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National Health and Health Care Reform. Ron Manderscheid, PhD Global Health Sector, SRA Intl., Inc. & Bloomberg School of Public Health, Johns Hopkins University. Some Framing Issues. Stepping Out of Our Comfort Zone Making New System Assumptions Developing Key Action Vectors. - PowerPoint PPT Presentation
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National National HealthHealth and and Health CareHealth Care Reform Reform
Ron Manderscheid, PhDRon Manderscheid, PhD
Global Health Sector, SRA Intl., Inc.Global Health Sector, SRA Intl., Inc.&&
Bloomberg School of Public Health, Johns Hopkins UniversityBloomberg School of Public Health, Johns Hopkins University
Some Framing IssuesSome Framing Issues
Stepping Out of Our Comfort ZoneStepping Out of Our Comfort Zone Making New System AssumptionsMaking New System Assumptions Developing Key Action VectorsDeveloping Key Action Vectors
Some Reform DriversSome Reform Drivers
Economic Meltdown (Health Reform Economic Meltdown (Health Reform mustmust be be related to National Economic Recovery)related to National Economic Recovery)
New Front Office in Washington (New Approach New Front Office in Washington (New Approach to Health Reform—President’s 8 Principles)to Health Reform—President’s 8 Principles)
New Approach to Entitlement Programs (SSA, New Approach to Entitlement Programs (SSA, Medicare, Medicaid)Medicare, Medicaid)
Addressing Chronic Disease (Current Model Addressing Chronic Disease (Current Model Doesn’t Work!— http://www.pfcd.org )Doesn’t Work!— http://www.pfcd.org )
President’s 8 Principles of ReformPresident’s 8 Principles of Reform
Protect Families’ Financial HealthProtect Families’ Financial Health Make Health Coverage AffordableMake Health Coverage Affordable Aim for UniversalityAim for Universality Provide Portability of CoverageProvide Portability of Coverage Guarantee ChoiceGuarantee Choice Invest in Prevention and WellnessInvest in Prevention and Wellness Improve Patient Safety and Quality CareImprove Patient Safety and Quality Care Maintain Long-Term Fiscal Sustainability Maintain Long-Term Fiscal Sustainability
Sobering StatisticsSobering Statistics
Current Cost of Health Care: $2.3 T/yr.Current Cost of Health Care: $2.3 T/yr. Current Cost of Chronic Care: $1.6 T/yr.Current Cost of Chronic Care: $1.6 T/yr. Estimate of Waste in System: $685 B/yr.Estimate of Waste in System: $685 B/yr. Expenditures on “Health”: 5%Expenditures on “Health”: 5% 17% are uninsured (34% for MH/SU). 80% of 17% are uninsured (34% for MH/SU). 80% of
public mental health consumers are public mental health consumers are unemployed.unemployed.
US ranks in the low 30s on basic health US ranks in the low 30s on basic health measures—behind Slovakia and Cuba. measures—behind Slovakia and Cuba.
We Have Been One-DimensionalWe Have Been One-Dimensional
Focus Only on Disease:Focus Only on Disease:
No Disease Disease No Disease Disease
We Need to Become Two We Need to Become Two DimensionalDimensional
Focus on Disease and Health:Focus on Disease and Health:
HealthHealth
No Disease Disease No Disease Disease
No Health No Health
Model of Wellness and Illness Model of Wellness and Illness (1981)(1981)
New Thinking:New Thinking:
WellnessIllness
Recovery
ImplicationsImplications
Illness Dimension Illness Dimension Illness Care Illness Care Wellness Dimension Wellness Dimension Promotion of Promotion of
Wellness and Wellbeing (sometimes Wellness and Wellbeing (sometimes called Positive Health or Health called Positive Health or Health Promotion)Promotion)
Representative Patrick Kennedy: “Stop it Representative Patrick Kennedy: “Stop it where it starts!”where it starts!”
Wellness EvolutionWellness Evolution
Preventive and Promotion Interventions for Preventive and Promotion Interventions for PersonsPersons
Preventive and Promotion Interventions for Preventive and Promotion Interventions for PopulationsPopulations
Population “Health Coaches”Population “Health Coaches” Population InsurancePopulation Insurance
Moving Further UpstreamMoving Further Upstream
Healthy People 2020 Framework Healthy People 2020 Framework emphasizes health determinants and emphasizes health determinants and interventions to address them; health care interventions to address them; health care is a secondary objective.is a secondary objective.
Healthy People 2020 ModelHealthy People 2020 Model
Some Key Behavioral Health Some Key Behavioral Health “Needs”“Needs”
Need to implement more consumer control of Need to implement more consumer control of health care and health (upstream factors)health care and health (upstream factors)
Need practical integration models:Need practical integration models: 25 years lost to premature death25 years lost to premature death MH/SU comorbiditiesMH/SU comorbidities Comorbidities with physical illnessesComorbidities with physical illnesses
Need to update an aging workforce Need to update an aging workforce Need “comparative effectiveness” resultsNeed “comparative effectiveness” results Need to stem erosion of financial toolsNeed to stem erosion of financial tools Need care coordinators and peer counselorsNeed care coordinators and peer counselors
Expected LegislationExpected Legislation
Senator Kennedy and Senator Baucus:Senator Kennedy and Senator Baucus: Insurance Coverage: 47 million +18/20 million (?)Insurance Coverage: 47 million +18/20 million (?) System Reform: Medical/Health Home ModelSystem Reform: Medical/Health Home Model Financing: Medicaid and SCHIP expansions, Financing: Medicaid and SCHIP expansions,
potentially Medicare, paid through employers who do potentially Medicare, paid through employers who do not insure employees and recoup of HHS funds.not insure employees and recoup of HHS funds.
Senator HarkinSenator Harkin Cover promotion and prevention interventions in Cover promotion and prevention interventions in
insurance benefitsinsurance benefits
Key UnknownsKey Unknowns
Impact of massive change on the health Impact of massive change on the health infrastructure.infrastructure.
Phase-in period that will be required.Phase-in period that will be required.
Some Key Questions for UsSome Key Questions for Us
How will we develop and implement health How will we develop and implement health promotion/disease prevention services? promotion/disease prevention services? Or disease prevention services for the Or disease prevention services for the chronic physical diseases?chronic physical diseases?
As the medical/health home is developedAs the medical/health home is developed—major role for primary care—how will we —major role for primary care—how will we change?change?
Some Key Questions for UsSome Key Questions for Us
FQHCs represent one medical/health FQHCs represent one medical/health home model. Are we working with them? home model. Are we working with them? Do we plan to do so? Other approaches to Do we plan to do so? Other approaches to the medical/health home?the medical/health home?
What would be different if principal funding What would be different if principal funding for services were fully through an for services were fully through an insurance model (by person)? How are we insurance model (by person)? How are we going to get there?going to get there?
American Recovery and American Recovery and Reinvestment Act of 2009Reinvestment Act of 2009
(Conference Version)(Conference Version)
Prevention and Wellness Fund: $1 BPrevention and Wellness Fund: $1 B Comparative Effectiveness Res.: $1.1 BComparative Effectiveness Res.: $1.1 B Federally Qualified Health Centers $2.5 BFederally Qualified Health Centers $2.5 B HHS IT Initiatives $2 BHHS IT Initiatives $2 B Workforce Training $500 MWorkforce Training $500 M
Looking ForwardLooking Forward
Representative Patrick Kennedy has Representative Patrick Kennedy has announced a White House Conference on announced a White House Conference on Mental Health and Neuroscience.Mental Health and Neuroscience.
We all hope that this will represent an We all hope that this will represent an outstanding opportunity for behavioral outstanding opportunity for behavioral healthcare.healthcare.
What Are Your 2-3 Key Action Vectors?What Are Your 2-3 Key Action Vectors?
Contact InformationContact Information
Ron Manderscheid, PhDRon Manderscheid, PhD Director, Mental Health and Substance Use ProgramsDirector, Mental Health and Substance Use Programs Global Health Sector, SRA Intl., Inc.Global Health Sector, SRA Intl., Inc. 6003 Executive Blvd., Suite 400 6003 Executive Blvd., Suite 400 Rockville, MD 20852Rockville, MD 20852 240-514-2607 (V)240-514-2607 (V) 240-514-2601 (F)240-514-2601 (F) 301-787-1414 (C)301-787-1414 (C) [email protected][email protected] www.sra.comwww.sra.com Enhancing human health around the world, everyday. Enhancing human health around the world, everyday.
