Selectively Supplementing Alaska’s Health Care TransformationA Working Discussion Using Transforming Health Care in Alaska 2009 Report/2010-2014
Strategic Plan as a Baseline
May 12, 2011
Working Draft
2
Most Americans Have No Conception of the StructuralBarriers to Alaskan Health Care
Population concentrations in a handful of locations, butReal Health Care Needs in Rural Locales
Limited Road Network Supplemented by Aircraft and BoatsImpede Routine and Timely Health Care Delivery
Limited Broadband Access in the State, Although Initiative Underway as Part of Federal Stimulus Package by Rural UtilitiesService – Department of Agriculture
Hospitals and Clinics Tend to be Concentrated and AreFunctionally Overlapping
3
Primary
Care
Psychiatri
st
Pharmacis
ts
Therapist
s
Behaviora
l Health
0102030
Percentage of Current Vacancies
Primary Care Includes Nurse Practitioners and OthersBesides Physicians, But Estimates Are that Primary CarePhysicians Must Increase by > 50% in Next 5 Years
While Most Healthcare Positions AreConcentrated in Urban Areas, SizeableDemand for Care in Rural Alaska
1991 200905
10
Alaskan Healthcare Costs ($B)
>6B1.6B
Dol
lars
(Bill
ions
)
Increased UtilizationInflation Undetermined0246
Causes of Average Annual 8.9% Cost Increase
Perc
enta
ge A
nnua
l Inc
reas
e
Reality: A Shortage of Health Care Workers and RapidlyRising Health Care Costs
Source: Derived from 2010-2014 Strategic Plan
Source: Derived from 2010-2014 Strategic Plan
Source: Derived from 2010-2014 Strategic Plan
Source: 2010-2014 Strategic Plan
Perc
ent
4
Alaska’s Population Likely Will Continue to Grow
Projected Increase in Aging Alaskan Population
Reality: The “Government” Cannot Bear the Health CareCosts Implied by Long Term Demographics
Who Pays the Healthcare Bill Today?
Government
Employers
Individual Alaskans
64%17%
19%
“Government” includes state, local, Federal
Percent of Total Alaskan Population
Alaskan Na-tivesRest of Popu-lation
2009
18%
82%
Percent of Total Alaskan Population
Alaskan Na-tives Rest of Popu-lation
20%
80%
2034
Assuming “Middle Estimate” for PopulationGrowth, the Total Alaskan Population WillIncrease by 23% by 2034 – With the NativeAlaskan Population Growing at a Faster Rate (37%)Than the Rest of the Population (20%)
Source: Derived from 2010-2014 Strategic Plan
Source: Derived from Elisabeth Mercer, “Population Projections,2010-2034: Alaska by age, sex, and race”, Alaska Economic Trends December, 2010
Source: Elisabeth Mercer, “Population Projections,2010-2034: Alaska by age, sex, and race”, Alaska Economic Trends December, 2010
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Evidence-Based PracticesSpecialists to Primary Care PhysiciansSpecialists to Other Primary Care --------------------------------------------------------Behavioral Health Expertise (See specialists in backup slides)Chronic Disease Treatment (Can be readily assemble along BH model)Wellness (e.g., Life Options Group, Happy Circles)Family Programs Integration
Multiple Modalities of CareFace-to-FaceTelephone Call Centers (e.g., Life Options Group)Portable Diagnostic & Wellness Tools (e.g., NASA module by CBT)Web-Based Platform for Asynchronous Communication with Healthcare workers and Care Recipients (e.g., LifeOptions Group)Web Services 3.0 Delivery of Personalized Care and Wellness Training (e.g., Nexxus Systems, directThought)
Shift to Patient Centric, Preventive Care ModelTailored programs for alcohol, prescription drug, substance abuse and obesity and exercise (e.g., University of Chicago, BIG Initiative)Delivered via multiple modalities
Selectively Leverage TechnologiesVirtual Health Training of Physicians, Nurses other Healthcare workers (e.g., BreakAway Ltd)EHR/HIE: Explore Open Source Solutions (e.g., Open Health Tools)
Develop Models of Public-Private Partnerships Federal GovernmentState GovernmentLocal GovernmentsPrivate EmployersHospitals and clinics – private, military, tribalNon-profits
Sustainability will hinge on Increasing Return on Investment, Curbing Increases in Health Care Costs &Creating a New Public Private Partnership Model
Based on Findings and Recommendationsof 2010 – 2014 Strategic Plan
Needs of Native Alaskans and Rest of Population Have Commonalities and Differences
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Identify 85% Complete List of Stakeholders and
Elicit Requirements
Outline the “To-Be” State (2034) & Basic Structure of Public
Private Partnership& Outreach Plan
Collect Information on Progress in Implementing
Commissions RecommendationsHigh-Level Business
Process ModelHigh-Level Data Flow
DiagramSummarize “As Is” State
Need “Champion(s)” and Outreach Plan to Alaskans and Federal Government
Reality: Cannot Rely on Sustained or Increased Federal Funding in Current Fiscal Environment
What Needs to be Done Now: Lay the Foundation for Adaptive Change
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Open Discussion
William D. Bajusz, Ph.D., ITIL®Vice President, Business DevelopmentGoldbelt Wolf, [email protected] Profile: www.LinkedIn.com/in/WilliamBajusz
Cindi BookoutDirector, Family ProgramsGoldbelt Glacier – Health Services, [email protected]
Focused PH Expertise
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Depression & bipolar disorder
• Michael Thase, MD, University of Pennsylvania• Gregory K. Brown, PhD, University of Pennsylvania
Mood Disorders • Sam Ozersky, AB, MD, FRCPC, Mood Disorders Clinic,
University of Toronto • Claudia Zayfert, PhD, Dartmouth Hitchcock Medical Center
PTSD & Anxiety• Brett T. Litz, PhD, Boston University• Murray B. Stein, MD, MPH,FRCPC, UCSD• Barbara O. Rothbaum, PhD, Emory School of Medicine
TBI • Murray B. Stein, MD, MPH,FRCPC, UCSD
Substance Abuse • Brian Shaw, PhD, BFS Consulting, Toronto Canada
Alcohol & Prescription Drug
Abuse
• Eric Goplerud, PhD, Center for Integrated Behavioral Health Policy, GWU
Sexual Abuse & Response
• Lisa M. Najavits, PhD, Boston University School of Medicine and Lecturer at Harvard Medical School
Integrating Technology & PH Expertise
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Medical Informatics
• Steven E. Locke, MD, Harvard Medical School• Thomas R. Zastowny, PhD, Consultant to DoD with
significant field experience
Emergentologist, CPHIMS
• Marion Lyver, MD, VP of Informatics, Mensante Corporation, Consultant & Member of Board of Directors of Canada’s Health Informatics Association
Web-Based Motivational & Crisis Coaching
• Steve Cole, MD, MA, Stony Brook University Medical Center
• Paul Earl, PhD, COO, LifeOptions Group, Inc.
Mental Health & Technology
• DeeAnna Merz Nagel, Med, LPC, LMHC, CEO of On-Line Therapy Group
EAP• Dennis Derr, EdD, Director of Behavioral Health at
Aetna®
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