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

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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?

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

  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics 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
  • 2013 Health Catalyst Proprietary 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?
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics Poll Questions 2. What is your role? a. Clinician b. Management c. Quality improvement d. IT e. Consultant 3 1. How are you involved in healthcare? a. Integrated delivery system b. Hospital c. Physician Group d. Other
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com 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)
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics 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
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics 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
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics 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
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics Advancing Life Expectancy
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics 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 medicines ability to save and extend life, and to improve the quality of life for the ill and injured is nothing short of miraculous
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics 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, lets debate in the context of the phenomenal progress weve made and the progress were capable of making. The day we engage the hearts and minds of clinicians will be the day that the issues facing healthcare are solved.
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics 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
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics Determinants of How Well We Live Behavior: Tobacco Ethanol Diet/Exercise pattern Etc. 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.
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics 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
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics U.S. Healthcare Spending
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics U.S. Healthcare Spending
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics 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?
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics 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
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics U.S. Healthcare Spending
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics U.S. Healthcare Spending US Spends two-and-a-half times the OECD average
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics 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
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com 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
  • 2013 Health Catalyst Proprietary and Confidential www.healthcatalyst.com Follow the discussion on Twitter - #HCTransformation, #TimeforAnalytics High Touch: Caring, not just curing A ma