Delivery System is Changing Leading to Higher Quality and Lower Costs ROBERT E FROMM, JR. MD, MPH SR. VP AND CMO, MIHS PROFESSOR OF MEDICINE, U OF A

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1 Delivery System is Changing Leading to Higher Quality and Lower Costs ROBERT E FROMM, JR. MD, MPH SR. VP AND CMO, MIHS PROFESSOR OF MEDICINE, U OF A

2 US Health Care Reform History Concept of Insurance and Issues with Health Insurance Decision Making Principles Affordable Care Act Provisions Driving Down Costs and Improving Quality TestAZ 2

3 3

4 Oberlander J. NEJM 376;7,

5 Oberlander J. NEJM 376;7,

6 Risk management to hedge against an uncertain loss Pooling funds of many to cover losses some may incur Large number of insureds Large loss potential Health insurance differs Non-cash settlement Coverage of expected and routine costs Moral Hazard Mehr and Camack Principles of Insurance, 6th edition, 1976, pp

7 Framing the Decision: The decisions you make are greatly influenced by how you frame the questions. Graphic Designer Hire Condo Rental Externalities Unaligned Incentives

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10 Better Care: Improve the overall quality of care by creating systems that are patientcentered, reliable, accessible and safe Healthy People and Communities: Support proven interventions in addition to delivering higher-quality care Affordable Care: Reduce the cost of quality care liverysystem a.html 10

11 Make care safer Engage patients and their families in care Promote communication and coordination of care Promote the most effective prevention and treatment practices Work with communities Make quality care more affordable eliverysystem a.html 11

12 orm/acabasics/. 12

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16 NON-ELDERLY POPULATION 20.4% of Arizona nonelderly adults are uninsured. 18.2% of US nonelderly adults are uninsured. Non-elderly population includes all individuals aged years. CHILDREN 14.8% of Arizona children are uninsured. 9.9% of US children are uninsured. Children includes all individuals under age 19. The Kaiser Commission on Medicaid and the Uninsured. The Uninsured: A Primer. Key Facts about Americans Without Health Insurance. October

17 U.S. ranks 24th out of 30 industrialized nations in terms of life expectancy Spend only 3% on preventative care when an estimated 75% of healthcare expenditures are used to treat preventable conditions IOM recommended increase public health and prevention spending by $12 billion annually Forsberg v, The Prevention and Public Health Fund: A critical investment in our nation s physical and fiscal health. APHA,

18 Prevention and Public Health Fund established Already has provided $1.25 Billion for public health and prevention 25 years of the 30 years increase in US life expectancy over the 20 th century are attributable to public health measures Forsberg v, The Prevention and Public Health Fund: A critical investment in our nation s physical and fiscal health. APHA,

19 $5 billion for prevention benefits including new annual wellness visit No deductibles or coinsurance on prevention plans that receive an A or B grade from US Prevention Services Task Force Moral gain vs. moral hazard. liverysystem a.html 19

20 CDC recommends that diagnostic HIV testing and opt-out HIV screening be a part of routine clinical care in all health-care settings while also preserving the patient s option to decline HIV testing and ensuring a provider-patient relationship conducive to optimal clinical and preventive care. The recommendations are intended for providers in all health-care settings, including hospital EDs Branson, B., et al, Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. MMWR, v. 55, n. RR-14 (September 2006). 20

21 21% of HIV positive people in the United States do not know they are HIV positive The HIV positive unaware account for 48% of new HIV infections. Spach, David, M.D., University of Washington HIV/AIDS: New Issues. PowerPoint presentation. April 23,

22 Arizona is considered a moderate morbidity state, with CDC-estimated prevalence in the middle rate category Prevalence of HIV is at cases per 100,000 persons and increasing in AZ 22

23 Dedicated to the community members. Approved as a teaching hospital by the American Medical Association in The Maricopa Medical Center was dedicated in MIHS was formed in MIHS is the only public, safety net hospital and healthcare system in Arizona 23

24 2,584 unduplicated patients* McDowell is the largest provider of HIV medical care in Arizona. One in every 4 People Living With HIV/AIDS in Maricopa County chooses to receive all or part of his/her care at McDowell * 2011 data 24

25 In 2005, Maricopa Medical Center officially implemented Rapid HIV Screening in Labor and Delivery. Since 2005, Maricopa Medical Center has not had any children born with perinatal HIV 25

26 In 2010, CDC released an expanding testing initiative to increase HIV ADHS began the collaboration with MIHS in September 2010 to develop systems to provide routine opt-out HIV testing in the ED. Testing began July 7, Over 11,500 HIV tests have been completed. 26

27 US Health Care Reform History Concept of Insurance and Issues with Health Insurance Decision Making Principles Affordable Care Act Provisions Driving Down Costs and Improving Quality TestAZ 27

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