1. What is good health? How would you describe good health for yourself? How would you describe good health for those you love? How would you describe a good healthcare system? Why does good health matter?

6. Health Spending per Capita, 2011 Adjusted for Differences in Cost of Living * 2010. Source: OECD Health Data 2013. % GDP $US

7. Hospital Spending per Discharge, 2009 Adjusted for Differences in Cost of Living Dollars * 2008. ** 2007. Source: OECD Health Data 2011 (June 2011). THE COMMONWEALTH FUND

8. U.S. Prices Higher: Total Hospital and Physician Costs for Select Procedures in Selected Countries, 2012 US dollarsAUSFRANETHNZSPASWIZUKUS (avg) US (95 th %ile) Appendectomy $5,467$4,463$4,498$5,392$2,245$4,782$3,408$13,851$28,426 Hip replacement 27,81010,92711,18714,3907,7319,57411,88940,36487,987 Bypass surgery 43,23022,84414,06126,43217,43717,72914,11773,420150,515 Source: International Federation of Health Plans, 2012 Comparative Price Report: Variation in Medical and Hospital Fees by Country. Available at http://hushp.harvard.edu/sites/default/files/downloadable_files/IFHP%202012%20 Comparative%20Price%20Report.pdf http://hushp.harvard.edu/sites/default/files/downloadable_files/IFHP%202012%20 Comparative%20Price%20Report.pdf

9. Serious Problems Paying or Unable to Pay Medical Bills in the Past Year Percent Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.

10. Pharmaceutical Spending per Capita, 2009 Adjusted for Differences in Cost of Living * 2008. ** 2007. Source: OECD Health Data 2011 (June 2011). THE COMMONWEALTH FUND Dollars

11. Life Expectancy at Birth, 2007 * 2006 ** 2005 Source: OECD Health Data 2009 (June 2009). Years

12. Diabetes Lower Extremity Amputation Rates per 100,000 Population Age 15 and Older, 2007* * 2006. ** 2005. *** Among countries shown. Source: OECD Health Care Quality Indicators Data 2009.

13. Mortality Amenable to Health Care Deaths per 100,000 population* * Countries’ age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections. Analysis of World Health Organization mortality files and CDC mortality data for U.S. Source: Adapted from E. Nolte and M. McKee, “Variations in Amenable Mortality—Trends in 16 High-Income Nations,” Health Policy, published online Sept. 12, 2011. THE COMMONWEALTH FUND

15. Poverty Status by Race/Ethnicity, Adults Under Age 65, 2009 Poverty status by federal poverty level (FPL) Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2010.

17. What is 70%?

18. The percent of US healthcare resources expended on chronic conditions and The percent of deaths in the US attributed to chronic diseases

19. Shifting from Sick Care to Health Care Acute An event or diagnosis Treatment based on whether it is curable or incurable Has a defined end point Passive patient involvement Chronic Gradual onset Treatment is ongoing, ever-changing and sometimes unknown Lacks a defined end point Active patient engagement

20. What exactly is changing? Information—Access & Transparency Payments—Volume to Value Accountability—Shared risk Technology—Communication & Integration Delivery—Siloed to Integrated Care—Reactive Episodic to Proactive Population Health Data—Combining Clinical and Financial Documentation—Accurate and Actionable

21. On Demand Isn’t Just for Cable

22. Easy Access to Data

23. Customization & Choices Are Hallmarks of Care

25. Problem People don’t always have easy access to primary care when they need it

26. Virtuwell Nurse practitioners diagnose and treat 50 common conditions virtually Patient needs are addressed within 30 minutes, including personalized treatment plans, prescriptions and provider notes Virtuwell collaborates with healthcare organizations including Group Health Cooperative and Health Partners

27. Virtuwell Outcomes HealthPartners reviewed over 180,000 cases and saw an average of $88 lower cost per episode over traditional physician clinics and a 98% customer satisfaction rate

29. Problem High costs and poor outcomes for stroke patients in and around London

30. London Stroke Initiative Stroke accounted for 10% of healthcare costs (including indirects) 34 London hospitals providing stroke care High mortality and huge numbers of patients failing to receive the right care and/or timely care

31. London Stroke Initiative 8 hospitals designated as Hyper Acute Stroke Units (HASUs) In three months—mortality decreased by 25%, costs decreased by 6% and LOS dropped by 3.5 days All eight centers now in the top quartile for national performance; 6 are best in UK Increased engagement among clinicians and staff who now participate in a network of high performing care

33. Problem Patients lack basic resources to support their health

34. Health Leads Embedded in clinics that serve low-income, high risk populations Clinicians write prescriptions for basic, non-medical services linked to healthcare including food and heat Advocates secure non-medical treatment for patients Staffed primarily by highly trained college student volunteers who access community resources

35. Health Leads Increased access to food, utilities, housing & jobs The work supports certification as a primary care medical home Helps clinicians focus on medical care Better clinical outcomes 90% of volunteers go into healthcare

36. Ensuring Good Health What is one thing you can do to achieve good health? What is one thing you can do to help your loved ones achieve good health? What is one thing you can do to ensure the healthcare system is supporting good health for all?