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CAN ForumMay 2016

Joint Peer Networking Committee

Overall Integration for Overall Health

Suzanne PfisterPresident and CEO

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Priorities

Health is created where we live, learn, work, and play.

People with health

coverage achieve better

well-being and health

than those who do not.

Insightful partners taking significant risks

to achieve improved understanding of health

in Arizona.

Dynamic and healthy communities are best supported by healthy organizations and leaders.

Access to CareHealthy Community Design

Capacity Building Innovations & Collaborations

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Your Workshop Objectives:Integration of healthcare services

for your members

• Primary Care physicians

• Oral Health

• Clinical Quality

• Case Management

• Behavioral Health

• Pharmacy

• Outreach and Enrollment

• Clinic Operations

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Major shifts in the “business” of healthcare

Two Trends Driving the Need for Better Integration

The push toward population management and “healthy communities”

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Disruptive Innovation

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• Hospitals partnering with insurers - narrow networks, owning insurers, and startup insurance companies (Dignity, Banner, Abrazo)

• Consumer oriented strategies – retail clinics, direct-to employer strategies, health apps

• Joint ventures – outpatient clinics, skilled nursing, long term care

• Care management – integrated networks, ACOs

Non-traditional Partnerships

Beckers’ Hospital Review – May 2016

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Growth of Retail Clinics• 1,800 retail clinics around the country.

• The median wait time for a commercially insured or Medicaid patient ranges from 5-8 days.

• The majority of retail clinics accepts all forms of insurance and and cash.

• 58 % of retail clinic visits were new users and not substitution for primary care or ED visits.

• Benefits: lower price, perceived convenience, accessibility.

March 2016 edition of Health Affairs

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• 20 million more insured

– 500,000 + in Arizona

• Value-based reimbursement and bundled payments

• Need for “vertical integration”

• Mergers and acquisitions

• Employers want to manage healthcare expenses: on-site clinics, nurse hotlines

Reasons Behind It

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• Full-service care

• Multiple services at one site

• Patients are coming to expect that convenience and accessibility

• Specialists along with primary care

• Social services along with healthcare

Where Do CHC’s Fit In?

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• Health is not just health care – 90% of our health is determined by factors outside of medicine

• In the US we focus too much on “sick care” and not disease prevention (less than 9% of expenditures)

What We Know….

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Gaps in Health Come from Many Factors

• Education and Income

• Unsafe or unhealthy housing

• Lack of healthy foods

• Lack of places to exercise or play

• Inequities

• Proximity to sources of pollution

• Access to health care

• Transportation challenges

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• Cities and counties are addressing health– Looking at land use policies to help people use alternative

transportation – Health considerations in city general plans

• Incorporating wellness and prevention in the workplace and social institutions

• Understanding how poverty and inequities can impact health– Finding ways to increase access to healthy foods

• Finding ways to add health into people’s daily lives– “hardwire” the healthy options

Addressing the Gaps

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Imagine a Healthy Community

6/23/2016

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• Community Ambassadors

• Playgrounds on clinic sites

• Providing fresh foods on-site

• Collaborations with external partners

Where Do CHC’s Fit In?

• Working with city/county officials to help with transportation and land use amenities

• Diversity Site Councils

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Reimagine

6/23/2016

To achieve further

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Final Thoughts

Connecting the dots in the intricate healthy community portrait is not a

quick or simple endeavor.

But take the opportunity to work together and make sure your own medical

solutions are integrated.

Then reach beyond the “sick care” solutions to achieve real HEALTH.

196/23/2016

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