HEALTH CARE REFORM, HEALTH CARE REFORM, POPULATION HEALTH AND THE POPULATION HEALTH AND THE FUTURE OF OCCUPATIONAL FUTURE OF OCCUPATIONAL AND ENVIRONMENTAL AND ENVIRONMENTAL MEDICINE MEDICINE Kenneth W. Kizer, MD, MPH WOEMA Annual Meeting San Francisco, CA September 14, 2012 2 “The specialty of occupational medicine is in peril…” Joseph LaDou, MD Am J Prev Med 2005; 28: 396-402 3 Because of its position at the crossroads of the employer-employee- healthcare system the specialty of occupational and environmental medicine is especially well-positioned to play a critical role in the future of American healthcare.
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HEALTH CARE REFORM,HEALTH CARE REFORM,POPULATION HEALTH AND THEPOPULATION HEALTH AND THEFUTURE OF OCCUPATIONALFUTURE OF OCCUPATIONALAND ENVIRONMENTALAND ENVIRONMENTAL
MEDICINEMEDICINE
Kenneth W. Kizer, MD, MPHWOEMA Annual Meeting
San Francisco, CASeptember 14, 2012
2
“The specialty of occupationalmedicine is in peril…”
Joseph LaDou, MDAm J Prev Med 2005; 28: 396-402
3
Because of its position at thecrossroads of the employer-employee-
healthcare system the specialty ofoccupational and environmental
medicine is especially well-positionedto play a critical role in the future of
American healthcare.
PRESENTATION OVERVIEW
Present a brief overview of the Institute forPopulation Health Improvement
Highlight the forces driving the transition ofAmerican healthcare and the growing focus onpopulation health
Discuss the confluence of forces laying thefoundation for a renaissance of occupationaland environmental medicine
Identify some needs that OEM needs toaddress to actualize the opportunity for arenaissance
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INSTITUTE FOR POPULATIONHEALTH IMPROVEMENT,UC Davis Health System
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INSTITUTE FOR POPULATION HEALTH IMPROVEMENT Population health
The intersection of public health and the clinical sciences New payment models require that population health management
be a core competency for health care systems Established as an independent operating unit in UCDHS in
March 2011; has since developed a diverse portfolio offunded activities >$70M and >100 employees
Serves as a resource for health care reform, health policy andclinical quality improvement
Assists government health-related agencies in designing,implementing and administering programs
Seeks to Improve the effectiveness and efficiency of clinical care Build health leadership and health care management capacity Facilitate access to and leverage of data sources to develop clinical
intelligence Promotes understanding of the multiple determinants of
health and appreciation of health being a function of thetotality of one’s circumstances
Conducts research and teaching
IPHI REPRESENTATIVE ACTIVITIES Provides technical assistance and other support to Medi-Cal
(California’s $48B/yr Medicaid program) Medi-Cal Quality Improvement and DSRIP Programs Designing the Evaluation of Medicare-Medicaid Dual Eligibles Program
Manages the California Cancer Registry Administers multiple statewide chronic disease prevention and
surveillance programs for the CDPH, including: California Heart Disease and Stroke Prevention California Arthritis Partnership Project LEAN California Active Living Program Breast and cervical cancer screening for underserved women California Tobacco Control Program
Conducting a statewide assessment of surgical adverse events Investigating feasibility of developing “Community Paramedicine” Manages the California Health Information Exchange Development
Program Conducting various population health research programs
Use of the OncotypeDx Genetic Assay in Medi-Cal Beneficiaries with Breast Cancer Evaluation of Opiate Overdose Prevention Policies (in collaboration with CHPR)
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AMERICAN HEALTHCARE INAMERICAN HEALTHCARE INTRANSITION AND THE GROWINGTRANSITION AND THE GROWINGFOCUS ON POPULATION HEALTHFOCUS ON POPULATION HEALTH
The Turbulent Waters of Early 21The Turbulent Waters of Early 21stst Century CenturyAmerican Health CareAmerican Health Care
1. The essenGality of constrainingthe unsustainable rise of healthcare costs
2. Need to improve clinical qualityand paGent safety
3. Changing demographics
4. Explosive growth of newtechnology
5. Health care personnelshortages
6. Higher service expectaGons
7. Health care reform legislaGon
Interna+onal Comparison of Spending on Health, 1980–2008
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United StatesNorwaySwitzerlandCanadaNetherlandsGermanyFranceDenmarkAustraliaSwedenUnited KingdomNew Zealand
Average spending on healthper capita ($US PPP)
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1980
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United StatesFranceSwitzerlandGermanyCanadaNetherlandsNew ZealandDenmarkSwedenUnited KingdomNorwayAustralia
Total expenditures on healthas percent of GDP
Source: OECD Health Data 2010 (June 2010).
Premiums Rising Faster Than InflaGon and Wages
* 2008 and 2009 NHE projec+ons.Data: Calcula+ons based on M. Hartman et al., “Na+onal Health Spending in 2007,” Health Affairs, Jan./Feb. 2009 and A. Siskoet al., “Health Spending Projec+ons Through 2018,” Health Affairs, March/April 2009. Insurance premiums, workers’ earnings,and CPI from Henry J. Kaiser Family Founda+on/Health Research and Educa+onal Trust, Employer Health Benefits AnnualSurveys, 2000–2009.Source: K. Davis, Why Health Reform Must Counter the Rising Costs of Health Insurance Premiums (New York: TheCommonwealth Fund, Aug. 2009).
Projected Average Family Premium asa Percentage of Median Family Income,
CumulaGve Changes in Components of U.S.NaGonal Health Expenditures and Workers’
Earnings, 2000–09
Percent Percent
108%
32%
24%
1112
1314
1617
18 18 18 1819 19 19
20 2021 21
22 2223
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0
5
10
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Projected
Why are Healthcare Costs Rising?Why are Healthcare Costs Rising? Population growth and aging Uncontrolled proliferation of technology Increasing chronic care needs Direct to consumer marketing of healthcare
products and services American culture
High value placed on ‘choice’ Excessive demand (“consumptive society”)
Legislated healthcare service mandates Consolidation of healthcare providers Rising liability insurance costs Care variation from best evidence (i.e., poor
quality)
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Growth of Mandatory ExpenditureGrowth of Mandatory ExpendituressMandatory Expenditures
Social Security Medicare and Medicaid Interest on the national debt Veterans disability pensions
Discretionary expenditures National Defense International Aid Veterans health care Education Highways and transportation Parks Everything else
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Growth of Mandatory ExpendituresGrowth of Mandatory Expenditures
Factors affecting mandatory expenditures since 2007Recession
Increased Medicaid expenditures Marked increase national debt and debt services
Economic stimulus legislationHealth care reform legislation
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THE OPPORTUNITY FOR ATHE OPPORTUNITY FOR ARENAISSANCE OF OCCUPATIONALRENAISSANCE OF OCCUPATIONALAND ENVIRONMENTAL MEDICINEAND ENVIRONMENTAL MEDICINE
GROWING FOCUS ON POPULATION HEALTH
Stagnant or deteriorating population health The workplace and home environments are
intimately connected 7 of the 10 leading causes of mortality are linked to
lifestyle and preventable conditions Increasing amount of health care provided at home
Others
Report Says 75 Percent of Young Americans UnfitReport Says 75 Percent of Young Americans Unfitfor Military Servicefor Military ServicePublished November 05, 2009 | AP
About 75 percent of the country's 17- to 24-year-olds are ineligible for military service, largelybecause they are poorly educated, overweight and have physical ailments that make themunfit for the armed forces, according to a report issued Thursday.
Other factors, such as drug use, criminal records and mental problems, contribute to whatmilitary leaders say is a major problem that threatens the country's ability to defend itself at atime when the all-volunteer force is already strained fighting two wars.
Healthcare Costs and U.S. CompetitivenessToni Johnson, Deputy Editor | March 26, 2012
The United States spends an es+mated $2 trillion annually onhealthcare expenses, more than any other industrialized country.According to data from the Organiza+on for Economic Coopera+onand Development (OECD), the United States spends two-‐and-‐a-‐half+mes more than the OECD average, and yet ranks with Turkey andMexico as the only OECD countries without universal healthcoverage. Some analysts say an increasing number of U.S. businessesare less compe++ve globally because of ballooning healthcare costs.U.S. economic woes have heightened the burden of healthcare costsboth on individuals and businesses.
GM health care billtops $60 billionCost adds $1,400 per vehicle,hurts competitivenessBy Ed Garsten / The Detroit News
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Rising Obesity Rates
Source: Thorpe, 2009
Total Obesity-‐Related Direct Health Care Spending, U.S. (2008-‐2018)
$0
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
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(Millions)
ProjectedHolding Obesity Rates Constant
THE ECONOMY Economic recovery will be prolonged Physical and mental health of the workforce is
inextricably linked to employee performance,engagement and productivity
Increased understanding that population healthmanagement is a long-term business strategy
The cost of job-related injuries and illnesses issizable and the majority of these costs are notborne by workers compensation
Employers and other healthcare payers need helpin designing the infrastructure and policies neededto support access to comprehensive healthcareservices for employees, families and retirees
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Health Health Care Care ReformReform
HEALTHCARE REFORM ARRA and HITECH The Affordable Care Act
Increases the number of insured and, therefore, demand forhealthcare services
Incentives for the workplace wellness programs to reducechronic diseases, promote sustainable and replicableworkplace health-related programs, and conduct peer-to-peerhealthy workplace mentoring
New healthcare payment models
The cost of job-related injuries and illnesses issizable and the majority of these costs are notborne by workers compensation
The workplace is an important venue for theprovision of healthcare services
Is creating a new healthcare economy
Union leaders forUnion leaders fornurses meet withnurses meet withEnglewood HospitalEnglewood Hospitalmanagement overmanagement overpotential layoffspotential layoffsThursday, August 23, 2012BY LINDY WASHBURNANDBARBARA WILLIAMSStaff Writers │ The RecordNorthwestern hospital confirmsNorthwestern hospital confirms
230 layoffs230 layoffsBy Peter Frost Tribune reporter 6:26 p.m. CDT, August 22, 2012
Northwestern Memorial Hospital confirmedWednesday that it has laid off 230 employees overthe last month as part of an effort to reduce its coststructure by a quarter by 2017.
August 8, 2012, 5:52 a.m. ET
Westchester MedicalWestchester MedicalCenter lays off moreCenter lays off moreworkersworkers
August 15, 2012
Health system cost-cutting changesHealth system cost-cutting changeswill include staff reductionswill include staff reductionsThe Cumberland Times-News Wed Aug 15, 2012, 10:37 PM EDT
CUMBERLAND — Changes are coming for theWestern Maryland Health System and itsemployees. The changes will include staffingreductions through attrition and some “involuntaryseparations.”
Health care mass layoffs escalateHealth care mass layoffs escalateAug. 6, 2012
The number of people losing their jobs in a mass layoff from a hospital oran ambulatory care center spiked of Labor Statistics. A mass layoff isdefined as at least 50 people losing their jobs from a single entity in oneday. in June, according to a monthly report issued July 20 by the U.S.Bureau
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CAPITALIZING ON THECAPITALIZING ON THEOPPORTUNITYOPPORTUNITY
SOME NEEDS FOR OEM TO ACTUALIZE ITSOPPORTUNITY
Better and more granular data on The role of the work place as a cause or contributor to acute and chronic
illnesses and injuries The impact of job-related injuries and illnesses on American productivity and
population health Greater worksite health data connectivity with other healthcare
providers and payers Broader engagement of OEM physicians with healthcare providers
and payers, especially in areas such as disability management andhealth promotion and disease prevention
Increased understanding of the many determinants of health andproductivity and the many ways that employers can influence these