pittsburgh nonprofit summit - health care & health care reform - implications for nonprofits and...
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Health Care & Health Care ReformImplications for Nonprofits & the People They Serve
10:00am – 11:15amFacilitator: Candi Castleberry-Singleton, UPMC
Speakers: Karen Feinstein, Jewish Healthcare Foundation / Dr. Donald Fischer, Highmark / Susan Rauscher, Catholic Charities
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• Text “Summit” to 57682 with your feedback and thoughts on today’s event!
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© Pittsburgh Regional Health Initiative 2011 3
Karen Wolk Feinstein,PhDPres ident & Chief Executi ve Offi cer
Pitt sburgh, PA M ay 1 2 , 2 0 1 1Spreading Quality,
Containing Costs.
Health Care and Health Care Reform – Implications for Non-profits and the People They Serve
2011 Nonprofit Summit
© Pittsburgh Regional Health Initiative 2011 4
Original Intent, What Might We Have Missed
© Pittsburgh Regional Health Initiative 2011 5
Where Value Derives
THE PATIENT
• Outcomes of Care
• Efficiency of Care
• Zero Defects
Value begins at the frontline
© Pittsburgh Regional Health Initiative 2011 6
Top 1% Top 5% Top 10% Top 15% Top 20% Top 50% Bottom 50%
0%
20%
40%
60%
80%
100%
22.9%
49.5%
65.2%74.6%
81.2%
97.0%
3.0%
Percent of Population, Ranked by Health Care Spending
Focus on Spending Leads to Complex PatientsP
erce
nt
of T
ota
l H
ealth
Car
e S
pend
ing
The 5% of the U.S. population with highest health care expenses was responsible for nearly half of total health care spending
Concentration of Health Care Spending in the U.S. Population, 2007
© Pittsburgh Regional Health Initiative 2011 7
Treating Chronic Illness Accounts for 75% of Expenditures
Major chronic in-terventional
34%
Chronic illness man-agement
35%
Major acute/ interven-tional23%
Minor acute8%
Preventive use only<1%
Percent of costs associated with medical needs
Source: Luft, Harold. Total Cure. Cambridge, 2008: Harvard University Press. pg. 66
© Pittsburgh Regional Health Initiative 2011 8
Currently: Where do the $$$ go? Hospital Care
Hospital Care31%
Physician and clinical services21%
Retail sales of prescription durges10%
Program administration and net cost of private insurance
7%
Investment in research, structures and equipment
7%
Nursing home care6%
Other professional serives and personal care
6%
Dental services4%
Government public health activi-ties3%
Home health care3%
Retail sales of durable medical equipment1%
% of Healthcare Spending, U.S., 2008
Source: Modern HealthcareJanuary 11, 2010, pg. 7
© Pittsburgh Regional Health Initiative 2011 9
The Complex Patient
Who is frequently hospitalized?
Do you know your customer?
Are you meeting their need?
© Pittsburgh Regional Health Initiative 2011 10
Let the Data Guide Work
The Complex Patient
HIV/AIDS End of Life
Skilled Nursing
Chronic Disease(COPD)
Behavioral Health and Substance Abuse
Multiple Conditions
© Pittsburgh Regional Health Initiative 2011 11
Why So Many Readmissions?
“Nobody integrates care for the medical condition as a whole and across the full cycle of care, including early detection, treatment, rehabilitation, and long-term management.”
- Michael E. Porter & Elizabeth Olmstead Teisberg, PhD
© Pittsburgh Regional Health Initiative 2011 12
The Second Systems Vision: Transforming the Care of Complex Patients
Acro
ss C
are
Setti
ngs
Essential Services System Requirements
Care Mgt
Clinical Pharmacy
Patient Engagement
Health IT
QI Training
Financial Incentives
Collaboration and
Integration
Medication Reconciliation
Informed Activated
Discerning Consumers
Data to Treat,
Measure, Evaluate
Perfect Patient
Care
RewardsFor Quality
Hospice/Palliative
Long Term Care
Rehab
Hospital
Emergency Services
Specialty Care
Primary Care
Screening and Tx
Behavioral Health
© Pittsburgh Regional Health Initiative 2011 13
Reducing Preventable Hospitalizations: Behavioral Health Comorbidities
Patients with co-morbid depression are more likely to be readmitted
% Readmitted with No Secondary
Depression
% Readmitted with Secondary Depression
Asthma 29% 42%
COPD 43% 51%
Pneumonia 34% 42%
All Other 29% 37%
Source: PRHI Analysis of PHC4 Data 2005-2006, SW PA
Patients with depression and co-morbid substance use disorders are more likely to be hospitalized for four days or longer
© Pittsburgh Regional Health Initiative 2011 14
Reducing Preventable Hospitalizations:PPC in Skilled Nursing Facilities (SNFs)
6% of seniors in SNFs = 17+% of healthcare costs
20% of hospital patients discharged to a SNF were readmitted
51% of residents have one or more ER visits
38% have a hospitalizations: 41% are readmitted
© Pittsburgh Regional Health Initiative 2011 15
PRHI Research on HIV-positive Patients
562 patients / 1,072 admissions (FFY 2007-2008)
One in four patients readmitted within 30 days
Nearly half of admissions have co-morbid depression and/or substance abuse, which can compromise self-care
High readmission rates may be attributed to flawed transitions in care — just like other chronic medical problems
Thank you from the Greater Pittsburgh Nonprofit
Partnership!
Workshop Evaluation
Text “HCR” to 57682 with your answers to the following questions:
• Please rate the overall value of this workshopE – Excellent G – Good P – Poor F – Fair
• Did you learn anything that you will apply at your own organization?Y – Yes N - No
• Please text other comments and feedback.
Submit by hitting “send!” You will receive an auto-reply from the GPNP.Sample text: “HCR E Y I’m beginning to understand the Health Care Act
more.”
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