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4/15/16
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WHOLE HEALTH:
Change the Conversa5on
Healthcare: Where We’ve Been, Where We Want to Go
VETERANS HEALTH ADMINISTRATION
Do you remember when you were first called to the healing arts?
The Calling
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VETERANS HEALTH ADMINISTRATION
Brief Exercise
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Write in your binder (page 20): • What is wrong with the prac5ce of healthcare today?
• What is right with the prac5ce of healthcare today?
VETERANS HEALTH ADMINISTRATION
Challenges
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VETERANS HEALTH ADMINISTRATION
Challenges: Information Technology / Data
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VETERANS HEALTH ADMINISTRATION
Challenges: Metrics
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VETERANS HEALTH ADMINISTRATION
Challenges: Incentives
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VETERANS HEALTH ADMINISTRATION
Challenges: Retaining Quality Personnel
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VETERANS HEALTH ADMINISTRATION
Challenges: Values
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Challenges: Reduced Opportunities for Collaboration
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VETERANS HEALTH ADMINISTRATION
Challenges: Health Disparities
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Challenges: Health Literacy
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VETERANS HEALTH ADMINISTRATION
Challenges: Polypharmacy
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Challenges: Direct to Consumer Marketing
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VETERANS HEALTH ADMINISTRATION
Challenges: Microbial Resistance
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Challenges: Scheduling
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VETERANS HEALTH ADMINISTRATION
History
It has been said that the best educaPon for a president of the United States comes from an inPmate study of the lives, leUers, and papers of his predecessors.
Some believe that the study of history can be of as great a spiritual and pracPcal value to a healthcare provider as to a president.
16 VETERANS HEALTH ADMINISTRATION
A Brief History of Medicine
• Ancient healers • Chinese medicine • Ayurveda • Ancient Greeks • The Romans • Middle Ages • 19th century • 20th century • 21st century
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VETERANS HEALTH ADMINISTRATION
A Brief History of Medicine
PrimiPve Medicine
TradiPonal Chinese medicine
Ayurveda
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vhines200 via Foter.com / CC BY-‐ND
VETERANS HEALTH ADMINISTRATION
A Brief History of Medicine
Ancient Egypt
Hippocrates
Aristotle
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Raed Mansour via Foter.com / CC BY
idea_hamster via Foter.com / CC BY-‐NC
Lawrence OP via Foter.com / CC BY-‐NC
VETERANS HEALTH ADMINISTRATION
A Brief History of Medicine
The Romans
Galen
Middle Ages
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fabio finocchioli via Foter.com / CC BY-‐NC-‐SA
VETERANS HEALTH ADMINISTRATION
History – Skip to 1800s
1812, first arPcle in NEJM -‐ treaPse on angina pectoris wriUen by founding member of Harvard Medical School
Described paPent treated with bloodlecng, sPmulants, topical ether, opium,
laxaPves, blistering agents over sternum, causPcs to provoke draining blisters on thighs and arms.
Symptoms did not improve – paPent sent on therapeuPc voyage to the
warmer climate for winter, returned in spring. AUacks returned. Bloodlecng, arsenic, tobacco. Death.
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N Engl J Med 2012;367:1077-82.
VETERANS HEALTH ADMINISTRATION
History – Skip to 1800s
Oliver Wendell Holmes (1860) – “…if the enPre materia medica,
as now used, could be sunk to the boUom of the sea, it would be all the beUer for mankind – and all the worse for the fishes.”
22 N Engl J Med 2012;367:1077-82.
Internet Archive Book Images via Foter.com / No known copyright restricPons
VETERANS HEALTH ADMINISTRATION
A Brief History of Medicine
Many years…
1800s Anesthesia – 1842
Germ theory – 1870s 1899 -‐ aspirin
Early 1900s Blood transfusion – 1901
EKG – 1913 Insulin used – 1922 Penicillin -‐ 1928
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VETERANS HEALTH ADMINISTRATION
A Brief History of Medicine 1950s
Pacemaker – 1952 DNA – 1953
Kidney transplant – 1954
Polio vaccine -‐ 1955
Mid-‐late 1900s Human heart transplant –
1967 HIV idenPfied – 1983 Sheep cloned -‐ 1996
2000s Human genome released
– 2003 Woolly mammoth
genome sequenced – 2015
T. Rex DNA -‐ 2016
24 VETERANS HEALTH ADMINISTRATION
Medicine – Yesterday, Today, Tomorrow
Since the days of bleeding and mercury to today’s molecular
medicines, clinicians have sought new and beUer therapies. The task and complexity of the mission are extraordinary.
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N Engl J Med 2012;367:1077-82.
VETERANS HEALTH ADMINISTRATION
There’s More To It
Drugs are necessary but not sufficient for transforming health.
N Engl J Med 2012;367:1077-‐82.
VETERANS HEALTH ADMINISTRATION
Connecting
“Only connect! … Only connect the prose and the passion, and both will be exalted, and human love will be seen at its height. Live in fragments no longer. Only connect, and the beast and the monk, robbed of the isolaPon that is life to either, will die.”
EM Forster
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VETERANS HEALTH ADMINISTRATION
The Privilege of Being a Healthcare Provider
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VETERANS HEALTH ADMINISTRATION
The VA – A Leader in Healthcare - For All of Us
The VA healthcare system has consistently out-performed the non-VA/private sector in quality of care and patient safety. The VA healthcare system has been a model for accountability – detecting problems and working to improve upon them. The VA is full of top professionals, many of whom could earn more elsewhere, who are committed to the values of a system that is anchored in service to our nation’s Veterans. Forbes, May 23, 2014
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VETERANS HEALTH ADMINISTRATION
Service VA Style
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• The largest integrated healthcare system in the U.S.
• 150 medical centers, ~ 1,400 community-‐based outpaPent clinics, community living centers, Vet Centers and Domiciliaries.
• Over 53,000 independent licensed health care pracPPoners
providing comprehensive care to more than 8 million Veterans each year.
VHA’s Path of Transformation
The Past
“What’s the maUer with you?”
Physician Dependent
Case-‐Based Paper Medical Record
“We’ll address your immediate concern.”
Moving Toward Personalized, Proac5ve, Pa5ent-‐Driven Care
“What maUers to you?
Clinical Team, PACT
Electronic Medical Record Focused on
Disease/Injury/Illness
“You have a risky problem, please follow this plan to improve by
your next visit.”
Personalized, Proac5ve, Pa5ent-‐Driven Care
“How can we help you live the life
you want to?”
Veteran, Family and Health Care Team
Electronic Health Record
(with Personal Health Goals)
“Let’s work together to create a plan that fits your
life.”
Changing Approach to Care Connecting the Dots
Enhancing Veteran Health & Well-‐being
Mission
Strategic Planning Priority #1
Blueprint for
Excellence Strategy 6
My VA
USH Priori5es
Honor America’s Veterans by providing exceptional health care that improves their health and well-being.
Goal 1: Provide Veterans personalized, proactive, and patient-driven health care.
Strategy 6: Advance a model of health care that is personalized, proactive, and patient-driven, and engages and inspires Veterans to their highest possible level of health and well-being.
VA is shifting the current culture of medical care from problem-‐based ”sick care” to “whole health care,” which engages and inspires Veterans to their highest level of health and well-‐being.
1. Access to Care 2. Employee Engagement 3. Consistency of Best Practices and Resource Prioritization 4. Development of a High Performance Network 5. Restore Trust and Confidence
VETERANS HEALTH ADMINISTRATION
Beyond the VA Crisis – Becoming a High-Performance Network
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“Our “whole health” model of care is a key component of the VA’s proposed future delivery system. This model incorporates physical care with psychosocial care focused on the veteran’s personal health and life goals, aiming to provide personalized, proacPve, paPent-‐driven care through mulPdisciplinary teams of health professionals.”
David J. Shulkin, M.D. N Engl J Med 2016; 374:1003-‐1005
VETERANS HEALTH ADMINISTRATION
Whole Health Key Characteristics • Personalized:
“My care is customized to me – my health concerns, my life, my values, even my genes (if available)”
• Proac5ve: “This approach not only addresses my specific medical treatments, but it also addresses ways to strengthen my innate capacity to heal – such as mind-‐body and nutriPonal approaches before surgery or during chemo.”
• Pa5ent Driven: “My care is based in an exploraPon of what maUers to me, and is designed to help me live my fullest life. This makes my healthcare truly important to me.”
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VETERANS HEALTH ADMINISTRATION
Mission: ‘Sick care to Health care’
• In 2011, the NLC and the former USH approved the whole health model of care as VHA’s healthcare delivery model
• Earlier this year, the Secretary’s MyVA plan highlighted a shis from a problem-‐based ‘sick care’ to ‘whole health care’ by engaging and inspiring Veterans to their highest level of health and well-‐being.
VETERANS HEALTH ADMINISTRATION
Pathways: Whole Health Partnership
Whole Health Partnership: SystemaPc approach to form a lasPng partnership with Veterans at the point of enrollment, and support their whole health, integraPng their self care and clinical care, where ever it is received. Includes: Whole Health Pathway
Health & Well-‐Being Center
Healthcare Clinic
VETERANS HEALTH ADMINISTRATION
Integrative Health Coordinating Center
• Guide and support development of IntegraPve Health throughout VHA – Clinical InnovaPon, Research &
EvaluaPon, EducaPon – Policy, Human Resources,
Veteran Benefits, Metrics – Seamless integraPon with
exisPng OPCC, VHA, VA iniPaPves
• Demonstrate improved health outcomes and return on investment
VETERANS HEALTH ADMINISTRATION
Whole Health Education Programs
Whole Health: Change the Conversation
Whole Health Coaching Education Course
Whole Health Facilitator Training Program
VETERANS HEALTH ADMINISTRATION
Each one of you is an integral part of the largest healthcare system in the naPon.
The VA - A Team to be Celebrated
40 VETERANS HEALTH ADMINISTRATION
Passion, Expertise, Commitment
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VETERANS HEALTH ADMINISTRATION
To this day, healthcare is a calling.
The Calling
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VETERANS HEALTH ADMINISTRATION
Solidarity
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