSS IT Priorities
• Implement an EMR
• Reduce Medical Errors/Promote Patient Safety

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9. Health Information Technology

• EMR Advantages
• Allergy Checking
• Duplicate Checking
• Drug-Drug Interaction
• Radiology Contrast Dye Alert
• Document Completion Check
• Vaccine Alert
• Emergency Center Lab Alerts
• Pharmacy and Therapeutics Committee Alerts
• Restraint Alert

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Increased compliancefor ASA prescriptions
Sunrise Go-live
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10. Behavioral Health

• Texas should ensure that high-quality behavioral
  health (mental health and substance abuse)
  services are affordable and accessible
• -Integrate behavioral health services into the
  delivery of primary health care

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11. Cost-Effective Delivery Systems

• Support the development of health science
  research programs to study cost-effective health
  care delivery systems and other characteristics
  of a high-quality and efficient health care
  system.
• The programs should include the study of
• The availability and accessibility of public
  health services throughout the state.

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12. School Health

• Develop integrated approaches to health in
  schools, including emphasis on nutrition,
  exercise, dental health, and disease management
• Increase physical activity to 60 minutes a day
• Develop and implement cost-effective,
  school-based disease management programs for
  children with chronic illnesses
• Develop robust programs designed to prevent
  substance abuse, teenage pregnancy, and obesity

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Conclusion

• The economic vitality and security of Texas
  depends on the health of its population.
• The strength and productivity of its workforce
  and the capacity for educational attainment
  depends critically upon the health of workers and
  students.

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Conclusion

• Substantial progress will require
• the expansion of disease management programs,
• the use of electronic health records,
• investments in health education and prevention,
  and
• the implementation of new and innovative health
  care delivery models that can decrease health
  care costs.

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For More Information

• Task Force Website
• http//www.utsystem.edu/hea/taskforce/homepage.htm
  
• Report Website
• http//www.coderedtexas.org

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