Health Care in the Greater Cincinnati Tri-State Area
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1 Health Care in the Greater Cincinnati Tri-State Area National Health Policy Forum A Tale of Three Cities Colleen O Toole, PhD Greater Cincinnati Health Council
2 Greater Cincinnati 14 County, Tri-State Region Almost 2 million people Over 200,000 uninsured About 200,000 underinsured 9 Fortune 500 Company Headquarters (e.g., Proctor & Gamble, Macy s, Kroger, etc.) One medical school; 12 nursing schools; 1 pharmacy school; no dental school
3 Local Health Care Market 40 hospitals: almost all non-profit 4 hospital systems with total of 17 hospitals Expansion to growing suburbs AND reinvestment in urban core Increased competition from physicianowned, for profit ventures
4 Local Health Care Market About 4500 practicing physicians Mostly in 3 5 MD groups; mostly single-specialty Increasingly challenged business model - more practices being purchased by hospitals Constrained reimbursements; EMR and P4P costs; younger MDs - work-life balance; etc. Current shortages in certain specialties, including primary care; concerns about future shortages Strained relationships between physicians and health plans
5 Local Health Care Market Health Plans: Past: 2 primary, local non-profit health plans Current: 3 major national for-profit health plans Compete on cost, not select panels Business community engaged in (not leading) health care initiatives Business Health Coalition Ohio Business Roundtable/CBC Chambers
6 Safety Net More than 15 public health / FQHC s in both urban and rural areas 2 historical safety net hospitals: strong (University and Cincinnati Children s) Indigent Care Levy - $22M 26 Hospitals 2007 Uncompensated Care: $239M (at costs) Above levy and DSH programs Doubled in last 4 years to
7 History of Collaboration Greater Cincinnati Health Council (Metropolitan Hospital Association) Hospital Quality Improvement Project: voluntary; hospital-specific quality measures reported publicly; business participation Health Improvement Collaborative of Greater Cincinnati Aligning Forces for Quality: multi-stakeholder; chronic disease management; quality measurement and public reporting; consumer engagement; analysis of disparities in care; medical home
8 Cincinnati AF4Q Framework
9 History of Collaboration HealthBridge Health Information Exchange: multi-stakeholder; clinical messaging; electronic physician access to hospitals clinical information systems; syndromic surveillance; electronic Class A disease reporting Health Foundation of Greater Cincinnati Access Health 100: 100% of residents with medical home; collaborative with >50 organizations; multi-year demonstration projects including CincyCare, Urgent Dental Care, Transportation Barriers to Medical Care
10 Website References Greater Cincinnati Health Council Health Improvement Collaborative HealthBridge Health Foundation of Greater Cincinnati
11 Impediments to Improvement Myths: Access to insurance is access to care Rationing does not exist in current system USA has the best health care system in the world Age-specific mortality rates for those 75 and older will stay the same
12 Impediments to Improvement Misaligned incentives: Currently have a sick care system not a health care system Competition leads to discontinuity of care Health care system that keeps mental/ behavioral health, dental, and vision care as disconnected components will continue to suffer failures Totally unaligned financial incentives for various stakeholders
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