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8/14/2019 Pre-Medical Student Presentation 2009-05-13
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Future Directions for theUnited States Health Care System
Heidi NelsonHeartland Health Outreach
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Heartland Health Outreach
Mission: to improve the health of disadvantaged populations- individuals andcommunities without access to health care-through the provision of culturally competent,multidisciplinary services designed to preventillness and improve physical, mental and socialwell-being, and through advocacy thatpromotes the right to access comprehensive,integrated systems of care.
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Target Populations
Homeless persons
Low-income individuals with HIV diseaseImmigrants and refugees
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Services
Primary care- medical and oral health
Mental health careTreatment for torture survivorsInterpreting services
Training and technical assistance
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What are you hearing and readingabout health care reform?
Heartland Alliance for Human Needs & Human Rights
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Challenges and Responses in
Health Care Today
Reed V. Tuckson, MD
Executive Vice President and Chief of MedicalAffairsUnitedHealth GroupMarch 27, 2009
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Challenge: escalating health carecosts due to preventable disease
Obama Administration, 5/12/09: Medicare
Hospital Trust Fund to run out in 2017, twoyears earlier than last years report
We wont get the cost of Medicare and Medicaiddown unless we get down the cost of healthcare overall.
-Kathleen Sebelius, US Secretary, HHS
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Challenge: people are makingchoices based on economics
Kaiser Family Foundation April Health Tracking
Poll: 59% of those polled say they or a familymember have delayed or skipped care in thepast year Substituting for doctor visits (42%)
Skipped dental care (36%) Did not fill a prescription (29%) Cut pills or skipped doses of medications (18%)
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Challenge: Poor or suboptimal
quality of careRegarding the Institute of Medicine Initiative,
Crossing the Quality ChasmThe first phase of this Quality Initiativedocumented the serious and pervasive natureof the nations overall quality problem including that the burden of harm conveyed by thecollective impact of all our health care quality
problems is staggering Mark Chassin, Mt. Sinai School of Medicine,1999
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Challenge: Fragmented Health CareSystem
Institute of Medicine, Crossing the Quality
Chasm, 2001
America needs care based on continuing, healing relationships
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We have to:
Be more engaged than ever beforeHave a shared visionFocus on care coordination
Push for research on what worksSeek community and population preventionstrategiesChallenge ourselves to improve quality
Tucksons Solutions to Improvingthe Health Care System
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The Obama AdministrationWhat can we expect for health system change?
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The American Recovery andReinvestment Act of 2009
What can we learn from the stimulus package
about the Administrations priorities?
Heartland Alliance for Human Needs & Human Rights
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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
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A Few Details on Health IT
National Coordinators Office in HHS
Promote interoperability Promotion of studies on HIT adoption
Medicare and Medicaid enhanced rates for meaningful use of HITPromotion of electronic health record adoptionthrough federal and regional TA centersAcademic curricula on HIT
Heartland Alliance for Human Needs & Human Rights
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Other health related aspects of
ARRA
Increased Medicaid federal participation rate to
provide relief to statesProvided subsidies for individuals who losetheir jobs to purchase COBRA
Heartland Alliance for Human Needs & Human Rights
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ARRA themes that reveal the
Administrations policy focus
Prevention
Primary CareHealth Information TechnologyComparative Effectiveness Research
Heartland Alliance for Human Needs & Human Rights
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Health Reform? Whats the Plan?
Budget plan approved in April by House and
SenateProvided a pathway for health reformlegislationBut, theres no planyet
Heartland Alliance for Human Needs & Human Rights
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Policy Themes in Health Reform
Public Plan
Like Federal Employee Health Benefits Program Individuals and Businesses could Purchase Who opposes?
Heartland Alliance for Human Needs & Human Rights
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Policy Themes in Health Reform
Mandates
For individuals to cover themselves For businesses to cover their employees
Heartland Alliance for Human Needs & Human Rights
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Policy Themes in Health Reform
Tax credits
Heartland Alliance for Human Needs & Human Rights
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Policy Themes in Health Reform
Coverage expansions
The very poor The near elderly Young adults
Heartland Alliance for Human Needs & Human Rights
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Whither Single Payer?
Heartland Alliance for Human Needs & Human Rights
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What are our prospects?
Joe Antos, American Enterprise Institute, May
12, 2009In many cases, these ideas [computerizedrecords, care coordination, eliminatingduplication] have been in play for 20 yearsthese represent no sacrifices. The real money is in delivery of services. Ideally we will eliminate the services we dont need, but thatsthe debate.
Heartland Alliance for Human Needs & Human Rights
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What are our prospects?
Richard Kirsch, Health Care for America Now
-Rick Scott is a tainted messenger. Hiscampaign is designed to protect health care profits.
Youtube: Americans for Health Care Now,Insurance Company Rules
Heartland Alliance for Human Needs & Human Rights
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What are our prospects?
Kathleen Sibelius, May 12, 2009
-I give health reform in 2009 a 60-40 chance.
Heartland Alliance for Human Needs & Human Rights
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What do aspiring medical students
need to know?
Comparative Effectiveness Research isessential to reducing health care costsElectronic Health Records have the potential toimprove quality if done rightQuality of care includes reducing disparities-first and foremost understand the patientsenvironment and resourcesConsider Health IT and Quality as career
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