supplementing alaskan healthcare transformation

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Selectively Supplementing Alaska’s Health Care Transformation A Working Discussion Using Transforming Health Care in Alaska 2009 Report/2010-2014 Strategic Plan as a Baseline May 12, 2011 Working Draft

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Page 1: Supplementing Alaskan Healthcare Transformation

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

Page 2: Supplementing Alaskan Healthcare Transformation

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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

Page 3: Supplementing Alaskan Healthcare Transformation

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

Page 4: Supplementing Alaskan Healthcare Transformation

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

Page 5: Supplementing Alaskan Healthcare Transformation

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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

Page 6: Supplementing Alaskan Healthcare Transformation

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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

Page 7: Supplementing Alaskan Healthcare Transformation

7

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]

Page 8: Supplementing Alaskan Healthcare Transformation

Focused PH Expertise

8

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

Page 9: Supplementing Alaskan Healthcare Transformation

Integrating Technology & PH Expertise

9

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®