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Welcome to Charleston!. It was the best of times…. …it was the worst of times. South Carolina ranked 45 th among all US states in health status in 2011. In 2012 we fell to 46 th . What’s driving our low health status?. Factor Rank Diabetes 49 Children in Poverty 48

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it was the worst of times
…it was the worst of times.
  • South Carolina ranked 45th among all US states in health status in 2011.
  • In 2012 we fell to 46th.
what s driving our low health status
What’s driving our low health status?

Factor Rank

  • Diabetes 49
  • Children in Poverty 48
  • Low Birth weight 47
  • High School Graduation Rate 47
  • Crime 46
  • Lack of Health Insurance 45
  • Obesity 42
  • Premature Death 42
  • Infant Mortality 40
  • Smoking 39

Source: America’s Health Rankings, published by the United Health Foundation

among the best heart care in country
Among the best heart care in country

Cut response time for heart attack in half

Average door to balloon time in SC is 45 minutes

Consistently rated one of best states

hospital infection rate below national average
Hospital infection rate below national average

“We won’t stop until we eliminate the threat of health acquired conditions in all hospitals across our state.”

Dr. Rick Foster

lead state for safe surgery initiative
Lead state for safe surgery initiative

“SC has a tremendous history of successfully introducing other quality initiatives such as improving the care of heart attack patients and reducing infection. We would like to collaborate with SC hospitals in developing a model to improve surgical safety at a state level that other states can follow."

Dr. Atul Gawande

key strategic objectives
key strategic objectives
  • Coverage
  • Insurance Reforms
  • Delivery System Reforms
  • Payment Reforms
  • Transparency
  • Health IT
implications for hospitals
implications for hospitals
  • Achieve solid clinical alignment between hospital and physicians
  • Deliver superior outcomes
  • Reduce costs
  • Develop integrated information systems
  • Form strategic alliances
  • Prepare for new payment models
implications for hospitals1
implications for hospitals
  • Achieve solid clinical alignment between hospital and physicians
  • Deliver superior outcomes
  • Reduce costs
  • Develop integrated information systems
  • Form strategic alliances
  • Prepare for new payment models

Change your business model.

supreme court
Supreme Court
  • Ruled 5-4 on June 28, 2012 to uphold law
  • Individual mandate, exchanges, insurance rules and other programs still stand
  • Medicaid expansion is now optional for each state
some background
Some background
  • January 1966--only six states originally participated when the program launched: Hawaii, Illinois, Minnesota, North Dakota, Oklahoma, Pennsylvania
  • 20 states signed on later that year
  • 11 states joined in 1967
  • 13 more states (southern) joined in 1968-1972
  • Arizona last to join in 1982
  • Eventually all states participated in basic program and SCHIP (enacted in 1997)
who s participating
Who’s participating?

25 states participating

14 states officially not participating

Primarily southern states including South Carolina

All but two also not participating in a state-run insurance exchange

changing their tune
Changing their tune
  • Florida Gov. Rick Scott dropped his staunch opposition
    • "While the federal government is committed to paying 100 percent of the cost of new people in Medicaid, I cannot, in good conscience, deny the uninsured access to care.”
  • Arizona Gov. Jan Brewer plans to push for expansion
    • “Weigh the evidence and do the math. With the realities facing us, taking advantage of this federal assistance is the strategic way to reduce Medicaid pressure on the State budget. We can prevent health care expenses from eroding core services such as education and public safety, and improve Arizona’s ability to compete in the years ahead.”
viewing the debate through different lenses
Viewing the debate through different lenses
  • Uninsured people
  • Insured people
  • Employers
  • Insurers
  • Physicians
  • Hospitals
  • Republicans
  • Democrats
  • Business Leaders
  • Wall Street
two ways to frame the debate
Two ways to frame the debate
  • It’s about States’ Rights
    • The federal government is forcing its will on us
    • We can’t afford to expand Medicaid
    • We should fight this intrusion on states’ rights
  • It’s about Economic Competitiveness
    • This law was passed by representatives from all 50 states and upheld by the Supreme Court
    • The other 49 states are offering to pay 90% of the cost of covering the uninsured in our state
    • We should let them, so our business community doesn’t have to bear the cost
has health care ever been so political
has health care ever been so political?
  • America’s health care system is no stranger to politics
  • Since WWII, health care policy in America has been inherently political
  • There’s no reason to think an election will de-politicize the politics of health care, certainly not when tax dollars are funding half of all health expenditures
slide27

National Health Expenditures

Total Annual Costs and Per Capita

1960 – 2010

(in billions)

Source: CMS National Health Expenditure Accounts

america ranks dead last in health status
America ranks dead last in health status

Source: U.S. in International Perspective: Shorter Lives, Poorer Health, published January 9, 2013 by the Institute of Medicine

america ranks dead last continued
America ranks dead last, continued

Source: U.S. in International Perspective: Shorter Lives, Poorer Health, published January 9, 2013 by the Institute of Medicine

obesity trends among u s adults brfss 1985
Obesity Trends* Among U.S. AdultsBRFSS, 1985

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

obesity trends among u s adults brfss 1986
Obesity Trends* Among U.S. AdultsBRFSS, 1986

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

obesity trends among u s adults brfss 1987
Obesity Trends* Among U.S. AdultsBRFSS, 1987

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

obesity trends among u s adults brfss 1988
Obesity Trends* Among U.S. AdultsBRFSS, 1988

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

obesity trends among u s adults brfss 1989
Obesity Trends* Among U.S. AdultsBRFSS, 1989

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

obesity trends among u s adults brfss 1990
Obesity Trends* Among U.S. AdultsBRFSS, 1990

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

obesity trends among u s adults brfss 1991
Obesity Trends* Among U.S. AdultsBRFSS, 1991

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

obesity trends among u s adults brfss 1992
Obesity Trends* Among U.S. AdultsBRFSS, 1992

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

obesity trends among u s adults brfss 1993
Obesity Trends* Among U.S. AdultsBRFSS, 1993

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

obesity trends among u s adults brfss 1994
Obesity Trends* Among U.S. AdultsBRFSS, 1994

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

obesity trends among u s adults brfss 1995
Obesity Trends* Among U.S. AdultsBRFSS, 1995

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

obesity trends among u s adults brfss 1996
Obesity Trends* Among U.S. AdultsBRFSS, 1996

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

obesity trends among u s adults brfss 1997
Obesity Trends* Among U.S. AdultsBRFSS, 1997

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

obesity trends among u s adults brfss 1998
Obesity Trends* Among U.S. AdultsBRFSS, 1998

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

obesity trends among u s adults brfss 1999
Obesity Trends* Among U.S. AdultsBRFSS, 1999

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

obesity trends among u s adults brfss 2000
Obesity Trends* Among U.S. AdultsBRFSS, 2000

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

obesity trends among u s adults brfss 2001
Obesity Trends* Among U.S. AdultsBRFSS, 2001

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

slide48

Obesity Trends* Among U.S. AdultsBRFSS, 2002

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

obesity trends among u s adults brfss 2003
Obesity Trends* Among U.S. AdultsBRFSS, 2003

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

obesity trends among u s adults brfss 2004
Obesity Trends* Among U.S. AdultsBRFSS, 2004

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

obesity trends among u s adults brfss 2005
Obesity Trends* Among U.S. AdultsBRFSS, 2005

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

obesity trends among u s adults brfss 2006
Obesity Trends* Among U.S. AdultsBRFSS, 2006

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

obesity trends among u s adults brfss 2007
Obesity Trends* Among U.S. AdultsBRFSS, 2007

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

obesity trends among u s adults brfss 2008
Obesity Trends* Among U.S. AdultsBRFSS, 2008

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

obesity trends among u s adults brfss 2009
Obesity Trends* Among U.S. AdultsBRFSS, 2009

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

obesity trends among u s adults brfss 2010
Obesity Trends* Among U.S. AdultsBRFSS, 2010

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

slide57

Obesity Trends* Among U.S. AdultsBRFSS,1990, 2000, 2010

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2000

1990

2010

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

is our system broken absolutely not
Is our system broken? Absolutely not.

WARNING:

Every system is perfectly designed to get the results it gets.

  • Paul Batalden,

Dartmouth Institute for Health Policy and Clinical Practice

The US health care system was designed to fix acute illness at any cost.

It does exactly what it was built to do.

slide59

Recruit workers in the era of wage controls during WWII (employer-sponsored health insurance)

Provide health insurance to retirees from age 65 until end of life (Medicare)

Cover the uninsured in America (Medicaid)

Treat everyone in emergency conditions even if they are unable to pay (EMTALA)

What was the US health care system built to do?

end result americans want three things
End result: Americans want three things…

Give me the best health care possible

Send the bill to someone else

Don’t bother me about my behaviors

slide61

Promote good health

Manage chronic disease

Contain costs

Encourage collaboration among competing hospitals and physicians

What was the US healthcare system NOT built to do?

our to do list
Our “To Do” List
  • Insurance Reforms/The Individual Mandate/Rising Prices
  • The Future of Disproportionate Share
  • Transparency—Prices, Quality, etc.
  • Deficit Reduction in Washington
  • Highly Reliable Care
  • The Future of Medicaid
think job security
Think job security!
  • We have a lot to do.
  • For now, however, your job is to enjoy each other and enjoy Charleston!