are we really ready for health care reform?

Are we really ready for health care reform?

Joanne Disch, PhD, RN, FAANClinical Professor, University of Minnesota School of Nursing

UM School of Nursing

Just how much can happen in 10 years?(modified from P Brennan, 9/21/2007)

Just ask a kid– Wireless everywhere– Harry Potter– iPods & Palm Pilots– Purple M&Ms– Spinning– No air travel w/o

removing shoes– Facebook, MySpace &

iTunes– FOFL

Or look at health care– HPV vaccine– P4P– HIE, NHIN, RHIO, EHR– Vioxx– Diabesity– Medical tourism– A dinner plate that

knows what’s on it


Did you know?

In 2011, 1/3 of the workforce > 50 Watches are becoming obsolete Consumers are suing to avoid having to

see a physician 50% of boomers are using the web for

games, networking, matchmaking An 85 y.o. man was noted to have ‘died

unexpectedly’


Our world is becoming -

V-U-C-A (BoardSource, 12/06)


Objectives

Review trends in society and the health care environment

Explore indicators of the public’s appetite for change

Examine options being recommended for health care reform

Reflect on what we ourselves will need to do if health care reform is to occur


The problem

$2.2 trillion (2007 = slowest growth rate in

10 years) % of GNP = 16.2%

$7,421/person


The problem

Health Status Measure U.S. RankingInfant mortality 25Maternal mortality 22Life expectancy from birth/women 23 men 22Adults receiving recommended care 40Hosp adults receiving rec care 84Hosp-standardized mortality rates 101


Another way to think about it

Access

Affordability

Quality

Consistency and predictability


How did this happen?

Certain costs are growing exponentially and hard to rein in, e.g., pharmaceuticals

Expanded use – overuse? – of expensive therapies, e.g., MRIs

Our financing mechanisms reward expensive hospital-based, physician-dependent, acute care

Chronic disease is on the rise We are America !


Toto, we’re definitely not in Kansas anymore…

Age– In 1950, 16 million people >65 (8%)– Today, 36 million (13%)– By 2050, 20% will be >65– Those >85 are the fastest growing; by 2050, they

will comprise 5% Diversity

– In 2025, 37% of US population = minority – Today, 1 in 5 people speak a foreign language at

home (many are ‘linguistically isolated’)– St. Paul School system – 50+ languages spoken


Chronic illness– Almost half of Americans have one or more

chronic disease or condition– Whites and women reported having more

chronic diseases– Average person with 1 condition sees 4

physicians a year– Those with 5 or more conditions see 14

physicians a year


Chronic disease

AGE % with 1 or > % with 3 or >

All ages 44% 13%

45-64 yrs 63% 22%

65-79 yrs 87% 45%

80 + 89% 54%


Caring for an Aging America

(The Commonwealth Fund, 2007)

At 65, Americans can expect to live to 87 80% of boomers report they’ll be working at

least part time, and this group wants to be engaged in health care decisions

WSJ: 44.4 million adult caregivers (21% of the adult population) – average = 21 hrs/wk

Women face particular challenges as they age


The Boomers

Factors in deciding to work (2006)– 87% - stay mentally active– 85% - stay physically active– 77% - be productive or useful– 71% - do something fun– 68% - need health benefits


Changing assumptions about aging

People will expect to live to a very old age Breakthroughs in science will change thoughts

about old and very old Illness is sometimes a surprise Consumers will have knowledge but less

wisdom Caregiving will not be place or time bound Diversity of cultures and experiences will

force change and create new opportunities Aging happens to all of us, and can be good


Rethinking our words

Retirement Work Seniors Volunteers The second 50 The third act Younger-old; older-old


“Old age is 15 years older than I am”(Oliver Wendell Holmes)


What do these have in common?

The Mall of America Cub Foods Minneapolis/St. Paul airport A gas station


e-communication

Comment Yes No

Patients should have access to their own EHR

91% 9%

The benefits of an EHR outweigh privacy risks

60% 40%

Patients should be able to e-mail their doctors w/o extra charge

75% 25%

Doctors should be paid for their time e-mailing patients

43% 57%


Growth in adult day centers

In 1974 ~ 18 centers

Today ~ 3500 centers, serving more than 150,000 daily

Reasonable cost– National daily average = $61– Range $21 (Alabama) to $130 (Vermont)


Key factors

Human connection Choice

– 89% of people >50 want to stay in their own homes or communities as they age

Respite for ‘informal’ caregivers– Family, friends, others

Enables people to age with dignity and purpose


The changing face of the American public:- more diverse- living longer

- electronically dependent - ‘families’ are more dispersed - expect to be more engaged in choices

about their care and care providers


Consumers are speaking up -

I want convenience – I want choice I want a relationship with my caregiver I want reasonable costs


The current health care system

Costly Inconsistent Uncoordinated Impersonal Payment systems skewed toward treatment of disease

rather than health promotion and disease prevention System still based on physician as hub of wheel Specialists earn much more than primary care

providers 80% of expenses to treat 20% Disproportionately large costs at end of life (futility)


What’s being done?

Increasing cost sharing w/ consumers– Multitier pharmacy plans– A shift from copayments to coinsurance– Increased deductibles– Combining deductibles with copayments– Smaller provider networks forcing consumers to

seek out-of-network care Spending with age; higher for women, whites

and non-Hispanics Drugs the costliest type of exp for all groups


Important questions

What would be the cost to insure– Some Americans? All Americans? Declared aliens? Undeclared aliens?

What services should be covered? Who should pay? Where does the money come from?


Policy considerations -

Revised insurance approaches Nationalized health care system Universal coverage Single-payer health care system


BUT . . .

We’re fixing the wrong problem . . .

We need to change the focus of our health care investment toward health promotion, chronic disease prevention – and a care delivery system that acts like a system


What could it look like?

Lifespan planning with emphasis on financial and health optimization

Managing chronic illness in the home Bringing health education into the

home or community Establishing caregiver networks Using technology to stay connected

and stay healthy


Examples of programs

Evercare Minute-clinic Block Nurse Program Nurse-Family Partnership Program Enhancing Care Coordination Project Minnesota Visiting Nurses Association


Evercare-

NP or care manager (CM) at the center of an integrated care team - coordinate services; facilitate communication among physicians, institutions, patients and their families;

Reduced hospitalizations for nursing home residents by 45%, and ER trips by 50%.

High satisfaction: 91% of enrollees Saved Texas ~ $123 million in Harris County

alone in 2 yrs


The Harambee Nursing Center

"Harambee" is an African tribal term: "a community coming together to better society.“

A community-based, nurse-led center offering health care - accessible, acceptable and affordable.

Reduced hospitalizations 25% Reduced cost of primary care 50%


Hospital at Home Geriatric Evaluation and Management Nurses Improving Care for

Healthsystem Elders Acute Care for Elders Transitional Care Program


Other ideas -

Increased use of ambulatory services, hospice (22% up vs. 9% down)

The Boston Community Co-op Sally’s idea Workplace changes


Workplace

Healthy snacks in machines (40%/50%) Discount/waived fee for gym Nutritional info in the cafeteria Health risk assessment Smoking cessation program (21%/70%) Health coaching On-site exercise facilities Weight loss programs (19%/54%) Bicycle-to-work programs Classes in nutrition (14%/44%)


Are you ready?

Participate in exercise (programs) Eat a healthy diet Stop smoking Drink moderate amounts of alcohol Get enough rest Establish relationships and networks Manage stress Engage in religious/spiritual activities Wear seat belts – drive safely Take drugs as prescribed Give back to your community


From communities

Revise community planning approaches – encourage more sidewalks, playing options

Change school programs to include healthy foods, exercise

Change zoning laws to allow for mixed communities

EX: The Netherlands


The Divided We Fail Platform

We believe that the opportunity to have access to health care and long-term financial security is a basic need that all Americans share. We believe it is the foundation for future generations.

We believe all Americans should have access to affordable, quality health care

We believe all Americans should have peace of mind about their future long-term financial security


Our partners

The Business Roundtable SEIU Millions of Americans The full AARP army


In MN: Health Care Home

Medical care home – “a physician-directed practice that provides care that is ‘accessible, continuous, comprehensive and coordinated and delivered in the context of family and community”

MN: first state to incorporate the concept of ‘health care home’ and ‘health care provider’ into state statute


At the SON

800 students in the school Innovative new educational programs to

increase the number of nurses, advanced practice nurses and leaders– Family care– Care for adult and older individuals– Integrative health– Generative leadership– Informatics


Ambulatory care services for women Research on ways to improve health care for

children, families, adults– Eating habits of young children– Asthma care– Preventing the need for amputation for people

with diabetes, peripheral vascular disease– Mental health use in Latina adolescents– Maintaining brain functioning in people with

Alzheimer’s, dementia


. . . also

Partnership with industry leaders (e.g., Target, VA) to improve care in communities

Working with the State Commissioner of Health and other legislators to develop new health care approaches, including health care homes


Trends are like horses – they’re easier to ride in thedirection they’re already going…


The public is demanding change The current model of health care is

unsustainable – and is it really health care? And is it really a system?

Health care reform is a priority for the new administration

Health care reform will occur– But let’s make sure we fix the right problem

!!


What will it take?

Innovative ideas An emphasis on optimizing health and

managing chronic disease A culture change that includes all health care

clinicians – and consumers as partners A new way of financing health care that

supports investing in health, wellness Partnerships among government,

organizations, communities and individuals A willingness to do things differently -


More on the topic:

The Risk Shift – Jacob Hacker

What We Can Do About The Health Care Crisis – Tom Daschle

A Whole New Mind – Daniel Pink

are we really ready for health care reform?

Documents

paul school system

health care environment

health care decisionswsj

health care reformreflect

recommended care

rec care

health carehpv vaccinep4phie

maternal mortality