Health Care Reform: Innovation, Inclusion, & Outreach

Transcription

1 Health Care Reform: Innovation, Inclusion, & Outreach Cynthia M. Williams, MBA Health Sciences South Carolina Annual SC Public Health Administration Conference Myrtle Beach, South Carolina May 25, 2011

2 Health Care Reform Background The Patient Protection and Affordable Care Act (aka PPACA or ACA) was enacted March 23, The law legislates changes affecting all areas of health care. Insurance & Access Affordability & Subsidies Quality & Patient Safety Medicaid and CHIP Prescription Drugs Prevention & Disparities Taxes & Subsidies Medical Malpractice Workforce Supply & Development Fraud & Abuse Medicare Employer Requirements Long Term Care 2

3 Health Care Reform Background There are three overriding objectives of the law, Individual patient health improvement. Population health improvement. Patient/consumer and system cost reductions. 3

4 The Triple Aim Solution Patient Care Experience? Health of the Population Per Capita Costs Where is the sweet spot? 4

5 Additional Goals of ACA There are four additional goals of the health care reform law, Drive for collaboration within the health care provider community. Continue and accelerate the implementation of information technology into the health care process. Reduce minority and rural population disparities within the health care system. Educate the patient/consumer for better decision-making. 5

6 The Drive for Collaboration Provisions of the law fund innovations in the health care system for testing new models integrated and coordinated patient care. The two emerging care models are, Accountable Care Organizations (ACOs) Patient-Centered Medical Homes (PCMHs) 6

7 The Accountable Care Organization 7

8 The Types of ACOs 8

9 Patient-Centered Medical Homes Practice Organization Quality Measures Health Information Technology Patient Experience Family Medicine The physician is the lead care provider for the PCMH care delivery system. 9

10 It Takes a Village Primary Care Physician Nurse Pharmacist Dietician Physical Therapist Dentist Mental Health Professional Optometrist Nutritionist Wellness Coordinator With both ACOs and PCMHs, the central concept is a community of care providers encircling themselves around the patient and providing holistic, team-based care. 10

11 Patient Support From Womb-to-Grave The expectation of the ACO and PCMH models is that the patient will be provided coordinated and continuous care through all stages of life. 11

12 ACA Requirements of the New Models Beginning in 2013 and 2014, hospitals and care providers must show evidence of meaningful use and outcomes. The ones that do it well get financial bonuses. The ones who don t receive financial penalties. Two additional areas of concern are hospital readmissions and system fraud and abuse. 12

13 Will the new models help bend the cost curve? Source: World Health Organization data 13

14 Building SC s Network of Care Models 14

15 HSSC Health Care Transformation through Innovation Task Force Clemson University (College of Nursing, Systems Research, and Economics Depts.) Dept. of Health & Human Services Greenville Hospital System Univ. Med Ctr Medical University of South Carolina Palmetto Health Spartanburg Regional Healthcare System University of South Carolina (Medicine, Public Health and Business Schools, and College of Nursing ) AnMed Health Medical Center SELF Regional Healthcare McLeod Health ** (tentative) SC Hospital Association SC Primary Health Care Association SC Nurses Association Dept. of Insurance SC Office of Rural Health AARP SC SC Voices for Patient Safety SC Public Health Institute Blue Cross Blue Shield Haynsworth Sinkler Boyd, P.A. Lovelace Family Practice Lakelands Rural Health Network SC Fair Share disability Resource Center 15

16 The Implementation of Information Technology The introduction of IT into the health care system began with the American Recovery and Reconciliation Act (aka known as the Stimulus Act) Electronic health records is the centerpiece of this effort. The vision is for a national network of data sharing capability that follows the patient/consumer. 16

17 Electronic Health Records Source: Ars Technica, copyright

18 Examples of Technology Tools How familiar are YOU with these technologies? 18

19 Care Facilities of the Future Smart Materials Ergonomic Design Green and Antibacterial Technologies Computer and Video Conferencing Technologies 19

20 Other Areas of Innovation Technology developments are occurring in all facets of health care such as, Post-PC and Non-medical Devices Mobile Applications Data Management Services Business Intelligence Services Process Engineering Services The ultimate goal is to provide tools and information to better assist care providers so that focus remains on the patient and improving patient care. 20

21 Reduce Health Disparities Current health data across the US indicates that significant disparities in health, access, and care delivery exist for the following populations, Elderly Underinsured Underserved Minority Lower income working families Women Disabled If health care can be provided to everyone, especially those most in need, this may also help to bend the cost curve. 21

22 National Plan for Health Disparities Reduction The health care reform law has many provisions that fund research to help eliminate racial, ethnic, and underserved population health disparities. US Health and Human Services released a strategic plan regarding this issue on April 8, 2011 entitled The National Stakeholder Strategy for Achieving Health Equity. The plan also states actions that will be taken to, Transform health care and expand access for populations experiencing disparities. Build on the work already done to expand insurance coverage and care access. Increase opportunities for students from these populations to become health professionals. Train more health care professionals on better ways to serve these populations. Train community resources to better assist these populations in navigating the health care system. 22

23 The Strategic Plan s Five Goals The National Stakeholder Strategy For Achieving Health Equity has five goals. Public Awareness Community Leadership Health System Improvements Cultural and Linguistic Competency Data Collection, Evaluation, and Research 23

24 Clinical Trials and Disparities The health care reform law also focuses on addressing chronic disease issues in the minority and underserved communities. These communities are targeted due to their higher rate if disease incidents compared to other populations. Clinical trials are one area where many research institutions are working to seek out increased minority and underserved participation. 24

25 Educate the Patient/Consumer The current health care law allows for funding and research to be done in the area of mental and behavioral health to support patient compliance. The law also has also provisions funding patient education on a variety of related topics, such as nutrition, medication management, pre- and postpregnancy health, etc. Lack of public understanding of the objectives and components of the law has negatively impacted the trajectory of this goal. 25

26 Why doesn t the Public Get It? Campaign for Liberty, copyright

27 The Dialogue?... 27

28 National US Poll Results 28

29 SC Minority Outreach Efforts Only 16% of South Carolina minority individuals understand ACA. Efforts have started within SC and nationally to educate the minority and faith communities on ACA and upcoming health care changes. Educating health care leaders as part of each one, teach one concept Distributing information at health fairs and forums Outreach to targeted groups within these communities Crafting culturally competent messages that resonate with the public 29

30 Thank You! 30