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Healthcare Transformation: What’s good about U.S. Healthcare?

Date post: 23-Aug-2014
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In his first webinar of Section I, Dr. Haughom provided an overview of healthcare transformation. In this webinar—a part of Section I—Dr. Haughom will provide a deeper look at the forces that have defined and shaped the current state of U.S. healthcare. Paradoxically, some of these same forces are also driving the inevitable need for change. Attendees will find answers to the following questions: What are the historical trends that have created the best healthcare system the world has ever seen? How are these same trends making healthcare reform inevitable? What are the primary determinants of health and how will they influence future policies regarding healthcare expenditures? What is the Rule of Rescue and what are its implications for the future? How do U.S. health expenditures compare to other nations and what are the implications?
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© 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics John L. Haughom, MD February 2014 Healthcare: The Way It Should Be The New Era of Opportunity
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Page 1: Healthcare Transformation: What’s good about U.S. Healthcare?

© 2013 Health CatalystProprietary and Confidential

www.healthcatalyst.com

Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics

© 2013 Health CatalystProprietary and Confidential

www.healthcatalyst.com

Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics

John L. Haughom, MDFebruary 2014

Healthcare: The Way It Should BeThe New Era of Opportunity

Page 2: Healthcare Transformation: What’s good about U.S. Healthcare?

© 2013 Health CatalystProprietary and Confidential

www.healthcatalyst.com

Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics

Healthcare: The Way It Should Be

Section One – Forces Driving Transformation • Chapter One – Forces Defining and Shaping

the Current State of U.S. Healthcare • Chapter Two – Present and Future

Challenges Facing U.S. Healthcare

Section Two – Laying the Foundation for Improvement and Sustainable Change • What will it take to successfully ride the

transformational wave?

Section Three – Looking into the Future • What will it take to successfully ride the

transformational wave?

Page 3: Healthcare Transformation: What’s good about U.S. Healthcare?

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3

Poll Questions… 2. What is your role?

a. Clinicianb. Managementc. Quality improvementd. IT e. Consultant

1. How are you involved in healthcare?a. Integrated delivery

systemb. Hospitalc. Physician Group d. Other

Page 4: Healthcare Transformation: What’s good about U.S. Healthcare?

© 2013 Health CatalystProprietary and Confidential

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Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics

Some Pertinent History• For much of history, if you were ill

or injured and saw a physician, your chances of survival actually went down.

• Hospitals were where people went to die .

“If a physician make a large incision with the operating knife and cure it,… he shall receive ten shekels in money.

If a physician make a large incision with the operating knife, and kill him,…his hands shall be cut off.”

Code of Hammurabi, 1780 BC, Law 215 (of 280)

Page 5: Healthcare Transformation: What’s good about U.S. Healthcare?

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Leadership is a Verb or Process, Not a Noun…

Between ~1860 and 1915, a few visionary clinical leaders changed all that...

– New high standards for clinical education– Strict requirements for professional licensing– Clinical practice founded on scientific research– New internal organization for hospitals– Creation of new, more modern nurse practices– Implementation of more modern hygiene techniques– New public health policies and treatments

Sir William Osler

Florence Nightingale

Page 6: Healthcare Transformation: What’s good about U.S. Healthcare?

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1912: The ‘Great Divide’

“…for the first time in human history, a random patient with a random disease consulting a doctor chosen at random stands a better than 50/50 chance of benefiting from the encounter.”

– Harvard Professor Lawrence Henderson, MD

Harris, Richard. A Sacred Trust. New York, NY, New American Library. 1966

Page 7: Healthcare Transformation: What’s good about U.S. Healthcare?

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Current Health Care…

…is the best the world has ever seen...

Some examples:• From 1900 to 2010, average life expectancy at birth

increased from only 49 years to almost 80 years

• Since 1960, age-adjusted mortality from heart disease (the #1 cause of death) has decreased by 56 percent

• Since 1950, age-adjusted mortality from stroke has decreased by 70 percent

Page 8: Healthcare Transformation: What’s good about U.S. Healthcare?

© 2013 Health CatalystProprietary and Confidential

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Advancing Life Expectancy

Page 9: Healthcare Transformation: What’s good about U.S. Healthcare?

© 2013 Health CatalystProprietary and Confidential

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Some Important Points• Most American hospitals and caregivers provide safe

and effective care for the vast majority of patients, the vast majority of the time

• The vast majority of caregivers are well trained and conscientious

• Western medicine’s ability to save and extend life, and to improve the quality of life for the ill and injured is nothing short of miraculous

Page 10: Healthcare Transformation: What’s good about U.S. Healthcare?

© 2013 Health CatalystProprietary and Confidential

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Does This History Matter?

• All of this history is important, because it changes how we think about the present and the future.

• As health care increasingly contributes to the national debate, let’s debate in the context of the phenomenal progress we’ve made and the progress we’re capable of making.

• The day we engage the hearts and minds of clinicians will be the day that the issues facing healthcare are solved.

Page 11: Healthcare Transformation: What’s good about U.S. Healthcare?

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The Great Equation

Health = medical care…and medical care = “access to care”

“But the Great Equation is wrong…”

Wildavsky A. Doing Better and Feeling Worse: The Political Pathology of Health Policy. Daedelus 106(1); 105-123

Page 12: Healthcare Transformation: What’s good about U.S. Healthcare?

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Determinants of How Well We Live

Behavior: TobaccoEthanol Diet/Exercise patternEtc.

Genetics

Environment/public health

Health care delivery (hospitals & clinics)

~40%

~30%

~20%

~10%

McGinnis J, Williams-Russo P, Knickman JR. The Case for More Active Policy Attention to Health Promotion. Health Affairs, 2002; 21(2):78-93.

Page 13: Healthcare Transformation: What’s good about U.S. Healthcare?

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How This Impacts the Policy Debate• It is widely accepted that clinicians help patients

• Yet, clinicians have little or no control over 90 percent of factors that determine health

• Thus, it is unlikely more money for clinical care will advance health ‒ Policymakers believe we are spending enough on

healthcare delivery

Page 14: Healthcare Transformation: What’s good about U.S. Healthcare?

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U.S. Healthcare Spending

Page 15: Healthcare Transformation: What’s good about U.S. Healthcare?

© 2013 Health CatalystProprietary and Confidential

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U.S. Healthcare Spending

Page 16: Healthcare Transformation: What’s good about U.S. Healthcare?

© 2013 Health CatalystProprietary and Confidential

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Healthcare an Expected Benefit?

Since World War II, healthcare coverage has been an expected benefit for the

employed…

…and since the late 1960s, an expected benefit for the elderly…

…but will it remain so?

Page 17: Healthcare Transformation: What’s good about U.S. Healthcare?

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Health Insurance as an Employee Benefit… …Will It Continue?

Probably not…

…data from December 2013 shows that less than 51% of employers now offer

health insurance as a benefit…

…and the trend is down…

Page 18: Healthcare Transformation: What’s good about U.S. Healthcare?

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U.S. Healthcare Spending

Page 19: Healthcare Transformation: What’s good about U.S. Healthcare?

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U.S. Healthcare SpendingUS Spends two-and-a-half times the OECD average

Page 20: Healthcare Transformation: What’s good about U.S. Healthcare?

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The Reality…

We are spending more than we can afford on clinical care…

…we have promised more than we can deliver…

…we are not spending as much as we need on major determinants of health…

…something has to change…

Page 21: Healthcare Transformation: What’s good about U.S. Healthcare?

© 2013 Health CatalystProprietary and Confidential

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Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics

A Twofold Solution

The solution to this national dilemma is twofold:

1. First, we need to slow the rate of growth in spending on health care; and

2. Second, we have to spend what we devote to health care more effectively (i.e., generate more value)

…clinician-driven, data-driven quality improvement is the answer…

Page 22: Healthcare Transformation: What’s good about U.S. Healthcare?

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High Touch: Caring, not just curing

“A man stricken with disease today is assaulted by the same fears and finds himself searching for the same helping hand as his ancestors did five or ten thousand years ago. He has been told about the clever tools of modern medicine and somewhat vaguely, he expects that by-and-by he will profit from them, but in his hour of trial his desperate want is for someone who is personally committed to him, who has taken up his cause, and who is willing to go to the trouble for him.”

Szilagyl DE. In defense of the art of medicine. Archives of Surgery 1965; 91:925-30

Page 23: Healthcare Transformation: What’s good about U.S. Healthcare?

© 2013 Health CatalystProprietary and Confidential

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What do we get for all that money? 1. High touch – patients value their relationship with a

trusted clinical advisor more than any other element in healthcare delivery (the clinician-patient relationship)

2. Choice – Americans have grown used to maximal choice, to being insulated from the costs of care. • It is unlikely this will continue for everyone; at a minimum,

American society will need to define the limits.

3. Rapid response – the Rule of Rescue

Page 24: Healthcare Transformation: What’s good about U.S. Healthcare?

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The Rule of Rescue

“The imperative people feel to rescue identifiable individuals facing suffering or death”

– A.R. Jonsen

• Subconscious personal identification at an emotional level

• A person instead of just a number; a name and a face ‒ The child down the well ‒ The miners trapped in the mine‒ The whales trapped in ice‒ The dog on the abandoned boat

Jonsen AR. Bentham in a box: Technology assessment and health care allocation. Law Med Health Care. 1986;14(3-4):172–174

Page 25: Healthcare Transformation: What’s good about U.S. Healthcare?

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System Performance, by nation

20

15

10

5

0

20

15

10

5

0

United States Germany Sweden United Kingdom

8.2

14.3

16.5 17.1

6.5

8.19.4 9.2

Major trauma Heart attack

Mor

talit

y R

ate

(%)

Organization for Economic Cooperation and Development (OECD) data available at: http://www.oecd-ilibrary.org/sites/health_glance-2011-en/04/08/index.html?itemId=/content/chapter/health_glance-2011-36-en

Page 26: Healthcare Transformation: What’s good about U.S. Healthcare?

© 2013 Health CatalystProprietary and Confidential

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Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics

System Performance, by nation

20

15

10

5

0

20

15

10

5

0

12.2

16.4

21.122.4

Neonates < 1500 grams

Mor

talit

y R

ate

(%)

24.525 25

Organization for Economic Cooperation and Development (OECD) data available at: http://www.oecd-ilibrary.org/sites/health_glance-2011-en/04/08/index.html?itemId=/content/chapter/health_glance-2011-36-en

United States Germany Sweden United KingdomUnited States Germany Sweden United Kingdom

Page 27: Healthcare Transformation: What’s good about U.S. Healthcare?

© 2013 Health CatalystProprietary and Confidential

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System Performance, by nation

United States Germany France United Kingdom0

20

40

60

80

100

120

140

160

180

200

Prevalence of Patients Undergoing Dialysis(Number of patients per 100,000 population)

Organization for Economic Cooperation and Development (OECD) data available at: http://www.oecd-ilibrary.org/sites/health_glance-2011-en/04/08/index.html?itemId=/content/chapter/health_glance-2011-36-en

Page 28: Healthcare Transformation: What’s good about U.S. Healthcare?

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System Performance, by nation

United States France United Kingdom Germany0

10

20

30

40

50

60

Prevalence of Patients Undergoing Renal Transplant(Number of patients per 100,000 population)

Organization for Economic Cooperation and Development (OECD) data available at: http://www.oecd-ilibrary.org/sites/health_glance-2011-en/04/08/index.html?itemId=/content/chapter/health_glance-2011-36-en

Page 29: Healthcare Transformation: What’s good about U.S. Healthcare?

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System Performance, by nation

United States Germany United Kingdom France160

170

180

190

200

210

220

230

Cancer Mortality Rates(Age-standardized rate per 100,000)

Organization for Economic Cooperation and Development (OECD) data available at: http://www.oecd-ilibrary.org/sites/health_glance-2011-en/04/08/index.html?itemId=/content/chapter/health_glance-2011-36-en

Page 30: Healthcare Transformation: What’s good about U.S. Healthcare?

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System Performance, by nation

FRA GER* UK US FRA GER* UK US

U.S. Men and Women Under Age 65 Have Higher Rates of Potentially Preventable Deaths

Slowest Rate of Improvement, 1999-2007

20

1999 2007

30405060708090

100

100

20

1999 2007

30405060708090

100

100

Amenable mortalitymen ages 0-64

Amenable mortalitywomen ages 0-64

*Data from Germany are 1999 and 2006 Source: Nolte E and McKee CM. In Amenable Mortality—Deaths Avoidable Through Health Care—Progress in the US Lags That of Three European Countries. Health Affairs, published online August 29, 2012.

Page 31: Healthcare Transformation: What’s good about U.S. Healthcare?

© 2013 Health CatalystProprietary and Confidential

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In Summary…

• Over the past century, remarkable progress was made

• We need more focus on other determinants of health

• Cultural norms—high touch, the desire for choice, and the Rule of Rescue—will likely continue to play a significant role in patient decisions

• The pressure to achieve more value from the resources applied to clinical care will grow

• Solving healthcare’s issues will be similar to other industries—engaging front line worker in data-driven quality improvement and new, more efficient care delivery models

Page 32: Healthcare Transformation: What’s good about U.S. Healthcare?

© 2013 Health CatalystProprietary and Confidential

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Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics

Healthcare: The Way It Should Be

Section One – Forces Driving Transformation • Chapter One – Forces Defining and Shaping

the Current State of U.S. Healthcare • Chapter Two – Present and Future

Challenges Facing U.S. Healthcare

Section Two – Laying the Foundation for Improvement and Sustainable Change • What will it take to successfully ride the

transformational wave?

Section Three – Looking into the Future • What will it take to successfully ride the

transformational wave?

Page 33: Healthcare Transformation: What’s good about U.S. Healthcare?

© 2013 Health CatalystProprietary and Confidential

www.healthcatalyst.com

Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics

33

Poll Questions… 5. Is your organization

considering new care models like the NCQA Medical Homea. Yes

b. No

c. Don’t know

3. How difficult will it be for Americans to balance high touch, the need for choice, and the Rule of Rescue to control healthcare costs? a. Very difficult

b. Difficult

c. Easy

4. Does your organization have an effective strategy to engage clinicians in data-driven improvement? a. Yes

b. No

c. Don’t know

Page 34: Healthcare Transformation: What’s good about U.S. Healthcare?

© 2013 Health CatalystProprietary and Confidential

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34

Questions and AnswersAdditional Information

• See us at HIMSS 2014 booth #6076

• Call 801.708.6800 to request a meeting

• Listen to two clients speak:‒ “Improving Outcomes with an

Innovative Approach to Population Health Analytics”» Stanford Hospital & Clinics » Yohan Vetteth, Pravene Nath, MD» Date/Time: Thursday, 2/27, 12 PM» Location: Room 304A, Session #229

‒ “Blending Clinical and Financial Data to Drive the Value Equation”» Texas Children’s Hospital» Charles Macias, MD» Date/Time: Wednesday, 2/26, 1 PM» Location: Room 304A, Session #191


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