Pittsburgh Nonprofit Summit - Health Care & Health Care Reform - Implications for Nonprofits and the...

Health Care & Health Care ReformImplications for Nonprofits & the People They Serve

10:00am – 11:15amFacilitator: Candi Castleberry-Singleton, UPMC

Speakers: Karen Feinstein, Jewish Healthcare Foundation / Dr. Donald Fischer, Highmark / Susan Rauscher, Catholic Charities

Share your thoughts!

• Text “Summit” to 57682 with your feedback and thoughts on today’s event!

• Share your thoughts on Twitter by adding #GPNPSummit to your tweets!

© Pittsburgh Regional Health Initiative 2011 3

Karen Wolk Feinstein,PhDPres ident & Chief Executi ve Offi cer

Pitt sburgh, PA M ay 1 2 , 2 0 1 1Spreading Quality,

Containing Costs.

Health Care and Health Care Reform – Implications for Non-profits and the People They Serve

2011 Nonprofit Summit


Original Intent, What Might We Have Missed


Where Value Derives

THE PATIENT

• Outcomes of Care

• Efficiency of Care

• Zero Defects

Value begins at the frontline


Top 1% Top 5% Top 10% Top 15% Top 20% Top 50% Bottom 50%

0%

20%

40%

60%

80%

100%

22.9%

49.5%

65.2%74.6%

81.2%

97.0%

3.0%

Percent of Population, Ranked by Health Care Spending

Focus on Spending Leads to Complex PatientsP

erce

nt

of T

ota

l H

ealth

Car

e S

pend

ing

The 5% of the U.S. population with highest health care expenses was responsible for nearly half of total health care spending

Concentration of Health Care Spending in the U.S. Population, 2007


Treating Chronic Illness Accounts for 75% of Expenditures

Major chronic in-terventional

34%

Chronic illness man-agement

35%

Major acute/ interven-tional23%

Minor acute8%

Preventive use only<1%

Percent of costs associated with medical needs

Source: Luft, Harold. Total Cure. Cambridge, 2008: Harvard University Press. pg. 66


Currently: Where do the $$$ go? Hospital Care

Hospital Care31%

Physician and clinical services21%

Retail sales of prescription durges10%

Program administration and net cost of private insurance

7%

Investment in research, structures and equipment

7%

Nursing home care6%

Other professional serives and personal care

6%

Dental services4%

Government public health activi-ties3%

Home health care3%

Retail sales of durable medical equipment1%

% of Healthcare Spending, U.S., 2008

Source: Modern HealthcareJanuary 11, 2010, pg. 7


The Complex Patient

Who is frequently hospitalized?

Do you know your customer?

Are you meeting their need?


Let the Data Guide Work

The Complex Patient

HIV/AIDS End of Life

Skilled Nursing

Chronic Disease(COPD)

Behavioral Health and Substance Abuse

Multiple Conditions


Why So Many Readmissions?

“Nobody integrates care for the medical condition as a whole and across the full cycle of care, including early detection, treatment, rehabilitation, and long-term management.”

- Michael E. Porter & Elizabeth Olmstead Teisberg, PhD


The Second Systems Vision: Transforming the Care of Complex Patients

Acro

ss C

are

Setti

ngs

Essential Services System Requirements

Care Mgt

Clinical Pharmacy

Patient Engagement

Health IT

QI Training

Financial Incentives

Collaboration and

Integration

Medication Reconciliation

Informed Activated

Discerning Consumers

Data to Treat,

Measure, Evaluate

Perfect Patient

Care

RewardsFor Quality

Hospice/Palliative

Long Term Care

Rehab

Hospital

Emergency Services

Specialty Care

Primary Care

Screening and Tx

Behavioral Health


Reducing Preventable Hospitalizations: Behavioral Health Comorbidities

Patients with co-morbid depression are more likely to be readmitted

% Readmitted with No Secondary

Depression

% Readmitted with Secondary Depression

Asthma 29% 42%

COPD 43% 51%

Pneumonia 34% 42%

All Other 29% 37%

Source: PRHI Analysis of PHC4 Data 2005-2006, SW PA

Patients with depression and co-morbid substance use disorders are more likely to be hospitalized for four days or longer


Reducing Preventable Hospitalizations:PPC in Skilled Nursing Facilities (SNFs)

6% of seniors in SNFs = 17+% of healthcare costs

20% of hospital patients discharged to a SNF were readmitted

51% of residents have one or more ER visits

38% have a hospitalizations: 41% are readmitted


PRHI Research on HIV-positive Patients

562 patients / 1,072 admissions (FFY 2007-2008)

One in four patients readmitted within 30 days

Nearly half of admissions have co-morbid depression and/or substance abuse, which can compromise self-care

High readmission rates may be attributed to flawed transitions in care — just like other chronic medical problems

Thank you from the Greater Pittsburgh Nonprofit

Partnership!

Workshop Evaluation

Text “HCR” to 57682 with your answers to the following questions:

• Please rate the overall value of this workshopE – Excellent G – Good P – Poor F – Fair

• Did you learn anything that you will apply at your own organization?Y – Yes N - No

• Please text other comments and feedback.

Submit by hitting “send!” You will receive an auto-reply from the GPNP.Sample text: “HCR E Y I’m beginning to understand the Health Care Act

more.”

Pittsburgh Nonprofit Summit - Health Care & Health Care Reform - Implications for Nonprofits and the...

News & Politics

Transcript of Pittsburgh Nonprofit Summit - Health Care & Health Care Reform - Implications for Nonprofits and the...