Pre-medical Student Presentation 2009-05-13

Future Directions for the United States Health Care System Heidi Nelson Heartland Health Outreach

Heartland Health Outreach  Mission:

to improve the health of disadvantaged populations- individuals and communities without access to health carethrough the provision of culturally competent, multidisciplinary services designed to prevent illness and improve physical, mental and social well-being, and through advocacy that promotes the right to access comprehensive, integrated systems of care.

Target Populations  Homeless

persons  Low-income individuals with HIV disease  Immigrants and refugees

Services  Primary

care- medical and oral health  Mental health care  Treatment for torture survivors  Interpreting services  Training and technical assistance

What are you hearing and reading about health care reform?

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Challenges and Responses in Health Care Today  Reed

V. Tuckson, MD  Executive Vice President and Chief of Medical Affairs  UnitedHealth Group  March 27, 2009

Challenge: ‘escalating health care costs due to preventable disease’ Obama Administration, 5/12/09: Medicare Hospital Trust Fund to run out in 2017, two years earlier than last year’s report ‘We won’t get the cost of Medicare and Medicaid down unless we get down the cost of health care overall.’ -Kathleen Sebelius, US Secretary, HHS

Challenge: ‘people are making choices based on economics’ Kaiser Family Foundation April Health Tracking Poll: 59% of those polled say they or a family member have delayed or skipped care in the past year – – – –

Substituting for doctor visits (42%) Skipped dental care (36%) Did not fill a prescription (29%) Cut pills or skipped doses of medications (18%)

Challenge: Poor or suboptimal quality of care Regarding the Institute of Medicine Initiative, Crossing the Quality Chasm ‘The first phase of this Quality Initiative documented the serious and pervasive nature of the nation’s overall quality problem including that “the burden of harm conveyed by the collective impact of all our health care quality problems is staggering”’ Mark Chassin, Mt. Sinai School of Medicine,1999

Challenge: Fragmented Health Care System Institute of Medicine, ‘Crossing the Quality Chasm,’ 2001 America needs care based on continuing, healing relationships

Tuckson’s Solutions to Improving the Health Care System We have to:  Be more engaged than ever before  Have a shared vision  Focus on care coordination  Push for research on what works  Seek community and population prevention strategies  Challenge ourselves to improve quality

The Obama Administration What can we expect for health system change?

The American Recovery and Reinvestment Act of 2009  What

can we learn from the stimulus package about the Administration’s priorities?

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Health Care Elements of the ARRA  ‘Quality

Affordable Health Care’ (conference agreement) – – – – – –

Health information technology ($19 billion) Prevention and wellness ($1 billion) Health care effectiveness research ($1.1 billion) Community health centers ($2 billion) Training primary care providers ($500 million) Indian Health Service ($500 million) Heartland Alliance for Human Needs & Human Rights

A Few Details on Health IT  National – –

Coordinator’s Office in HHS

Promote interoperability Promotion of studies on HIT adoption

 Medicare

and Medicaid enhanced rates for ‘meaningful use’ of HIT  Promotion of electronic health record adoption through federal and regional TA centers  Academic curricula on HIT Heartland Alliance for Human Needs & Human Rights

Other health related aspects of ARRA  Increased

Medicaid federal participation rate to provide relief to states  Provided subsidies for individuals who lose their jobs to purchase COBRA

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ARRA themes that reveal the Administration’s policy focus  Prevention  Primary

Care  Health Information Technology  Comparative Effectiveness Research

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Health Reform? What’s the Plan?  Budget

plan approved in April by House and

Senate  Provided a pathway for health reform legislation  But, there’s no plan…yet

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Policy Themes in Health Reform  ‘Public – – –

Plan’

Like Federal Employee Health Benefits Program Individuals and Businesses could Purchase Who opposes?

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Policy Themes in Health Reform  Mandates – –

For individuals to cover themselves For businesses to cover their employees

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Policy Themes in Health Reform  Tax

credits

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Policy Themes in Health Reform  Taxing

health benefits

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Policy Themes in Health Reform  Coverage – – –

expansions

The very poor The near elderly Young adults

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Whither Single Payer?

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So, what are our prospects for health reform in 2009?

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What are our prospects? Joe Antos, American Enterprise Institute, May 12, 2009 ‘In many cases, these ideas [computerized records, care coordination, eliminating duplication] have been in play for 20 years… these represent no sacrifices. The real money is in delivery of services. Ideally we will eliminate the services we don’t need, but that’s the debate.’ Heartland Alliance for Human Needs & Human Rights

What are our prospects? Rick Scott, Conservatives for Patients’ Rights Former CEO, HCA -Let’s remind the politicians Americans know what works. Choice, competition, accountability and personal responsibility. Youtube: Conservatives for Patients’ Rights, The Four Pillars of Health Reform Heartland Alliance for Human Needs & Human Rights

What are our prospects? Richard Kirsch, Health Care for America Now -Rick Scott is a tainted messenger. His campaign is designed to protect health care profits. Youtube: Americans for Health Care Now, Insurance Company Rules

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What are our prospects? Kathleen Sibelius, May 12, 2009 -I give health reform in 2009 a 60-40 chance.’

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What do aspiring medical students need to know?  Comparative

Effectiveness Research is essential to reducing health care costs  Electronic Health Records have the potential to improve quality if done right  Quality of care includes reducing disparitiesfirst and foremost understand the patient’s environment and resources  Consider Health IT and Quality as career options Heartland Alliance for Human Needs & Human Rights