HEALTH  CARE  REFORM,HEALTH  CARE  REFORM,POPULATION  HEALTH  AND  THEPOPULATION  HEALTH  AND  THEFUTURE  OF  OCCUPATIONALFUTURE  OF  OCCUPATIONALAND  ENVIRONMENTALAND  ENVIRONMENTAL

MEDICINEMEDICINE

Kenneth W. Kizer, MD, MPHWOEMA Annual Meeting

San Francisco, CASeptember 14, 2012

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“The specialty of occupationalmedicine is in peril…”

Joseph LaDou, MDAm J Prev Med 2005; 28: 396-402

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Because of its position at thecrossroads of the employer-employee-

healthcare system the specialty ofoccupational and environmental

medicine is especially well-positionedto play a critical role in the future of

American healthcare.

PRESENTATION OVERVIEW

Present a brief overview of the Institute forPopulation Health Improvement

Highlight the forces driving the transition ofAmerican healthcare and the growing focus onpopulation health

Discuss the confluence of forces laying thefoundation for a renaissance of occupationaland environmental medicine

Identify some needs that OEM needs toaddress to actualize the opportunity for arenaissance

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INSTITUTE FOR POPULATIONHEALTH IMPROVEMENT,UC Davis Health System

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INSTITUTE FOR POPULATION HEALTH IMPROVEMENT Population health

The intersection of public health and the clinical sciences New payment models require that population health management

be a core competency for health care systems Established as an independent operating unit in UCDHS in

March 2011; has since developed a diverse portfolio offunded activities >$70M and >100 employees

Serves as a resource for health care reform, health policy andclinical quality improvement

Assists government health-related agencies in designing,implementing and administering programs

Seeks to Improve the effectiveness and efficiency of clinical care Build health leadership and health care management capacity Facilitate access to and leverage of data sources to develop clinical

intelligence Promotes understanding of the multiple determinants of

health and appreciation of health being a function of thetotality of one’s circumstances

Conducts research and teaching

IPHI REPRESENTATIVE ACTIVITIES Provides technical assistance and other support to Medi-Cal

(California’s $48B/yr Medicaid program) Medi-Cal Quality Improvement and DSRIP Programs Designing the Evaluation of Medicare-Medicaid Dual Eligibles Program

Manages the California Cancer Registry Administers multiple statewide chronic disease prevention and

surveillance programs for the CDPH, including: California Heart Disease and Stroke Prevention California Arthritis Partnership Project LEAN California Active Living Program Breast and cervical cancer screening for underserved women California Tobacco Control Program

Conducting a statewide assessment of surgical adverse events Investigating feasibility of developing “Community Paramedicine” Manages the California Health Information Exchange Development

Program Conducting various population health research programs

Use of the OncotypeDx Genetic Assay in Medi-Cal Beneficiaries with Breast Cancer Evaluation of Opiate Overdose Prevention Policies (in collaboration with CHPR)

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AMERICAN HEALTHCARE INAMERICAN HEALTHCARE INTRANSITION AND THE GROWINGTRANSITION AND THE GROWINGFOCUS ON POPULATION HEALTHFOCUS ON POPULATION HEALTH

The  Turbulent  Waters  of  Early  21The  Turbulent  Waters  of  Early  21stst  Century  CenturyAmerican  Health  CareAmerican  Health  Care

1. The  essenGality  of  constrainingthe  unsustainable  rise  of  healthcare  costs

2. Need  to  improve  clinical  qualityand  paGent  safety

3. Changing  demographics

4. Explosive  growth  of  newtechnology

5. Health  care  personnelshortages

6. Higher  service  expectaGons

7. Health  care  reform  legislaGon

Interna+onal  Comparison  of  Spending  on  Health,  1980–2008

0

1000

2000

3000

4000

5000

6000

7000

8000

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

United StatesNorwaySwitzerlandCanadaNetherlandsGermanyFranceDenmarkAustraliaSwedenUnited KingdomNew Zealand

Average  spending  on  healthper  capita  ($US  PPP)

0

2

4

6

8

10

12

14

16

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

United StatesFranceSwitzerlandGermanyCanadaNetherlandsNew ZealandDenmarkSwedenUnited KingdomNorwayAustralia

Total  expenditures  on  healthas  percent  of  GDP

Source: OECD Health Data 2010 (June 2010).

Premiums  Rising  Faster  Than  InflaGon  and  Wages

*  2008  and  2009  NHE  projec+ons.Data:  Calcula+ons  based  on  M.  Hartman  et  al.,  “Na+onal  Health  Spending  in  2007,”  Health  Affairs,  Jan./Feb.  2009  and  A.  Siskoet  al.,  “Health  Spending  Projec+ons  Through  2018,”  Health  Affairs,  March/April  2009.  Insurance  premiums,  workers’  earnings,and  CPI  from  Henry  J.  Kaiser  Family  Founda+on/Health  Research  and  Educa+onal  Trust,  Employer  Health  Benefits  AnnualSurveys,  2000–2009.Source:  K.  Davis,  Why  Health  Reform  Must  Counter  the  Rising  Costs  of  Health  Insurance  Premiums  (New  York:  TheCommonwealth  Fund,  Aug.  2009).

Projected  Average  Family  Premium  asa  Percentage  of  Median  Family  Income,

2008–20

0

25

50

75

100

125

2000 2001 2002 2003 2004 2005 2006 2007 2008* 2009*

Insurance premiums

Workers' earnings

Consumer Price Index

CumulaGve  Changes  in  Components  of  U.S.NaGonal  Health  Expenditures  and  Workers’

Earnings,  2000–09

Percent Percent

108%

32%

24%

1112

1314

1617

18 18 18 1819 19 19

20 2021 21

22 2223

24

18

0

5

10

15

20

25

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

Projected

Why are Healthcare Costs Rising?Why are Healthcare Costs Rising? Population growth and aging Uncontrolled proliferation of technology Increasing chronic care needs Direct to consumer marketing of healthcare

products and services American culture

High value placed on ‘choice’ Excessive demand (“consumptive society”)

Legislated healthcare service mandates Consolidation of healthcare providers Rising liability insurance costs Care variation from best evidence (i.e., poor

quality)

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Growth of Mandatory ExpenditureGrowth of Mandatory ExpendituressMandatory Expenditures

Social Security Medicare and Medicaid Interest on the national debt Veterans disability pensions

Discretionary expenditures National Defense International Aid Veterans health care Education Highways and transportation Parks Everything else

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Growth of Mandatory ExpendituresGrowth of Mandatory Expenditures

Factors affecting mandatory expenditures since 2007Recession

Increased Medicaid expenditures Marked increase national debt and debt services

Economic stimulus legislationHealth care reform legislation

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THE OPPORTUNITY FOR ATHE OPPORTUNITY FOR ARENAISSANCE OF OCCUPATIONALRENAISSANCE OF OCCUPATIONALAND ENVIRONMENTAL MEDICINEAND ENVIRONMENTAL MEDICINE

GROWING FOCUS ON POPULATION HEALTH

Stagnant or deteriorating population health The workplace and home environments are

intimately connected 7 of the 10 leading causes of mortality are linked to

lifestyle and preventable conditions Increasing amount of health care provided at home

Others

Report Says 75 Percent of Young Americans UnfitReport Says 75 Percent of Young Americans Unfitfor Military Servicefor Military ServicePublished November 05, 2009 | AP

About 75 percent of the country's 17- to 24-year-olds are ineligible for military service, largelybecause they are poorly educated, overweight and have physical ailments that make themunfit for the armed forces, according to a report issued Thursday.

Other factors, such as drug use, criminal records and mental problems, contribute to whatmilitary leaders say is a major problem that threatens the country's ability to defend itself at atime when the all-volunteer force is already strained fighting two wars.

Healthcare Costs and U.S. CompetitivenessToni  Johnson,  Deputy  Editor    |    March  26,  2012

The  United  States  spends  an  es+mated  $2  trillion  annually  onhealthcare  expenses,  more  than  any  other  industrialized  country.According  to  data  from  the  Organiza+on  for  Economic  Coopera+onand  Development  (OECD),  the  United  States  spends  two-­‐and-­‐a-­‐half+mes  more  than  the  OECD  average,  and  yet  ranks  with  Turkey  andMexico  as  the  only  OECD  countries  without  universal  healthcoverage.  Some  analysts  say  an  increasing  number  of  U.S.  businessesare  less  compe++ve  globally  because  of  ballooning  healthcare  costs.U.S.  economic  woes  have  heightened  the  burden  of  healthcare  costsboth  on  individuals  and  businesses.

GM health care billtops $60 billionCost adds $1,400 per vehicle,hurts competitivenessBy Ed Garsten / The Detroit News

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Rising Obesity Rates

Source:  Thorpe,  2009  

Total  Obesity-­‐Related  Direct  Health  Care  Spending,  U.S.  (2008-­‐2018)

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

$350,000

$400,000

2008 2013 2018

(Millions)

ProjectedHolding Obesity Rates Constant

THE ECONOMY Economic recovery will be prolonged Physical and mental health of the workforce is

inextricably linked to employee performance,engagement and productivity

Increased understanding that population healthmanagement is a long-term business strategy

The cost of job-related injuries and illnesses issizable and the majority of these costs are notborne by workers compensation

Employers and other healthcare payers need helpin designing the infrastructure and policies neededto support access to comprehensive healthcareservices for employees, families and retirees

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Health Health Care Care ReformReform

HEALTHCARE REFORM ARRA and HITECH The Affordable Care Act

Increases the number of insured and, therefore, demand forhealthcare services

Incentives for the workplace wellness programs to reducechronic diseases, promote sustainable and replicableworkplace health-related programs, and conduct peer-to-peerhealthy workplace mentoring

New healthcare payment models

The cost of job-related injuries and illnesses issizable and the majority of these costs are notborne by workers compensation

The workplace is an important venue for theprovision of healthcare services

Is creating a new healthcare economy

Union leaders forUnion leaders fornurses meet withnurses meet withEnglewood HospitalEnglewood Hospitalmanagement overmanagement overpotential layoffspotential layoffsThursday, August 23, 2012BY LINDY WASHBURNANDBARBARA WILLIAMSStaff Writers │ The RecordNorthwestern hospital confirmsNorthwestern hospital confirms

230 layoffs230 layoffsBy Peter Frost Tribune reporter 6:26 p.m. CDT, August 22, 2012

Northwestern Memorial Hospital confirmedWednesday that it has laid off 230 employees overthe last month as part of an effort to reduce its coststructure by a quarter by 2017.

August 8, 2012, 5:52 a.m. ET

Westchester MedicalWestchester MedicalCenter lays off moreCenter lays off moreworkersworkers

August 15, 2012

Health system cost-cutting changesHealth system cost-cutting changeswill include staff reductionswill include staff reductionsThe Cumberland Times-News Wed Aug 15, 2012, 10:37 PM EDT

CUMBERLAND — Changes are coming for theWestern Maryland Health System and itsemployees. The changes will include staffingreductions through attrition and some “involuntaryseparations.”

Health care mass layoffs escalateHealth care mass layoffs escalateAug. 6, 2012

The number of people losing their jobs in a mass layoff from a hospital oran ambulatory care center spiked of Labor Statistics. A mass layoff isdefined as at least 50 people losing their jobs from a single entity in oneday. in June, according to a monthly report issued July 20 by the U.S.Bureau

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CAPITALIZING ON THECAPITALIZING ON THEOPPORTUNITYOPPORTUNITY

SOME NEEDS FOR OEM TO ACTUALIZE ITSOPPORTUNITY

Better and more granular data on The role of the work place as a cause or contributor to acute and chronic

illnesses and injuries The impact of job-related injuries and illnesses on American productivity and

population health Greater worksite health data connectivity with other healthcare

providers and payers Broader engagement of OEM physicians with healthcare providers

and payers, especially in areas such as disability management andhealth promotion and disease prevention

Increased understanding of the many determinants of health andproductivity and the many ways that employers can influence these

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QUESTIONS/COMMENTSQUESTIONS/COMMENTS