Change is Inevitable…Are we Ready?The Impact of National

Health Care ReformPresentation to:

20th Annual Education Session

Health Care Quality Institute

Marco Island, FL

June 27, 2014

Pause Listen Think Pray Go

Presentation Objectives• Discuss the impact national health care reform is having

on care delivery models, patient experience, and public health financing;

• Share strategies for addressing the rapid change and uncertainty health care; and

• Address the need to bring more value at a lower cost without jeopardizing quality.

ABOUT AHS

http://itvs.org/films/waiting-room

Our Mission

Caring, Healing, Teaching, Serving All

Excellence for All

Safety Net Provider

Alameda Health System

Integrated Regional Network

Our Vision

AHS is recognized as a world-class

patient and family centered system of care that promotes

wellness, eliminates disparities and

optimizes the health of our diverse communities

… 2012Assess and Plan

2013-2017Build, Adapt, Transform

2022…Sustain system & manage pop

H

E

W

FJ

Organizational Overview1864 Alameda County Infirmary opened on the Fairmont Campus

1927 Highland Hospital opened in Oakland

1960s Ambulatory health care services launched

1992 John George Psychiatric Pavilion opened

1990s Alameda County Medical Center (ACMC) was formed by merging Fairmont Hospital with Highland Hospital and John George Psychiatric

1998 Alameda County Hospital Authority was created

2012 Adopted 10 year Financial Plan and 5 year Strategic Plan

2013 ACMC renamed and rebranded to Alameda Health System (AHS) Expanded Ambulatory – Same Day Services; San Leandro Hospital acquired

2014 Alameda Hospital affiliation completed

Organizational Overview849 licensed beds, 4,545 employees, 1000+ MDs, 5 acute hospitals, 3 SNFs and 4 Wellness centers

Average Daily Census: 411; Discharges: 20,461, ED Visits: 146,932

OP Clinic Visits 312,465 ; Surgeries: 9,176; Births: 1,080; Operating budget: $805M

Emergency Medicine, General Surgery, Internal Medicine, Orthopedics, Oral Maxillofacial Surgery, Podiatry

Nurses, allied health professionals, pre-doctoral psychology interns

Nationally recognized public health system

Training tomorrow’s doctors (160/year)

Training students/providers

Market Presence

Alameda Hospital

Highland Hospital & Wellness Eastmont Wellness

John George Psych Hospital

Newark Wellness

San Leandro Hospital

Hayward Wellness

Fairmont Hospital

ChangeHard

InevitableUnavoidable

The nation is experiencing the most significant TRANSFORMATION of the health care delivery system since the launch of Medicare.

• Successful transformation is dependent on our ability to CHANGE.

HITEC PPACA PCMH ACO HBE VBP

2009 2010 2011 2012 2013 2014

Transformation

Patient Protection and Affordable Care Act

• Guaranteed Issue – Pre-existing condition clause

• Minimum health insurance standards

• Individual mandate• Health Insurance Exchange

• Federal Subsidies for individuals, families, and small employers

• Medicaid expansion• Medicare shift from FFS to

bundled payments• Employer mandate

January 1, 2014 Changes

Alameda Health System

ACCESS

Market competitive standard for access in the communities we serve that supports organizational growth

51

SUSTAINABILITY

Financial sustainability that supports growth and reinvestment to sustainour mission

2

INTEGRATION

Effective physician and hospital partnership that supports clinical integration leading to improved quality and experience for patients

3

EXPERIENCE

Patients feel valued, cared for and continue to choose us as their medical home/provider of care

4

NETWORK

Community engagement and external partnerships that align resources necessary for a sustainable clinically integrated network of care

5

WORKFORCE

Culture of excellence in the workforce that empowers staff to embrace and lead transformation to a high performance health system

6

Strategic Goals

2010 Federal Spending: $3.5T

                        Defense;

20%

Social Security; 20%

Medicare, Medicaid, CHIP; 21%

Safety-Net; 14%

National Debt; 6%

Employee Benefits; 7%Research; 2%Transport; 3% Education; 3% Other; 3%

Federal goal is to shrink that number year after year after year

14%

Patient Experience

National Health Care Reform• Accountable Care Organizations

• Medicare Innovation Projects

• Administrative Simplification

• Anti-Discrimination

• Provider Profiling

ChangeHard

InevitableUnavoidable

Implementing a Turn Around

Financial Focus

Board Alignment

Goal

Alignment

Build Excellence

Focus on Culture

Performance Improvement

1: Recognize MegaForces

• Demographic Shifts• Technology Changes• Workforce Shortages• Economy• Accountable Care• Payment Reform• Health Care Consumerism• ICD-10• Changing Regulations/Compliance

2: Prepare and Empower

3: Don’t Wait

4: Plan, Do, Check, Act

5: Influence Consumer Decision Making

The Consumer Decision Model

Access

Sustainability

Experience

Changing the Face of Health Care

Looking to the Future

The Four Agreements: Miguel Ruiz

Don’t make assumptions

Don’t take anything personally

Be impeccable with your word

Always do your best

Issues Before Us!COMPETITION

Clinical Integration

Medical Homes

Resid

ual U

nin

suredPopulation Mgmt

Legacy Costs

Pri

mar

y C

are

Acc

ess

Val

ue-

bas

ed p

urc

has

ing

FQHCs

Community MDsMediCal

Covered CA

LEANEHR

Technology Use

Safety Culture

Workforce SupplyAre We Ready?

THANK YOU!

Carladenise A. Edwards, Ph.D.CHIEF STRATEGY OFFICER