1. Health Care/Policy Perspective Kathleen T Grimm, MD MHSc July 16, 2014

2. Objectives A Big Reason for Paradigm Shift The Largesse of the Challenge The Momentum

3. U.S. Health Costs Rising More Steeply, 1970- 2008

8. Determinants of Health and Their Contribution to Premature Death Adapted from: McGinnis JM, Williams‐Russo P, Knickman JR. “ The case for more active policy attention to health promotion” Health Affairs (Millwood) 2002;21(2):78‐93.

9. The Buffalo Community

10. Objectives A Big Reason for Paradigm Shift The Largesse of the Challenge The Momentum

14. We have learned that more and more health care does not explicitly improve health Health can’t be defined in one dimension alone- it is in the context of a person’s life

15. Objectives A Big Reason for Paradigm Shift The Largesse of the Challenge The Momentum

17. “For nearly 15 years we’ve had the secret to delivering better care at lower cost in America. The information has sat, hidden away in the medical literature, and barely mentioned among physicians. It’s a remarkable story of bias. The neglect of this information by the medical community tells you a lot about our failings as a profession and the poor training we receive. It’s also a powerful commentary on the values of our society and the biases built into our society’s view of health and healthcare”. Philly.com’s The Field Clinic blog. Dr. Jeffrey Brenner: “I believe ACE scores should become a vital sign, as important as height, weight, and blood pressure

18. Generating Hypotheses About Care Needs of High Utilizers: Lessons from Patient Interviews Theme 1: Childhood instability Theme 2: Difficult relationships and encounters with health care providers during adulthood Theme 3: Importance of positive relationships with health care providers POPULATION HEALTH MANAGEMENT Volume 16, Supplement 1, 2013