1. Public Hospital District 4.0

2.  Hospitals 1.0 The End of the Road  Hospitals 2.0 Inpatient Care  Hospitals 3.0 Outpatient Care  Hospitals 4.0Extending the Continuum? Fall 2010: Open a Discovery Process!

3. NEW GAME, DIFFERENT RULES Most people don’t know what it is they want, exactly, but they are pretty sure they haven’t got it. Alfred E. Newman

4.  Nominal health care spending doubles $2.4 trillion in 2009 to $4.6 trillion in 2019  17.3% of GDP in 2009, 19.6% of GDP in 2019  At current trend, health care is ~37% of national GDP in 2050 and ~49% in 2082

5.  The War on Cancer From 1980-2000, gains in cancer treatment kept patients alive for 23 million additional years.  Heart Disease Heart disease spending has increased the average U.S. life by 0.62 years, costing $43,600 per year of life added.

6. $50,000 in additional lifetime medical spending per year of life added

7.  Cost Spiral is, really and truly, unsustainable… If $1 out of $6 isn’t enough, how much is? …and the cliff is under our feet!  There really won’t be enough doctors or nurses to meet demands of current system. Recent published survey estimates the shortage of primary care physicians in the US at 44,000 by 2016. A UW study suggests that there will be 5,000 RN vacancies in hospitals on any given day in 2014.

8.  Inadequate coordination among providers :  Primary care physicians and specialists  Primary care physicians and emergency departments  Physicians and sources of diagnostic data  Hospital-based physicians and primary care physicians  Inadequate coordination between providers and patients/families :  Physicians and patients and their families  Hospitals and patients and their families

9.  Safe  Timely  Effective  Efficient  Patient Centered  Documented Performance Built On Best Practices

10. Biomedical Model  Rigid Adherence to Medical Model  Attention Only On Acute, Episodic Illness  Focus on Individual  Cure as Uncompromised Goal  Focus on Disease Expanded View  Multifactoral View of Health  Chronic Illness Management  Focus on Community Health, Defined populations  Support Adjustment and Adaptation in Lieu of Cure  Focus on Person and Disease

11.  Affiliations, mergers and acquisitions are re- making the health/medical care landscape in Washington state. Only a handful of free standing community hospitals left; most PHDs are actively managing physician practices; a new deal every day. Also being driven by increasing complexity, especially complexity in information management. The message seems to be: “bigger is better.”

12.  Even familiar activities suddenly carry new and unfamiliar risks

13. MEDICAL HOMES ACCOUNTABLE CARE ORGANIZATIONS The Primary Care Medical Home provides a wholistic a clinical orientation, most frequently defined by patients with a chronic diagnosis/es An accountable care organization model works from a payment and governance orientation, characterized by aggregate spending and utilization targets with a much broader reach than the PCMH.

14.  AWPHD intends to understand and respond to, not direct, the needs of members.  How best do that in a time of such dynamism?  What might Public Hospital Districts look like in 2015?  Will more follow Stevens Healthcare approach?  Valley Medical Center approach?  Skagit Valley Hospital approach?  THE ANSWER IS ALMOST CERTAINLY YES!

15.  It seems  likely that PHDs will grow in multiple ways– and that they will require representation and advocacy support to be successful.  likely that Commissioner Education will become increasingly important.  unlikely that the demands for transparency and issues related to OPMA and PRA will become less “noisy” over the next few years.  AWPHD, in some form, will be valuable!

16. A Simple Question:  In the Healthcare Market Place Today--  Whose “community,” “population,” or “market” is more easily defined than a public hospital district’s?

17. Our Answer: No One’s! Have the legal authority and responsibility to assess, define and respond to a broad range health and medical service needs; Offer accountability through elected boards, open meetings and public votes; Enjoy defined boundaries and populations, taxing and bonding capacity;

18.  ALSO:  WE ARE NOT RARE!

20. Neither are we alone:  Local Public Health Agenda For Change  Efforts to create a “Regional Health Authority” to bring people “with special needs” into Medical Home/Accountable Care Organization discussions

22.  It seems  likely that PHDs will grow in multiple ways– and that they will require representation and advocacy support to be successful.  likely that Commissioner Education will become increasingly important.  unlikely that the demands for transparency and issues related to OPMA and PRA will become less “noisy” over the next few years.  AWPHD, in some form, will be valuable!

23.  Over the next year, promote vision of rural hospitals in a reformed health care system  Emphasize the value of local hospital care the to local community and to policy makers  Improve Commissioner understanding of trends and emerging role  Support You!

24.  How much support can PHD’s afford?  Growing pressure on dues: In 2011 AWPHD will spend about 1/2 what it spent in 2005. But the pressure on hospitals to cut expenses has really just begun.  FOCUS ON VALUE! AWPHD will maximize value of each dollar we ask for, ensure its use is consistent with members’ greatest needs.

25. CAN YOU CHANGE QUICKLY ENOUGH? CAN YOU AFFORD NOT TO?  “It is neither the biggest nor the fastest that “wins” at evolution—it is the most adaptable.” Charles Darwin