TRANSFORMING HEALTHCARE: Opportunities for the Wisconsin Healthcare Workforce

Transcription

1 Objectives: TRANSFORMING HEALTHCARE: Opportunities for the Wisconsin Healthcare Workforce June 5, Impact of technology on change need 2. Impact of medical discovery on change need 3. Impact of government payment programs on change need 4. Impact of population health affordable care on change need Medical Discovery Leading to Workforce Transition We have a long history of transformation transition. Initial bar quite low. Discovery produces: 1. New diagnostic testing analytic laboratory, genetics, germline somatic mutations 2. New equipment radiology (CT, MRI, 3D Mammography) 3. New therapies robotic technology, pharmaceutical options 4. Workforce requirements Technical Environmental Discoveries Understanding the realization that cautery = a means to sterilize The development of the wheel made work travel feasible 1. Increased ability to be mobile 2. Accomplish greater work 1

2 Some of the greatest wonders of the world 1. No computers, sophisticated analytics 2. People translated ideas results 3. With technology changes, faster pace Medical Discoveries Sterilization surgical success Clean water cholera-diarrheal illness Vaccination elimination of polio, small pox Antibiotics penicillin community acquired pneumonia DNA germline, inherited diseases (cancer, cardiac bleeding) Mechanization standardize products, processes Medications diabetes, cholesterol, cancer, hypertension, anticoagulation, precision medicine Government Payment Programs 1. Medicare/Medicaid programs linked in Largest payer in healthcare industry 3. As payer-demands on payment - Documentation clinical documentation - Care delivery MIPS, MACRA - Quality - Cost control value based care Status of Health Care Significant cost 17% GDP 2. Outcomes less favorable that countries with government funded health care 3. Many individuals without payment systems 4. Emergency Department source of care Success with Population Health Population Health Reduce unnecessary futile care 1. (16-30% of spend) 2. Focus health, wellness, prevention 3. Manage disease through continuum of care 4. Avoid never events Re-admissions Never events (infections) Wrong site surgery Population health is defined as the health outcomes of individuals, including the distribution of such outcomes within the group. These groups are often geographic populations such as nations or communities, but can also be other groups such as employees, ethnic groups, disabled persons, prisoners, or any other defined group. The right hand side of the figure indicates that there are many health determinates or factors, such as medical care systems, individual behavior, genetics, the social environment, and the physical environment. Each of these determinants have a biological impact on individual and population health outcomes. 2

3 Population Health Accountable Care Act 1. Design-deliver health care differently 2. Accountable care organization (partnerships) 3. Value based contracts (no longer fee for service, fee for value) 4. Forced health care to redesign delivery system 5. Increase patient responsibility, co-pays, deductible Transitions in Health Care Acute Care Settings Hospitals transition from center of health care - site of chronic care management. 1. Need fewer beds 2. Reduced financial margins 3. Reduced staff needs 4. Rationalization of services - What needs 24/7 coverage - Provider networks - Critical case number to be competent Transitions in Health Care Ambulatory Settings 1. Urgent care minute clinics (access) 2. Surgical outpatient centers 3. Radiology services (free standing) 4. Reduces cost no facility fee 5. Patient convenience Providers Transitions in Health Care 1. Independent physicians multispecialty groups employed (hospital) 2. Physician shortage - increased allied providers CRNA, ACP, PAs, etc. 3. Team based approach to care (medical homes) 4. Payment based on value (cost / cost + outcomes) IT, Data Analytics Transitions in Health Care Care Transitions in Health 1. Electronic health records 2. Data explosion - clinical - billing 3. Quality metrics (process, outcomes) 4. Data analytics to steer change to value based - Care processes (patient flow) - Care FTE s (metrics for staffing) - Measurements (quality data, patient tracking) OPPORTUNITIES Risk for all aspects of care delivery 1. Traditional roles change 2. Sites of care cost convenience 3. Health care seekers / consumers 4. Great pressure on financial margins 3

4 Patient Care Models 1. Team based care hospitals 2. Physician lead 3. Nurse lead 4. Pharmacy lead 5. Informatics lead acute care, pharmacy, disposition planning, patient tracker 6. CDI, care management Patient Care Models Outpatient Setting Medical home model certification 1. Physician leader 2. Nurse lead 3. Pharmacy lead 4. Informatics lead chronic care, pharmacy, follow care planning 5. Nurse navigator Patient Care Medicare CMS Alternative Payment Models Care Bundles 1. Global reimbursement - Vascular procedures (cath, pacemakers) - Valve replacement, CABG - Joint replacement bundles - Oncology episodes of cancer care, six month blocks with fixed payments 2. Payment models force - Lowest cost work team - Lowest cost for place of care (outpatient) - Data gathering/analytics safety, cost, quality Jack Ma, past CEO, Alibaba Group: 15 years ago, I said the internet would have a significant impact on healthcare. Nobody listened. I was a nobody. (net worth $43.6B) Health Care Transitions in 1. Next big breakthrough technology, pharmacy, discovery 2. With current knowledge can only improve incrementally FTE efficiency 3. Informatics decision support, patient flow across care continuum 4. One payer system reduce back office costs 15-20% Technology 1. Robot today s version will be Model T in 15 years 2. X-Ray MRI Molecular Diagnostic heart, cancer 3. CABG replaced with endovascular procedures 4. Joint replacement cartilage stem cell 4

5 Pharmacy 1. Precision medicine target therapies for cancer, screening, therapy 2. Cardiovascular cholesterol blocking drugs, decrease CAD 3. Diabetes islet cell stem cell transplants 4. Viral targeted therapies for malignancy 5. Vaccinations for prevention infection, cancer Information technology data analytics 1. Patient portals information education, results 2. Chronic care home monitoring 3. Providers patients for visits 4. Analytics lead care team not providers 5. OV ipad, iphone, telehealth 6. Allied health to be personal touch Job Qualifications for the Future: 1. Expert at one component of health care 2. Acquire multiple areas of experience in health care; finance, informatics, HR, advocacy, community health 3. Several jobs in your career continuum to accumulate this experience. 4. Develop ability to retain human touch 5. Quality taken for granted Qualities of Servant Leadership 1. Prudence consults past and current wisdom 2. Justice treats others fairly 3. Courage speaks the truth in love does not shy away from tough decisions 4. Temperance intentional about self-restraint 5. Humility Accepts feedback and learns from every situation 6. Solidarity takes time to understand be one with others 7. Faith dare to dream behold 8. Hope convinced of greater goodness 9. Love act visibly with compassion Transitions in Health Care Nursing Opportunities 1. Education teaching next generation of health care workforce 2. Discovery genetics unlock pharmacy, treatment, screening options 3. Informatics operational efficiency, reduce cost, variation in care delivery to improve quality 4. Technology develop tools to diagnose, treat current diseases at molecular level, develop tools in concert with genetics to screen those likely to develop chronic disease Change will occur by design or default. If you are not part of change, you are part of the problem. If you don t change, you are behind. 5