david lewis
TRANSCRIPT
![Page 1: David lewis](https://reader036.vdocuments.mx/reader036/viewer/2022081506/557d34a2d8b42ac2788b475d/html5/thumbnails/1.jpg)
![Page 2: David lewis](https://reader036.vdocuments.mx/reader036/viewer/2022081506/557d34a2d8b42ac2788b475d/html5/thumbnails/2.jpg)
David C. Lewis, M.D.Professor Emeritus of Community Health
and MedicineDonald G. Millar Distinguished emeritus
Professor of Alcohol and Addiction Studies
Brown [email protected]
![Page 3: David lewis](https://reader036.vdocuments.mx/reader036/viewer/2022081506/557d34a2d8b42ac2788b475d/html5/thumbnails/3.jpg)
IndividualismIndividualism
FederalismFederalism
PluralismPluralism
IncrementalismIncrementalism
American Political American Political CharacterCharacter
![Page 4: David lewis](https://reader036.vdocuments.mx/reader036/viewer/2022081506/557d34a2d8b42ac2788b475d/html5/thumbnails/4.jpg)
The ProblemThe Problem
“ “The American health care system is the The American health care system is the poster child for underachievement…The poster child for underachievement…The largest limiting factor is not lack of money, largest limiting factor is not lack of money, technology, information, or even people technology, information, or even people but rather a lack of an organizing principle but rather a lack of an organizing principle that can link money, people, technology, that can link money, people, technology, and ideas into a system that delivers more and ideas into a system that delivers more cost-effective care (in other words, more cost-effective care (in other words, more value) than current arrangements.” value) than current arrangements.”
Source: Stephen M. Shortell and Julie Schmittdiel, in Source: Stephen M. Shortell and Julie Schmittdiel, in Toward a Toward a 2121stst Century Health System Century Health System, edited by Alain C. Enthoven an , edited by Alain C. Enthoven an dLaura Tollen, 2004.dLaura Tollen, 2004.
![Page 5: David lewis](https://reader036.vdocuments.mx/reader036/viewer/2022081506/557d34a2d8b42ac2788b475d/html5/thumbnails/5.jpg)
HealthcaHealthcare re ReformReform
![Page 6: David lewis](https://reader036.vdocuments.mx/reader036/viewer/2022081506/557d34a2d8b42ac2788b475d/html5/thumbnails/6.jpg)
Reform is Reform is NecessaryNecessary47 million are uninsured47 million are uninsured50 million are underinsured50 million are underinsured79 million struggle with medical debt79 million struggle with medical debtLack of coordinated careLack of coordinated careHigh cost, low value for the dollarHigh cost, low value for the dollarInconsistent qualityInconsistent qualityInefficient use of resourcesInefficient use of resourcesCare is not patient-centeredCare is not patient-centeredProfessional judgment challengedProfessional judgment challenged
![Page 7: David lewis](https://reader036.vdocuments.mx/reader036/viewer/2022081506/557d34a2d8b42ac2788b475d/html5/thumbnails/7.jpg)
![Page 8: David lewis](https://reader036.vdocuments.mx/reader036/viewer/2022081506/557d34a2d8b42ac2788b475d/html5/thumbnails/8.jpg)
BIGGEST COSTSBIGGEST COSTS
HOSPITAL READMISSIONSHOSPITAL READMISSIONS
SPECIALIST SERVICES SPECIALIST SERVICES
![Page 9: David lewis](https://reader036.vdocuments.mx/reader036/viewer/2022081506/557d34a2d8b42ac2788b475d/html5/thumbnails/9.jpg)
Patient-Centered Patient-Centered Medical HomeMedical Home
Personal physicianPersonal physicianWhole Person OrientationWhole Person OrientationPhysician Directed Medical PracticePhysician Directed Medical PracticeCare is Coordinated and/or IntegratedCare is Coordinated and/or IntegratedQuality and SafetyQuality and SafetyEnhanced AccessEnhanced AccessPayment ReformPayment Reform
![Page 10: David lewis](https://reader036.vdocuments.mx/reader036/viewer/2022081506/557d34a2d8b42ac2788b475d/html5/thumbnails/10.jpg)
INSURANCE REFORM INSURANCE REFORM WILL BE INFLUENCED WILL BE INFLUENCED
BYBY
STATE BASED DECISIONS ABOUT DESIGN OF STATE BASED DECISIONS ABOUT DESIGN OF EXCHANGESEXCHANGES
VIABILITY OF EMPLOYER BASED COVERAGEVIABILITY OF EMPLOYER BASED COVERAGE
COMPARATIVE EFFECTIVENESS RESEARCHCOMPARATIVE EFFECTIVENESS RESEARCH
![Page 11: David lewis](https://reader036.vdocuments.mx/reader036/viewer/2022081506/557d34a2d8b42ac2788b475d/html5/thumbnails/11.jpg)
Ensure that governing boards Ensure that governing boards and other advisory bodies and other advisory bodies tasked with developing and tasked with developing and administering the Exchanges administering the Exchanges include individuals with include individuals with expertise regarding the expertise regarding the unique needs of individuals unique needs of individuals with mental health and/or with mental health and/or substance use disorders. substance use disorders.
![Page 12: David lewis](https://reader036.vdocuments.mx/reader036/viewer/2022081506/557d34a2d8b42ac2788b475d/html5/thumbnails/12.jpg)
Recognize and enforce the Recognize and enforce the essential health benefits essential health benefits requirements of the Exchanges. requirements of the Exchanges. This includes the requirement This includes the requirement that comprehensive mental that comprehensive mental health and substance use health and substance use disorder benefits, at parity with disorder benefits, at parity with medical/surgical benefits, be medical/surgical benefits, be covered by all plans covered by all plans participating in the Exchanges. participating in the Exchanges.
![Page 13: David lewis](https://reader036.vdocuments.mx/reader036/viewer/2022081506/557d34a2d8b42ac2788b475d/html5/thumbnails/13.jpg)
Ensure a strong outreach and Ensure a strong outreach and education component, targeted to the education component, targeted to the public, eligible employers, and service public, eligible employers, and service providers to ensure sufficient access to providers to ensure sufficient access to coverage and benefits. coverage and benefits.
![Page 14: David lewis](https://reader036.vdocuments.mx/reader036/viewer/2022081506/557d34a2d8b42ac2788b475d/html5/thumbnails/14.jpg)
Determinations about Determinations about who needs what services, who needs what services, levels of care, and lengths levels of care, and lengths of stay must be made by of stay must be made by professionals treating the professionals treating the patient, and medical patient, and medical management tools cannot management tools cannot be used inappropriately be used inappropriately to deny needed care. to deny needed care.
![Page 15: David lewis](https://reader036.vdocuments.mx/reader036/viewer/2022081506/557d34a2d8b42ac2788b475d/html5/thumbnails/15.jpg)