THE COMMONWEALTH FUND Transforming The U.S. Health System: What Needs To Be Done & Your Role Stephen C. Schoenbaum, MD, MPH Executive Vice President for Programs www.cmwf.org Mountainside Hospital February 8, 2007
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THE COMMONWEALTH FUND Transforming The U.S. Health System: What Needs To Be Done & Your Role Stephen C. Schoenbaum, MD, MPH Executive Vice President for.
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Slide 1
THE COMMONWEALTH FUND Transforming The U.S. Health System: What
Needs To Be Done & Your Role Stephen C. Schoenbaum, MD, MPH
Executive Vice President for Programs www.cmwf.org Mountainside
Hospital February 8, 2007
Slide 2
THE COMMONWEALTH FUND What Well Cover Introduction to The
Commonwealth Fund and The Commission on a High Performance Health
System Goals for a high performance health system Where we stand
now Keys to transforming the health system What you can do
Slide 3
THE COMMONWEALTH FUND The Commonwealth Fund Established in
1918, The Commonwealth Fund (www.cmwf.org) is a private national
foundation that aims to promote a high performing health care
system by supporting independent research on health care issues and
making grants to improve health care practice and
policy.www.cmwf.org
Slide 4
THE COMMONWEALTH FUND The Commonwealth Fund Commission on a
High Performance Health System Objective: Move the U.S. toward a
higher-performing health care system that achieves better access,
improved quality, and greater efficiency, with particular focus on
the most vulnerable due to income, gaps in insurance coverage, race
and ethnicity, health, or age Chairman: James J. Mongan, M.D.
President and CEO Partners HealthCare System, Inc.
Slide 5
THE COMMONWEALTH FUND Goals for a High Performance Health
System HIGH QUALITY, SAFE, COMPASSIONATE, COORDINATED CARE ACCESS
AND EQUITY FOR ALL EFFICIENCY CAPACITY FOR SYSTEM AND WORKFORCE
INNOVATION AND IMPROVEMENT LONG, HEALTHY, AND PRODUCTIVE LIVES
Slide 6
THE COMMONWEALTH FUND Scores: Dimensions of a High Performance
Health System SOURCE: Commonwealth Fund National Scorecard on U.S.
Health System Performance, 2006
Slide 7
THE COMMONWEALTH FUND Mortality Amenable to Health Care Deaths
per 100,000 population* Percentiles International Variation,
1998State Variation, 2002 Mortality from causes considered amenable
to health care is deaths before age 75 that are potentially
preventable with timely and appropriate medical care. LONG, HEALTHY
& PRODUCTIVE LIVES
Slide 8
THE COMMONWEALTH FUND U.S. Adults Receive Half of Recommended
Care; Quality Varies Significantly by Medical Condition Source: E.
McGlynn et al. 2003. "The Quality of Health Care Delivered to
Adults in the United States," The New England Journal of Medicine
248(26): 26352645. Percent of recommended care received
Slide 9
THE COMMONWEALTH FUND Patients Reporting Any Error by Number of
Doctors Seen in Past Two Years Percent 2005 Commonwealth Fund
International Health Policy Survey
Slide 10
THE COMMONWEALTH FUND Number of States with High Proportion of
Uninsured Adults Ages 1864 Is Growing Data: Two-year averages
19992000 and 20042005 from the Census Bureaus March 2000, 2001 and
2005, 2006 Current Population Surveys. Estimates by the Employee
Benefit Research Institute. Source: The Commonwealth Fund National
Scorecard on U.S. Health System Performance, 2006 ACCESS: UNIVERSAL
PARTICIPATION
Slide 11
THE COMMONWEALTH FUND Quality and Costs of Care for Medicare
Patients Hospitalized for Heart Attacks, Colon Cancer and Hip
Fractures, by Hospital Referral Regions, 2000-2002 Median Relative
Resource Use = $25,995 * Indexed to risk-adjusted 1 year survival
rate (median = 0.70). ** Risk-adjusted spending on hospital and
physician services using standardized national prices. Data: E.
Fisher and D. Staiger, Dartmouth College analysis of data from a
20% national sample of Medicare beneficiaries. Source: The
Commonwealth Fund National Scorecard on U.S. Health System
Performance, 2006 EFFICIENCY
Slide 12
THE COMMONWEALTH FUND Best Practice Curve Median Amount Spent
per Patient per HRR = $28,694 Greenville, NC Newark, NJ Saginaw, MI
Manhattan, NY Orange County, CA East Long Island, NY Ft.
Lauderdale, FL Camden, NJ Variation in Annual Total Cost and
Quality for Chronic Disease Patients Quality of Care* and Medicare
Spending for Beneficiaries with Three Chronic Conditions, by
Hospital Referral Region New Brunswick, NJ Hackensack, NJ
Slide 13
THE COMMONWEALTH FUND International Comparison of Spending on
Health, 1980 2004 Data: OECD Health Data 2005 and 2006. Average
spending on health per capita ($US PPP) Total expenditures on
health as percent of GDP Source: Commonwealth Fund National
Scorecard on U.S. Health System Performance, 2006 EFFICIENCY
13
Slide 14
THE COMMONWEALTH FUND Percentage of National Health
Expenditures Spent on Health Administration and Insurance, 2003 Net
costs of health administration and health insurance as percent of
national health expenditures a b c * Source: The Commonwealth Fund
National Scorecard on U.S. Health System Performance, 2006
EFFICIENCY
Slide 15
THE COMMONWEALTH FUND The Discourse Has Changed FROM: Americans
have the best health care system in the world President Bush, State
of the Union Speech, 2004 TO: We need to do better We spend more on
health care than any other country We need more value for what we
are spending
Slide 16
THE COMMONWEALTH FUND We Know The Problems Now We Need
Solutions
Slide 17
THE COMMONWEALTH FUND Keys to Transforming the U.S. Health Care
System 1.Guarantee affordable health insurance coverage 2.Implement
major quality and safety improvements 3.Work toward a more
organized delivery system that emphasizes primary and preventive
care and is patient-centered 4.Increase transparency and reporting
on quality and costs 5.Expand the use of interoperable information
technology 6.Reward performance on quality and efficiency
7.Encourage public-private collaboration to achieve simplification,
more effective change
Slide 18
THE COMMONWEALTH FUND Guarantee Affordable Health Insurance
Coverage 1. Guarantee Affordable Health Insurance Coverage
Slide 19
THE COMMONWEALTH FUND What Are the Most Important Health Care
Issues for Presidential and Congressional Action? Percent listing
issue as first or second priority:Total Less than $50,000 $50,000
$74,999 $75,000 or more Ensure that all Americans have adequate,
reliable health insurance 52565250 Control the rising cost of
medical care37354239 Lower the cost of prescription drugs31 2733
Ensure that Medicare remains financially sound in the longterm 29
3230 Improve the quality of nursing homes and long-term care
14161513 Reform the medical malpractice system14101218 Reduce the
complexity of insurance12 10 Source: C. Schoen, S.K. How, I.
Weinbaum, J.E. Craig, Jr., and K. Davis, Public Views on Shaping
the Future of the U.S. Health System, The Commonwealth Fund, August
2006.
Slide 20
THE COMMONWEALTH FUND Why Do We Need Universal Coverage? Waste
cost-shifting ineffective care (poorer adherence) duplication
back-end vs. front-end care Societal benefit Its Not Just
Altruism
Slide 21
THE COMMONWEALTH FUND The Action Now Lies In States Single
payer isnt likely Common elements Expand public programs (cover
more poor people) Require individual participation Require employer
participation
Slide 22
THE COMMONWEALTH FUND Massachusetts Health Plan MassHealth
expansion for children up to 300% Federal Poverty Level; adults up
to 100% FPL Individual mandate, with affordability provision;
subsidies between 100% and 300% of poverty Employer mandatory
offer, employee mandatory take-up Employer assessment ($295 if
employer doesnt provide health insurance) Connector to organize
affordable insurance offerings through a group pool Source: John
Holahan, The Basics of Massachusetts Health Reform, Presentation to
United Hospital Fund, April 2006.
Slide 23
THE COMMONWEALTH FUND California Governors Proposal Individual
mandate Premium subsidies for adults below 250% federal poverty
level Employer offer health insurance or pay 4% of wages into pool
Provider fee assessment (2% of physician revenues to 4% of hospital
revenues) Insurance market regulation Guaranteed issue Community
rating with age bands 85 percent minimum medical loss ratio
Slide 24
THE COMMONWEALTH FUND Effective May, 2006: New law in New
Jersey allowing persons up to age 30 to be covered under their
parents insurance
Slide 25
THE COMMONWEALTH FUND Implement Major Quality and Safety
Improvements 2. Implement Major Quality and Safety Improvements 1.
Guarantee Affordable Health Insurance Coverage
Slide 26
Allegheny General Hospital Richard Shannon, MD
Slide 27
Highmark Quality Blue Year 4 MRSA
Slide 28
THE COMMONWEALTH FUND Institute for Healthcare Improvement 100K
Lives Campaign: Success Story
Slide 29
THE COMMONWEALTH FUND Patient-Centered Hospital Care: Staff
Managed Pain, Responded When Needed Help, and Explained Medicines,
2005 Percent of patients reporting always * ** ***
Slide 30
THE COMMONWEALTH FUND Reid Hospital; Richmond, Indiana 2004 HQA
Ave. Reid Hospital Q4 2004 AMI:ACEI when appropriate 75100 CHF: LV
assessment 7899 CAP: Pneumo- coccal Vaccine 46100