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BUILDING A THRIVING COMMUNITY
2014 NACo Healthy Counties Forum San Diego, CA January 30, 2014
T H E C A S E O F L I V E W E L L S A N D I E G O
Nick Macchione, FACHE Agency Director Health and Human Services Agency County of San Diego, CA
WHAT THE HEALTH IS GOING ON IN SAN DIEGO?
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GAME CHANGERS IN HEALTH CARE Laws & Policies: PPACA, State Realignments
Demographics: Aging, Diversity/Latinization
Epidemiology: Chronic Diseases, Health Inequity
Technology: Information Technology, Biotech
Consumer Value = Price + Outcome + Experience
Globalization: New emerging markets
Cost: Health GDP and National Deficit
TRADITIONAL BUDGET BALANCING APPROACH
Cut people from care Cut provider rates Cut services
Meanwhile…
THE FOURTH PATH Change how care is delivered to improve health and wellness: Optimize existing healthcare, public health and social
service resources to innovate new service delivery, reduce waste and improve outcomes Create local accountability by all, not some
₋ Health (and Safety) In-All-Policies ₋ Promote individual responsibility
Achieve fiscal sustainability thru new payment reforms Connect the Unconnected thru modernized IT Advance evidence-based policy making and planning
WELLNESS TRIPLE AIM
Improved Health and Social Well Being for the
Population
Lower Cost per Capita
Better Services for Individuals
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Building Better Health
Living Safely Thriving
Building Better Health
Living Safely Thriving
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Building Better Health
Pursuing policy and environmental changes
Improving the culture from within
Building a better service delivery system
Supporting positive healthy choices
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Population Health Leadership
Admin
Neighborhood
Patient-Centered Health Home
10 March 19, 2008 Team San Diego GMU Module 1 Draft 10 10
Inpatient/ Outpatient
Care Public Health
Behavioral Health
Military/Veteran Services
Social Services
Accountable Care Community
Individual
White Space (No Network)
“Love-Fest”
“Rumble in the Jungle”
“Co-opetition” (San Diego County)
THE
LEVE
L O
F CO
MPE
TITI
ON
THE LEVEL OF COOPERATION
Meet Donald
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His wish is simple, NOT to sleep in any more hospital beds!
What’s at stake?
One Person Many Facets
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
Within 30Days
Within 60Days
Within 90Days
12.6% 17.0%
24.3%
2.3% 5.7% 8.0%
SMH Readmission Rate for 2009
“Transitions Care Coach first, nurse second.” “Personalized
Technology”
“Healthy Bottom Line”
Treating the Cause, Not the Illness!
Horizontal Integration & Silo Busting
In-Home Services
Day Health Care
Acute Hospital
Transit Skilled
Nursing Facility
Medical Specialty
Meals Service
Primary Care
PATIENT
Patients/caregivers provided social support services, by referral or direct provision, to reduce the risk of avoidable readmission.
CARE TRANSITIONS INTERVENTION Evidence-based program to reduce hospital readmissions
Patient- and caregiver-centered
Supported by a Transition Coach
Patients with complex care needs receive specific tools - electronic or paper Patients learn self-management skills
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IT Boomers!
Providing alternative
pathways for general
information and access to services
Live Well Roadmap
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Live Well, San Diego is capitalizing on the inherent linkages between the public, private, and non-profit sectors and using them to promote wellness at the client and neighborhood levels.
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Innovation Works!
Using innovative approaches such as mobile libraries that take services
to residents in their own
neighborhoods
Live Well Perspective Matures
Past
Transactional
Volume-Based
Competitive Advantage
Silos & Categorical
Connecting the Unconnected
Sick Care/Social Welfare
Present Future
Transformative
Value-Based
Co-opetition
Integrated System
InterOptimability
Wellness
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QUIET OPTIMISM Policy makers, providers, customers and advocates are
committed
Relationships are expanding and being built on trust
Shifting from collaboration/integration to generation
Realistic approach with implementation – marathon, not a sprint
Data sharing & Technology have become effective enablers
Winnable battles on chronic health and safety conditions are showing improvements with meaningful results
Public is beginning to believe and engage
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Live Well San Diego!
