HEALTHCARE IN 2012 AND BEYOND

1. HEALTHCARE IN 2012 AND BEYOND Its about the Region Its about the Community Its about our Friends and Neighbors

2. THE MAIN ASSUMPTION • Access to adequate healthcare is a right of every American. • Teddy Roosevelt proposed a national healthcare system. • Lyndon Johnson led the development of Medicare and Medicaid.

3. What Do We Want From Healthcare • For the Individual • Improved Health • Improved Quality of Life • Reduced Suffering • For the Employer • Improved/Maintained Employee productivity • For the Community • Productive Community Members • Overall Improved Quality of Life • All members have Maximal Individual outcomes

4. Why does the Healthcare Industry have to change? Why do we as a community have to look at health differently?

5. One of the Dilemmas • We have looked at the provision of healthcare in silos, because payment was based on doing things to/for people in silos. Each silo has been evaluated separately • Outpatient Medical Services • Inpatient Medical Services • Home Care Medical Services/ Hospice • Mental Health Services • Medicaid • Nursing Home/ Adult Family Home Services • Nutrition Services • Social Services • Community Health/Public Health Services

6. Costs of care are increasing 2-3% faster than CPI. Commercial insurance premiums doubled from 2000-2007. • Institutional care is 43% of the Medicare spend. • Chronic Disease is a major contributor to cost. • Diabetes, Hypertension, CAD, CHF, COPD, Depression • 5% patients= 50% of Medicare cost • 10% patients= 65% of Medicare cost • 50% patients= 3% of Medicare cost • The population is aging. In 15 years the number of Medicare beneficiaries will increase from 40-80 Million. • Technology: Previously untreatable conditions are now treatable/curable. More care can be offered.

7. Quality of Care is Not Great Overall • Great Care: High Quality, Low Cost, Good Patient Experience • Neonatal Mortality

8. Lifespan • Vaccination Rates

9. How Do We Move Forward Focus on systems of care 9

10. Regional Systems of Care • Care needs to be Evidence Based • The “right care” is safest and less expensive in the long run. • Local Care is Best: • Where it is safe, efficient, and effective. • Inpatient Care frequently requires specialty physicians/technology (most efficient with maximal use). • Outpatient care is increasing, inpatient decreasing, Silos must be reduced: What is the right care, where is the right place to provide the care, when is the proper time to provide the care?

11. Regional Systems of Care • Team Based Care (everyone practices at the top of their license). • Specialist Physician $4/minute • Primary Care Physician $2/minute • Physician’s Assistant/ ARNP $1/minute • RN $.35/minute • CNA/CMA $.23/minute • Mental Health Services • Community Based Social Service Agencies • Education– Schools, Community Education

12. How Can We Accomplish This • The easiest would be a national strategy. This is not occurring. We need a regional or local one. • We need integration of care. • We can develop a regional strategy. • Develop a strategy that rewards. • Value (Outcomes divided by cost). • Involve patients, payers (employers), and providers.

13. We Are Fortunate in NCW • Geographic Isolation—Most care is in the region. • High quality providers, facilities, and services already in existence and not in excess. • Sized big enough to cover nearly all aspects of care and control costs locally. • Small enough to make rapid changes and communicate throughout the organization and community. • Committed health care providers (Physicians, Nurses, Staff, Therapists). We grew up here or like living here. This is our community, it is not just a job.