HIMSS Oregon Chapter Annual Conference

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• HIMSS Oregon Chapter Annual Conference
• The Flight of the Phoenix Emerging from the
  Ashes of National Healthcare Reform
• John Kitzhaber, M.D.

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AGING OF THE BABY BOOM GENERATION
78 million people 30 percent of U.S.
population Unfunded liability in Medicare 70
Trillion
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FEDERAL RESPONSE
700 billion bailout of Wall Street 730 billion
economic stimulus package Billions in loans to
Auto industry Budget Deficit 1.4
Trillion National Debt 12 Trillion How Much
is a Trillion?
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To resolve crisis need

• Agreed upon system objectives
• Accurate diagnosis of problem why current
  system is not achieving those objectives
• Clear description of the design elements
  necessary to achieve objectives

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ObjectivesHealth vs. Health Care

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System Objectives The Triple Aim (Institute for
Healthcare Improvement)

• Improve population health
• Reduce per capita cost
• Improve patient experience
• Outcome
• Safety
• Satisfaction

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Health Field ModelInfluence Factors on Health
Status
Environmental 5
Social 15
Human Biology 30
Medical Care 10
Lifestyle Behavior 40
Source McGinnis J.M., Williams-Russo, P.,
Knickman, J.R. (2002). Health Affairs, 21(2), 83
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Chronic Disease

• People with chronic diseases ? 70 HC
  spending
• Diabetes
• Coronary Artery Disease
• Congestive Heart Failure
• Asthma
• Mental health / chemical dependency
• George Halvorson Health Care Reform Now

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Distribution of Health Care Expenditures

• 1 of population ? 35 of HC spending
• 5 of population ? 60 of HC spending
• 10 of population ? 70 of HC spending
• George Halvorson Health Care Reform Now

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Managing Chronic Disease

• Preventable
• Progressive
• We know how to intervene to prevent
  complications.
• Requires
• Care team to coordinate care and share
  information
• Most important care giver is patient and family
• Well educated patients who can recognize early
  warning signs of a complication
• Rapid response

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Problems in the Delivery System

• Acute care infectious disease model
• Solo or small group practices working
  independently
• Lack of Data
• Most people with chronic conditions
• Interact with the care system only in crisis
• Get the appropriate care only 50 of the time

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Financial Incentives

• Financial incentives reward acute care
  interventions and discourage reorganization
  around chronic care management.
• 9,000 individual billing codes
• No code for a cure
• No billing code for prevention
• No billing code for health improvement
• These are not billable events
• George Halvorson Health Care Reform Now

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Transformational Change

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The New Delivery Model

• Revenue flows to risk bearing entities at the
  regional or local level each of which would bear
  economic risk and assume responsibility for the
  health of a defined population.
• A hospital with an affiliated physician group
• A large primary care group practice
• Visionary health plan
• New entity

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Creating a Health Community
Risk bearing entity must partner with other
organizations to create a Health
Community. Prevention, wellness and medical
care are integrated to create a true health
system.
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Defined Population

• Single point of contact
• Population-wide health education
• Regular, ongoing screening
• Effective management of chronic conditions

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Flexibility in use of public resources
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Capitated Payment

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The Second Curve Scenario B
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LEADERSHIP STARTS WITH US
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We are all faced with a series of great
opportunities brilliantly disguised as
insoluble problems.-- John W. Gardner