a balanced portfolio perspective for investing in population health david kindig md, phd colorado...
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A BALANCED PORTFOLIO PERSPECTIVE FOR
INVESTING IN POPULATION HEALTH
David Kindig MD, PhDColorado Hot Issues in Health Care
November 12-13, 2004
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COLORADO HEALTH 2004United Health Foundation
Rankings• Overall State Rank
13 (9th in 2003)• Total Outcomes
6 (total mortality 10th, infant mortality 16th)
• Total Risk Factors (Determinants) 14
(smoking 6th, obesity 1st, health insurance 36th, high school graduation 30th, adequacy of prenatal care 48th)
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UNITED HEALTH 2004STATE RANKINGS
Because Colorado’s overall risk factors are lower (14th) than overall outcomes (6th)
“ the state’s relative healthiness may remain steady or decline in future years if the risk factors are not addressed”
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Trend of overall state rank in United Health Foundation’s State Health
Rankings
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PRESENTATION SUMMARY
1. Improving health requires a balanced investment in all the determinants of health.
MEDICAL CARE IS ONLY ONE
DETERMINANT OF HEALTH
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2. Within medical care, we need to identify the most cost-effective investments and “pay for performance”
3. New public and private partnerships are needed to build a balanced portfolio
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SocialEnvironme
nt
PhysicalEnvironme
nt
GeneticEndowment
IndividualResponse Behavior Biology Health
&Function
Well-Being Prosperity
Disease HealthCare
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EDUCATION AND HEALTH
Good education policy is good health policy
Years of schooling is one of the strongest predictors of improved health outcomes
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Mortality Rate and Years of Schooling
Less than 12 years
13+ years DIFF
1994 595 255 340
1999 585 219 364
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90 million American
adults may lack the
needed literacy skills
to effectively use the
U.S. health system
Total US Population (2002)
INSTITUTE OF MEDICINE 2004HEALTH LITERACY
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PAY FOR PERFORMANCE
2. Within medical care, we need to identify the most cost-effective investments and “pay for performance”
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COLORADO HEALTH EXPENDITURES PER CAPITA
(1998 CMS)
Massachusetts $4810 US Mean $3759 Colorado $3331 Utah $2731
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New York Times Says……
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THE NEW YORK TIMES NATIONALFRIDAY, JULY 11, 2003
Medicare to Pay Bonuses For Best of Hospital Care
By ROBERT PEAR with MARY WILLIAMS WALSH
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3. New public and private partnerships are needed to build a balanced portfolio
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Health Outcomes “Trust”
Medical
Care
Purchasers
(Public &
Private)
Other
Sector
Agents
IntegratedDeliverySystem
SchoolsSocial ServicesEnvironmentPublic Health
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CONCLUSION
A balanced scorecard is needed to guide a balanced health investment portfolio ...
so both market forces and government can be more effective and deliver value … the best health outcomes for the dollars invested in the multiple determinants of health