11/2/2016. Texas Medical Center. An Overview. Arthur (Tim) Garson, Jr., MD, MPH Director, Health Policy Institute Texas Medical Center
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1 11/2/2016 Texas Medical Center An Overview Arthur (Tim) Garson, Jr., MD, MPH Director, Health Policy Institute Texas Medical Center 1
2 11/2/2016 The Texas Medical Center (TMC) is the world s largest medical complex Today, TMC comprises 56 member institutions, including: 21 renowned hospitals 13 support organizations 8 academic and research institutions 6 nursing programs 3 public health organizations 3 medical schools 3 universities 2 pharmacy schools 1 dental school TMC embers 2
3 11/2/2016 TMC Facts & Figures The TMC receives 7.2 Million Visits Per Year, which is 106K 88K 76K 53K Those visitors are served by over 106,000 employees TMC Exxon Google (more than Exxon Apple or Google) Apple Patients are treated in one of Including: 7,000 beds if they were all stacked, they would measure 1.65 miles, or 7 Empire State Buildings 171,000 Annual Surgeries 25,000 Babies Delivered Annually Faculty 17,500 Nurses 15,000 Research ers 5,700 Physicians 5,000 Most heart surgeries in the world Strategic Plan Directives: 5 Institutes Health Policy Innovation Genomics Clinical Research Regenerative Medicine 3
4 Health Policy Institute 1. Become THE resource for health policy and analytics for Texas and a known trusted resource for the US 2. Use innovative programs to stimulate collaboration across the 56 member institutions 3. Support groundbreaking practical research to support health policy 4. Educate the next generation of health leaders in health policy as well as educate the public 5. Become an example for employers and use outcomes as a basis for evidencebased policy HEALTH POLICY INSTITUTE INITIATIVES 1. Improve health care access for Texans State and federal approaches 2. Collaborative grant program 21 Submissions; 4 awards with principal investigators from 4 different institutions; collaborators from 11 institutions 3. Seminar series Grantees and deans February 2016 Mark McClellan in May TMC O2 Obesity and Overweight 100% of 57 TMC participating Trevisio >20% of choices by customers yellow/green 5. TMC 72: Information for city & state government and TMC members 72hour turnaround or indepth analysis 6. Consumer Health Report survey 5 states Deep dive in quality, affordability, food labeling Imagine that a candidate for political office in your state agreed with your views on each of the following issues. How much would that contribute to your decision to vote for him or her? 4
5 11/2/2016 Innovation Institute: TMC X The TMC X provides a gateway to the facilities, resources and network of the world s largest medical center TMC X resources for startups include Unprecedented clinical access An allstar network of advisors Newly renovated office space From ideation to commercialization, we work closely with life science and digital health startups to transform scientific innovations into tangible tools that save lives, manage disease, and improve quality of life Translational Research Campus Baylor College of Medicine TMC3 Campus 5
6 NOVEMBER 9 THE AFFORDABLE TexasCare CARE ACT: PRINCIPLES FOR A BIPARTISAN FIX Arthur (Tim) Garson, Jr., MD, MPH Director Health Policy Institute HFMA, New Orleans November 2016 PROBLEMS and POTENTIAL FIXES 1. Specific ways to decrease cost are not sufficient 2. Pathways to improve quality are lacking 6
7 ESTIMATES OF ANNUAL HEALTH CARE WASTE (Berwick, 2012) Failures of care delivery Failures of care coordination Overtreatment Administrative complexity Pricing failures Fraud and abuse TOTAL $128 billion $35 billion $192 billion $248 billion $131 billion $177 billion $910 billion APPROACHES TO FIXING COST AND QUALITY 1. Pay practitioners in a way that does not increase unnecessary care a. Salary + bonus 2. Encourage integrated health systems a. Salary practitioners b. Promote Electronic Health Records c. Reduce unnecessary care d. Must include an Academic Health center 7
8 APPROACHES TO FIXING COST AND QUALITY 3. Review the 20 most commonly used services (e.g. MRI of brain) for evidence a. Permit use of costeffectiveness 4. Improve mechanisms to incent positive health behavior in patients a. Smoking, obesity b. Medication adherence 5. Improve management at the end of life a. Durable Power of Attorney 6. Examine delivery of chronic care zerobase home health agencies APPROACHES TO FIXING COST AND QUALITY 7. Enhance the use of Health Savings Accounts a. Permit employers to contribute up to deductible with taxfree dollars as long as service necessary 8. Understand which preventive measures should be applied to which patients, and when 9. Make efforts to have patients become prudent buyers 10. Create federal grants to states for innovation in cost and quality a. Demonstrations b. Tort reform 8
9 PROBLEMS and POTENTIAL FIXES 3. Health insurance still not affordable for a large number of Americans HOW TO MAKE THE AFFORDABLE CARE ACT AFFORDABLE In the Exchange Marketplace, at 200% of FPL (less than $12 per hour for a fulltime worker) Can purchase plan with deductible of $5,000 for about $1,400 a year. Maximum financial exposure $6,400 or $533/mo About 28 percent of income What is affordable? 200% FPL ($23,760); 5% ($100/mo) 400% FPL 10% ($47,520); 10% = $400/mo) The total out of pocket must be affordable 9
10 HOW TO MAKE THE AFFORDABLE CARE ACT AFFORDABLE Goal: more people in the exchanges 1. Change plans a. Catastrophic (+ prevention) b. Change rating for age. a. Currently, requires that the oldest (64 and older) is no more than 3x the youngest (21) a. If set the oldest at what is needed, the youngest is too expensive b. Suggestion is to make the rating 5x c. Change risk adjustment currently get bill 6 months after close Many insurers cannot afford the current losses 2. Reduce cost 3. Public option buy into Medicare (+??) 4. Increase subsidies 5. Increase the individual mandate IMPROVING ACCESS Right practitioner at the right time at the right place 1. More doctors and nurses Train more Later retirement PostMD graduates to underserved areas Loan prepayment 2. Pay salary 3. Task shifting a. Generalist physicians more specialty care b. Nurse practitioners c. Paraprofessionals: Community paramedics, GrandAides, community health workers d. Pharmacists e. Dental therapists 10
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