Five Principles of HROs

• preoccupation with failure: having proactive analysis and discussion knowing that theres the possibility of failures
• sensitivity to operations:paying attention to the front line
• reluctance to simplify interpretations: question assumptions and recieved wisdom
• commitment to resilience: detect, contain and bounce back from errors
• deference to expertise: authority to person with most expertise

IHI Triple Aim

• Population Health
• Experience of Care
• Per Capita Cost

National Health Expenditures per Capita

• in 1990 $2,814
• 2009 is $8,160
• 2018 projected $13,100

Past Outcomes of Care Measures

• volume of services
• provider centric and specific measures
• individual process steps (with outcome assumed)
• new care measures moving forward

New Outcome of Care Measures 

moving forward

• value of services
• patient centered measures
• scope of processes(w/ outcomes to be proven)
• actual outcomes achieved

Elements of Experience

• access to care:provider availability, perception of care, access to care/information outside of office hours
• continuity of care: navigability of care, provider interaction
• patient engagement in care: evidence of patient activation/leadership, design of care to meet patient expectations, provision of understandable advice/guidance to patient

October 1, 2013

• the marketplace officially opens
• consumers can start submitting applications and enrolling for coverage

January 1, 2014

• marketplace plan coverage begins
• medicaid expansions begin in many states
• new insurance protections begin, such as the ban on denying coverage based on pre-existing conditions
• minimum essential coverage requirement begins

March 31, 2014

• the first marketplace open enrollment period ends
• after this date consumers will no be able to get health coverage through the marketplace until the nexter anual enrollment period(fall 2014)
• unless they have a qualifying life event like a job loss, birth or divorce

Top Complaints of US Healthcare

• lack of insurance
• US GDP spending on health care was unsustainable
• inefficient payment system
• lack of consistent technology
• focus on treatment instead of prevention
• US ranked  37th for healthcare-worst ranking of western country

Tort Reform

• medical malpractice 
• refers to proposed changes in common law civil justice systam that would reduce tort litigation or damages

Public Hospitals

• prisons
• va
• state-FQHC (federally qualified health centers)
• local
• federal

Private Hospitals

• not for profit
• religious 
• for-profit
• physician owned hospitals

How many patients experience adverse events as a result of care deficiences in US hospitals?

• 1 out of 3 patients

WWII and Health Care

• inequality in health coverage
• the hospital survey and construction act of 1946
• fee for service starts to transition to employer paid insurance or third-party payment system began

Lydon Johnson

• 1965 social security act
• is health a human right
• insuring the elderly and the disabled

Reagan

• 1980 reaganomics
• disbanded the healthy system agency
• competitive market place
• increase in medical tech and knowledge
• increase in disease- AIDS

Clinton

• 1990s
• american health security act of 1993
• emergence of HMO-mission of efficiency in health care and the way it is delivered-utilization-market based economics
• 1996-executive order-children health insurance program

Ford and Nixon

• 1974 national health planning and resources development act
• development of health care agencies/systems throughout the country
• there needed to be federal oversight-which caused the creation of the health care system agencies

George W. Bush

• 2003-medicare prescription drug act-Part D
• health savings account-Tax free health care dollars $$$$

How many times has US congress

voted to defund ACA

• 37 times

Insurance reform

• increase people covered
• increase benefits
• lower cost

Will the Health Reform law require nearly all americans to have health insurance starting in 2014 or else pay a fine?

• No
• Yes
• I dont know

• Yes the law will do this

Will the health reform law establish a government panal to make decisions about end of life care for people on medicare?

• no the law will not do this

Federal Poverty Level

• in 2012 is 11,170 for a single and 23,050 for a family of 4

Federal Payroll Tax

• increases from 0.9% to 2.35% for those people who make over 200k individually or 250k as a couple
• also a 3.8 assesment on unearned incomes for these taxpayers

Patient-Centered Medical Home (PCMH)

• a model for care, provided by physician-led practices, that seeks to strengthen the physican-patient relationship by replacing episodic care based on illnesses and individual's complaints with coordinated care for all life stages
• the physician led care team is responsible for coordinating all of the individuals health care needs

Pre-Existing Condition Insurance Program

(PCIP)

• insures individuals who have pre-existing conditions and have been uninsured for at least six months
• goal of PCIP is to tide these individuals over until 2014 when insurers can no longer deny

Basketball model

• from fractured health care book
• when us puts together olympic team of the superstars (best on planet)
• often dont fair as well because everyone likes to hold on to the ball for themselves
• similar to insurance as in system where no one talks to each other and defensive medicine

Six Pillars of Reform

• coverage
• delivery/work force reform
• cost reform
• health insurance reform
• quality of services
• wellness and prevention

California Silver Plan

• single- income $45k
• $2500 deductible
• $45-$65 for office visits

Hospital Reimbursement

• depends on the following
• location
• procedure
• insurance(private and public)
• patient outcomes

ACA increased coverage

• preexisting conditions
• no lifetime limits
• no anual caps
• 63 preventitive services
• supply and demand 

Doctors and Reimbursement 

• many exchanges have not announced rates
• pressure to keep premiums low because of low income enrollees
• many doctors not joining
• concern if exchange plans will be functioning to reimburse
• estimations indicate a fall by 20% in reimbursement

Independent Payment Advisory Board

• 15 person panel
• medicare solvency
• reduce spending growth
• cannot ration care
• cannot increase revenue or change benefits
• cannot change beneficiary premiums