What is Driving Health Care Reform and How to Use it for Success

Edward O’Neil, PhD, MPA, FAANeoneil@thecenter.ucsf.edu

Director and ProfessorThe Center for Health Professions

University of California, San Francisco

2

Health Care Cost and Obama Agenda

• Cost doubled as % of GDP in thirty years

• CBO is projecting double again to 30% by 2035.

• Increases not driven aging population

• Costs do not appear to contribute to quality.

• An enormous opportunity for the nation to rebuild health care on a more effective and responsive foundation.

Source: CBO Health Fact Sheet, http://www.cbo.gov/publications/collections/health.cfm

Sources of Growth in Projected Federal Spendingon Medicare and Medicaid (Percentage of GDP)

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Current Drivers - Demographic - Aging

Source: U.S. Census Bureau

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Current Drivers - Diversity- DisparityLife Expectancy at Birth, US

6870.7

72.774.7 75.775.6

78.1 79.4 79.9 80.6

69.768.2

64.563.860

76.575.173.672.568.3

60657075808590

1970 1980 1990 2000 2006 2006

Source: National Center for Health Statistics, HHS, National Vital Statistics Report, August 19, 2009http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_01.pdf

White Male

Black Female

White Female

Black Male

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Changes in Cause of Death, 1900–1999

Source: Centers for Disease Control and Prevention. Control of infectious diseases, 1900–1999. Morbidity and Mortality Weekly Report 1999; 48:621–629.

6

Growing Disease Burden

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• By 2030, 171 million Americans, nearly half the population, will have one or more chronic condition

The Number of People with Chronic Conditions is Rapidly Increasing (millions of people by year)

100110120130140150160170180

1995 2000 2005 2010 2015 2020 2025 2030

• Medicare spending is 12% of the federal budget and is expected to increase 8% every year from 2007 to 2016

Source: Wu, Shin-Yi and Green, Anthony. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000

7

30

32

34

36

38

40

Perc

ent

1997 1999 2000 2001

Limitation of Activity Casused by Chronic Condition, >65

SOURCE: Health US, 2003, USHHS, CDC,NCHCS, October 2003, 56.

Current Drivers - Epidemiology

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Paradigms

• Effective tools• Make things work• Provide

coherence • Eventually, limit

what we think we can do

• Fail0

1020

30

40

5060

70

80

Inputs

Prod

uctiv

ity

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Current Situation- Comparative use

6.4 7.0 6.45.9 5.1 4.0

0.0

5.0

10.0

15.0

JapanGermany

France

Canada

UK US

Annual MD Consults Percapita

SOURCE: Health Affairs, V 28, 5, 2009, p1311

21.7

1 0.90.9

0.7

0.0

1.0

2.0

JapanGermany

France

Canada

UK US

Bed Days Per Capita

$2,474$3,251$3,306$3,460

$2,580

$6,347

-$1,500

$500

$2,500

$4,500

$6,500

JapanGermany

France

Canada

UK US

Per Capita Spending US$

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Changing Role• Consumer choice• New market entrants• Price sensitive • 4 of 5 bankruptcies in 08 • Richer array of services• Consolidated

broker/integrators

Consumer- Emerging View

Warning: Not actual RNs

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Macro Reform: Change the Model or…

PracticeModel

ManagePrevent Diagnosis

Treat

•Training

•Money

•Technology

•Consumer

Great leverage

Long-term

Consumer driven

Expensive

Good models

Professional role

•Self-help groups

•Oral health

•Dx centers

•Self tests

•Start of life

•Drug delivery

•End of life

•Chronic diseasePracticeModels

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What does it take to keep the paradigm going?

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Transition

Today• Acute treatment• Cost unaware• Professional

prerogative• In-patient • Individual

profession• Traditional practice• Information as

record• Patient passivity

Tomorrow• Chronic prevention

and management• Price competitive• Consumer

responsive• Ambulatory – Home

and Community• Team• Evidence based

practice• Information as tool• Consumer

engagement and accountability

Strategic Success

Source: Center for the Health Professions, UCSF.

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HTTP://FUTUREHEALTH.UCSF.EDU

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