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transforming health systems in uncertain times

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Presentation on theme: "transforming health systems in uncertain times"— Presentation transcript:

1 transforming health systems in uncertain times
Peter Long, Ph.D. President and CEO February 5, 2018

2 key takeaway messages It is an incredibly dynamic period in health care in United States and California, which means: Insurance coverage is likely to decline from its highest levels and life expectancy is declining Care and payment models are changing Current workforce needs major change across multiple dimensions Health care contributes a small amount to overall health Fundamentally different approaches will be required to make significant progress More questions than answers today

3 blue shield of california foundation
We believe all Californians can be healthy and safe Our mission: Blue Shield of California Foundation builds lasting solutions to end domestic violence and make California the healthiest state, especially for our most vulnerable neighbors. About us: Total Grantmaking since 2002: Over $390 million 2017 Grantmaking: $25.6 million, 421 grants Independent Board: 9 Trustees, 5 from Blue Shield of California Total Number of Staff: 24 Source of Funding: Annual contributions from Blue Shield of California

4 the solutions depend on the questions…
Senate GOP (S 2330); House-passed GOP(HR 4250); Democrats (S 1890; HR 3605)

5 Changes in health insurance coverage over time

6 Why are people uninsured?

7 u.s. life expectancy reflects income inequity

8 What we know 80 percent of health is determined by factors outside of the healthcare system Every day, we collaborate with forward-thinking partners and seek new solutions to end domestic violence and improve the health & wellbeing of all Californians – especially our most vulnerable neighbors. We use our grantmaking to help create a brighter future. We see what is, imagine what can be, and work together to move California further forward.

9 strategies to improve health care
current situation strategies to improve health care

10 national academy of medicine workshop on high-needs patients
5% of patients account for nearly half of the nation’s spending on health care How do we improve care management for this population in an effort to improve health outcomes and reduce costs?

11 themes and conclusions
The high-need patient population is diverse, complex, expensive, and transient. One size doesn’t fit all. We need to strike a balance between standardized and customized approaches to care. Segmenting patients is one tool to inform and target care, and should be rapidly tested in real-world settings in conjunction with care models that have been shown to work. The solutions (e.g., tools, care models, policies) must extend beyond the medical – social and behavioral factors are essential to address. In order to be actionable, policy solutions must account for existing system constraints and complexities (e.g., integration of medical + social, financing of care models).

12 potential paths forward
More research is needed to bolster the evidence base for care models that work. There are major policy barriers to broad implementation of what we know DOES work. In the meantime, action is needed now Health systems need to work with payers to better identify and target high-need patients and test new practices (i.e., taxonomy). Payers need to work with health systems so it’s feasible to adopt care models (or specific attributes) that we know work. Policymakers need to continue progress toward a value-based system, with alternative payment models (including those that work within FFS structure) that support care for these patients.

13 financing approaches: fqhc pilot
FQHC Capitation Payment Preparedness Program (CP3) and Senate Bill 147 (Hernandez)

14 eConsult Original two counties: Los Angeles and San Francisco Second phase: Alameda, San Mateo, Santa Clara, Kern, Contra Costa, Monterey, San Joaquin, and San Diego Foundation funding currently supports eight healthcare systems at varying stages of planning, implementation, and scale-up of eConsult. Los Angeles County’s Growth in Number of Participating Specialties eConsult Expansion Across California Counties Effect of eConsult on Referrals and Treatment

15 ca future health workforce commission
As California ages, grows and becomes increasingly diverse, our health workforce lags further behind the demand We don’t have enough health providers and we don’t have the right people in the right places with the right training The California Future Health Workforce Commission was formed to address these issues by prioritizing training, innovation, and diversity in behavioral health, aging, and primary care and prevention

16 systemic barriers to health improvement
Unsupportive policy and payment framework Uncertainty with evidence base Different definitions of success Limited patient, and community engagement Under-achieving implementation science

17 sources of power in U.S. health care
Federal level: policy & payment State level: policy, payment & regulation Local level: community engagement, collaboration & action

18 what would health look like in our communities?
3.0 what would health look like in our communities?

19 coordinated healthcare system community integrated health system
where are we now? 1.0 sick care system 2.0 coordinated healthcare system 3.0 community integrated health system Era 1900s-1950s 1950s-present 2000 onward Health Is Absence of acute disease Reduction of chronic disease Creating capacities to achieve goals, satisfy needs Care Goal Improve life expectancy Reduce disability Optimize health

20 health transformation framework
1.0 sick care system 2.0 coordinated healthcare system 3.0 community integrated health system SYSTEM DESIGN Health service providers, operating separately Team-based care within health Community integrated services, health care as one component CARE MODEL Little coordination between in/out patient care, episodic treatment Chronic condition management, patient-centered care coordination Health, psychosocial, and wellness care integrated across the life course DOMINANT PAYMENT APPROACH Fee-for-service Value-based health payments Population-based global budgets, linked to multi-sector financial impact APPROACH TO QUALITY Variable, low transparency Consistent, standardize processes and outcomes Continuous learning and quality improvement BENEFICIARY LENS Individual Patient and family Subpopulations and communities, equity- oriented

21 our bold goal To make California the healthiest state in the country, and the state with the lowest rates of domestic violence by leveraging the power of community and innovative solutions

22 our areas of focus Breaking the cycle of domestic violence
Collaborating for healthy communities Designing the future of health Breaking the cycle of domestic violence Collaborating for healthy communities Designing the future of health

23 3.0 principles and design strategies
community empowerment and engagement information and measurement community integration functions financing approaches

24 collaboration underpins community health
Source (left): Foundation Center Maps. “Constellation” of Grants to Organizations Based in city of Riverside, CA in support of health, community development, human rights, or human services, (Right) Centers for Disease Control.

25 bringing 3.0 design elements together in communities
California Accountable Communities for Health Initiative (CACHI) Imperial County Public Health Department, Imperial County Merced County Department of Public Health, Merced County Be There San Diego/University of California, San Diego, San Diego County Dignity Health/St. Joseph’s Medical Center, San Joaquin County Santa Clara County Public Health Department, Santa Clara County Sonoma County Department of Health Services, Sonoma County

26 integration beyond health care
Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE)

27 cachi’s origins

28 value-based purchasing drives move to accountable health
If we reward outcomes over volume, mobilizing all factors that affect health will have rewards There are still unknowns: which approaches are the most effective? who should lead these efforts? what is a sustainable financial model? Many experiments…few answers Support from government and philanthropy

29 California is leading the way
continuing to do so will require us to work together and develop new ideas and solutions.

30 unanswered questions Can we achieve transformation started from the existing system? Who is included in the system and who is excluded? How should resources be allocated among systems and within health care system? What is the optimum balance of intervention at individual and population level? How can we create the right policy environment to support Health 3.0? How will we know if we are successful?

31 Peter Long, Ph.D.


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