Novant Health s answer to a failing U.S. healthcare system

Transcription

1 Population health and the patient oriented delivery system 1 Novant Health s answer to a failing U.S. healthcare system Population health and the patient oriented delivery system

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3 3 Table of contents The problem an unsustainable system... 4 Today's healthcare statistics... 4 Today's healthcare model broken... 6 Novant Health's mandate population health... 6 The solution - a patient oriented delivery system (PODs)... 7 Redesigned health and healthcare... 9 A real healthcare system References... 11

4 4 Population health and the patient oriented delivery system The problem an unsustainable system Today s healthcare system is unsustainable. It is built on a system that treats the symptoms of disease rather than promoting health and a healthy lifestyle. Today s healthcare statistics In 2013, the U.S. had the highest or U.S. life expectancy is 78.7 years. This ranks the U.S. 49th among 224 nations and 27th out of the top 34 industrialized countries. 1, 2 near-highest ranking among 17 high-income countries in infant Life expectancy at birth mortality, heart and lung disease, Hong Kong 83.4 sexually transmitted diseases, adolescent pregnancies, injuries, Japan 82.6 homicides and disability. 3 In 2012, the U.S. infant mortality rate was France 81.7 six babies for every 1,000 born Canada 80.9 alive. North Carolina s infant mortality was 7.4 per 1,000 live United States 78.7 births, with deaths for white babies, Latino babies and black babies ranking 5.5, 4.2 and 13.9 respectively for every 1,000 births. 4 Virginia and South Carolina report similar infant mortality rates with 6.7 and 7.6 per 1,000 live births respectively, as well as similar racial and ethnicity disparities. 5, 6 Highest in infant mortality, heart and lung disease, sexually transmitted diseases, adolescent pregnancies, injuries, homicides and disability

5 Today s healthcare statistics (continued) Population health and the patient oriented delivery system 5 rose just 38 percent. 7 If food prices inflated at the same rate as healthcare since 1945, a dozen eggs would cost $55 today. 7 Healthcare costs as a percentage of GDP per capita vs. life expectancy 3.8 Hong Kong Hong Kong Japan Japan 82.6 Healthcare premiums have risen 3.5x faster than average U.S. wages U.S. healthcare costs are increasing at an untenable rate, far beyond other routine costs. Health insurance premiums increased 131 percent between 1999 and 2009; while wages The U.S. spends more than any other nation on healthcare $8,608 per capita (17.2 percent of its GDP), but still ranks at the bottom in mortality. 8, 9 The U.S. Department of Health and Human Services (USDHHS) projects that the health segment of GDP will continue to rise, reaching 19.5 percent by Many patients have no access to care because they are uninsured Spain 8.9 Australia 7.0 Chile 10.8 Canada 20% 16% 12% 8% 4% Healthcare cost as a percentage of GDP per capita Spain 82.3 Australia 81.8 Chile 79.0 Canada France France United States United States 78.7 Life expectancy The Centers for Disease Control Even more alarming is the estimate (CDC) estimates that diabetes affects that one in four people with diabetes almost 26 million American adults (>8 percent). The CDC designated 15 states in the Southeast as the diabetes belt, where people are don t know they have it. Another 86 million Americans are living with prediabetes and are much more likely to develop diabetes The CDC designated 15 states as the "diabetes belt," where people are more likely to have diabetes. more likely to have diabetes than within five years if nothing is 11, 12 those who live outside the belt. done to lower blood sugar. 12 The demand for healthcare services is expected to far outpace the supply of physicians over the next 10 years, largely due to the number of Americans over age 65 and the increase in people with chronic illness. 13 In addition, an estimated 43 million Americans do not have health insurance. These three populations alone strain the existing healthcare delivery system as a result of the frequency and complexity of the care they require. The combination of growth among the aging, the chronically ill and the number of uninsured will further strain the system and limit the ability for patients to obtain the right care at the right place and at the right time. 36% increase in Americans aged 65+ 7% increase in number of physicians

6 6 Population health and the patient oriented delivery system Today's healthcare model broken Today s U.S. healthcare model is fragmented, impersonal and expensive. Healthcare providers and hospitals are paid for nearly every service provided to a patient. The fee-for-service model translates into more service, more money. This model is focused on treating symptoms rather than preventing disease. Furthermore, services and tests performed by one provider are not readily available to other providers or the patient. Current conditions are treated often without fully considering the patient's total healthcare needs. Health promotion and disease prevention information, if given, are episodic and delivered primarily when the patient comes into the office. Communication between the patient and his or her providers often stops when the patient leaves the office. As a result, the patient is disengaged from his or her own health and healthcare, continually reacting to disease episode after disease episode. The patient and provider typically communicate after a health problem occurs, rather than working together to prevent it. The patient and provider typically communicate after a health problem occurs, rather than working together to prevent it. Novant Health's mandate population health For the past decade, Novant Health has taken steps to transform healthcare, creating a system that promotes health and prevents, delays, detects and controls disease. We are continuing this journey as we develop a patient oriented delivery model that promotes the health of our patients. This model integrates each patient s needs to create and sustain health, instead of just treating disease episodes. We believe the best preventive healthcare is high quality, low cost and easy for people to access. We believe the best preventive healthcare is high quality, low cost and easy for people to access.

7 Population health and the patient oriented delivery system 7 The solution a patient oriented delivery system (PODs) Novant Health is transforming healthcare. Our new model focuses on meeting patients where they are in their healthcare journey and working with them to improve their overall physical, mental and social health. We are reinventing the healthcare experience to be simpler, more convenient and more affordable so patients can focus on getting better and staying healthy. The patient oriented delivery system consists of all the health services in a geographic area, creating an integrated team of providers who coordinate care across multiple care settings. Services include: Supporting patients to receive preventive care Setting and meeting goals to stay healthy Managing existing conditions to slow or reverse the progression of disease Transitioning patients out of the hospital and back into the community Helping patients manage multiple medications Connecting patients to the right community resources Providers will share the right information, which will reduce the cost of healthcare and improve the healthcare experience. Most importantly, it puts the patient at the center of an integrated system of services. The patient oriented delivery system puts the patient at the center of everything we do.

8 8 Population health and the patient oriented delivery system Novant Health s innovative care is centered on personalized and consistent communication with the patient. A coordinated team of healthcare professionals is responsible for managing each individual s care plan. This multidisciplinary, integrated system will coordinate the right intervention, for the right patient, at the right time and place.

9 Population health and the patient oriented delivery system 9 Redesigned health and healthcare More substantive communication The primary care team will learn about the patient s health history and lifestyle in order to plan preventive measures and offer healthcare advice for physical and mental health. Patient education will be key in this model since 70 percent of healthcare costs are driven by people s behavior and more than 75 percent of healthcare costs are due to chronic disease. 14 Many chronic diseases, such as obesity, diabetes, heart disease, high blood pressure, cancer and mental health are all managed (or mismanaged) by the patient. 12 Overall, this new system of care will greatly enhance collaboration and communication among providers and patients, which benefits patients and creates efficiencies for all. More advanced practitioners The physician will coordinate a team of advanced practitioners (nurse practitioners and physician assistants) to deliver the education, care and consultations the patient needs. The patient gains more time with healthcare professionals to better understand his or her unique health issues. At the same time, the physician is freed up to focus on the most complex patient matters. Pharmacy services will be an important part of this group to improve medication reconciliation and compliance, which will help reduce hospital admissions and readmissions, and increase post-hospitalization follow-ups. Better access and convenience Novant Health s electronic health record will make interfacing between the patients and the healthcare team easy. Patients will be able to use online scheduling and communication features with Novant Health s MyChart 24 hours a day, seven days a week. E-visits, video visits and extended hours will also improve access and convenience. More consistent care More consistent and coordinated care throughout and after an illness will be provided through a variety of mechanisms. Care and communication between providers and patients will continue, ensuring that healthcare does not end when the patient leaves the office or hospital. The care team monitors the patient s health at home by using the telephone and MyChart. The providers can do virtual consultations to deal with non-urgent healthcare problems. If the patient does need to come to the office or hospital, the care team maintains scheduled communication afterward with the patient and any specialist to whom he or she may have been referred. Supportive care, including end-of-life care, will be a key feature of this model. Technology New technology will be another key component of this model. Using mobile devices and telemedicine video conferencing, a team of care coordinators will keep track of patients remotely and closely monitor certain high-risk patients. Patients, authorized family members and care providers will log on to Novant Health s MyChart to view health data and set up parameters to receive alerts notifying them of needed care or health plans. In the future, new devices will connect into MyChart and seamlessly send data from patients to their care team from wireless devices that track items such as blood glucose levels, oxygen levels, blood pressure and weight. 15

10 10 Population health and the patient oriented delivery system A real healthcare system Most of the healthcare industry is devoted to intervention of an established disease, but most of those diseases are lifestyle-related and preventable. Novant Health is a change leader in the industry. The Novant Health patient oriented delivery system will continue to shift focus away from disease intervention and toward disease prevention and health promotion. This model will allow us to: Ensure quality and safety Create authentic personalized relationships between patients and Novant Health Deliver support to providers that makes daily interaction with patients more efficient Create a system that is easier for patients and providers This model will create sustained value to patients and will ultimately improve patients overall health and reduce healthcare costs.

11 Population health and the patient oriented delivery system 11 References 1 Central Intelligence Agency (CIA) Country Comparison: Life Expectancy at Birth. The World Factbook. Retrieved April 29, The State of US Health, : Burden of Diseases, Injuries, and Risk Factors. US Burden of Disease Collaborators. JAMA. 2013;310(6): doi: /jama U.S. Health in International Perspective: Shorter Lives, Poorer Health. National Institutes of Health (NIH), National Institutes of Health Committee on Population, Board on Population Health and Public Health Practice. 4 Infant Mortality in North Carolina. The North Carolina Healthy Start Foundation. Accessed April 28, 2014 at 5 Infant Mortality Strategic Plan for Virginia. Virginia Department of Health. Accessed July 28, 2014 at 6 South Carolina Department of Health and Environmental Control. Accessed July 28, 2014 at 7 The Healthcare Imperative - Lowering Costs and Improving Outcomes. Accessed April 28, 2014 at 8 U.S. Health in International Perspective: Shorter Lives, Poorer Health. National Institutes of Health (NIH), National Institutes of Health Committee on Population, Board on Population Health and Public Health Practice. 9 Bloomberg Visual Data: Most Efficient Health Care: Countries. Bloomberg. August 19, Keehan S, et al. and the National Health Expenditure Accounts Projections Team. Health Spending Projections Through 2017: The Baby-Boom Generation Is Coming To Medicare. Health Affairs Web Exclusive, February 26, National Diabetes Statistics Report, 2014: Estimates of Diabetes and Its Burden in the United States. Centers for Disease Control and Prevention. Atlanta, GA: U.S. Department of Health and Human Services Southeastern States Mired in the Diabetes Belt : CDC Report. U.S. News & World Report. Accessed April 24, Physician Shortages to Worsen Without Increases in Residency Training. Association of American Medical Colleges. Accessed April 29, 2014 at 14 The Power to Prevent, the Call to Control: At a Glance National Center for Chronic Disease Prevention and Health Promotion. Updated December 17, Abrams, S. Is This the End of the Nursing Home? AARP Bulletin. March 2014.

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