Berkeley Forum s Vision for California s Healthcare System and Palliative Care Presentation to the New America Media Journalism Fellowship Program

Transcription

1 Berkeley Forum s Vision for California s Healthcare System and Palliative Care Presentation to the New America Media Journalism Fellowship Program Clare Connors, MPH, Research Associate, Berkeley Forum for Improving California s Healthcare Delivery System School of Public Health, University of California, Berkeley July 12, 2013

2 2 Outline Berkeley Forum report overview - Berkeley Forum participants and report Affordability crisis Berkeley Forum Vision - Initiatives summary Palliative Care

3 3 Berkeley Forum Participants Health Plans Anthem Blue Cross Blue Shield of California Health Net Kaiser Permanente Providers Cedars-Sinai Medical Center Dignity Health HealthCare Partners Medical Group MemorialCare Health System Monarch HealthCare Sharp HealthCare Sutter Health Public Sector California Department of Insurance Dave Jones, Insurance Commissioner* California Health and Human Services Agency Diana S. Dooley, Secretary* U.S. Department of Health and Human Services Herb K. Schultz, Regional Director (Region IX)* *These individuals participation in the Forum meetings/discussions does not represent any formal endorsement of the Report by their state or federal Department/Agency nor in their official individual capacities as elected or appointed public officials at the aforementioned Departments/Agencies

4 4 Berkeley Forum Report A New Vision for California s Healthcare System: Integrated Care with Aligned Financial Incentives - Released February 26, 2013: rkeley.edu Many of the following tables and figures can be found in our report above

5 5 Health insurance premiums projected to consume up to 32% of household income in 2022 Historical ( ) and Projected ( ) Employer-Sponsored Health Insurance Premiums for Single and Family Coverage as a Percent of Median Household Income in California

6 6 Integration case study: Mr. Jones 62 year-old Mr. Jones diagnosed with congestive heart failure 3 years ago

7 7 Berkeley Forum Vision Integrated Care - Double the share of the state's population receiving care via fully or highly integrated care systems from 29% in 2012 to 60% by 2022 Payment Reform - Rapid shift towards risk-adjusted global budgets - Reduce the share of healthcare expenditures being paid via fee for service from 78% in 2012 to 50% in 2022 Population Health - Emphasis on population health, including lifestyle and environmental factors that promote good health All working towards the Triple Aim: Better care, better health, lower cost

8 8 Four-fifths of spending is paid via FFS, and over two-thirds of patients receive care from low- or moderately-integrated systems Breakdown of Payment Mechanisms and Delivery System Integration in California, by Lives and Dollars, 2012

9 9 $110 billion in expenditure reductions possible from initiatives -- equivalent to $800 per household per year ( ) Healthcare Expenditure Reductions in California from Initiatives under Current Developments and Forum Vision Scenarios, Total Reductions,

10 10 Forum Vision reduces healthcare expenditures from 17.1% of GSP to 16.5% of GSP in 2022 Cost Curve: Projected Healthcare Expenditures as a Share of Gross State Product,

11 11 Forum interest in palliative care Forum members expressed particular interest in palliative care at the initial Forum meeting Feb 23, 2012 Leaders continually returned to this topic. Why?: - Clear win-win: Better reflects patient wishes and preferences while increasing value & reducing expenditures - Relevant to all constituents in the room - Focus on 5/50 population and concentration of high expenditures - New technology as a major driver of costs - Interest in shared-decision making and promoting informed patient - Primacy placed on global budgets/transition away from FFS (key issue in PC business case) One of the two focus areas in the report and cost-savings for communitybased palliative care modeled along with six other initiatives

12 12 Who informed Forum s PC work California HealthCare Foundation California Coalition for Compassionate Care Center to Advanced Palliative Care UCSF Palliative Care Leadership Center (Steve Pantilat) Kathleen Kerr (Consultant) CSU-San Marcos Palliative Care Institute (Karen Haynes) Children s Hospice (Devon Dabbs) City of Hope (Betty Ferrell) Sutter (Brad Stuart) Sharp (Daniel Hoefer, Suzi Johnson) Kaiser (Daniel Johnson)

13 13 California has significant room for improvement in end of life care 42% of deaths still occur in hospitals (2009) 61% of Medicare deaths are not served by hospice (2010) Median hospice enrollment length is only 18 days (all U.S.) CA is in the highest 10% of states based on a hospital intensity index in the last two years of life. In the last six months of life, California has: - Higher than U.S. average number of hospital days (11.7 days vs. 10.9) - More patients with seven or more ICU days than U.S. (20.3% vs. 15.2%)

14 14 Forum Report: Endorsements & Recommendations Priority conditions Workforce development Patient and general public education Quality standards Global budgets/care integration

15 15 Forum Report: Endorsements & Recommendations Strongly favors widespread access to quality palliative care for patients with serious illness, appropriate to their individual circumstances Initially prioritizes palliative care services for conditions such as oncology, advanced chronic obstructive pulmonary disease and congestive heart failure Supports the person-centric approaches undertaken by organizations such as Kaiser, Sutter (AIM) and Sharp (Transitions) Encourages greater investment in workforce development (such as through the new Palliative Care Institute at CSU) Supports broader education for the general public on PC and advanced care planning Encourages the development and uptake of quality provider standards Believes that progress towards Forum Vision is critical to increasing the adoption of PC

16 16 Forum Initiative: Increase Use of Community-based Palliative Care (PC) The Forum wanted to focus on the next step community/outpatient palliative care where programs are much less developed We roughly estimated that perhaps only 10% of patients that are good candidates for it are receiving community-based PC in California today Studies suggest that PC generally results in lower and/or shorter hospitalizations and ICU stays, reduced ED visits, and increased selection of hospice care Forum Vision goal: increase access to and adoption of community-based PC - Increase penetration from estimated current 10% to 50% by 2022 Estimated expenditure reduction : $11.4 billion (0.3% of total expenditures) : $2.4 billion (0.4% of 2022 total expenditures) Care improvement

17 17 Next Steps Forum was initially conceived as a one-year project, but will continue to collaborate Palliative Care emphasis Address potential implementation barriers including: - developing a PC workforce - establishing the business case for PC - identifying appropriate patients - improving patient education/misperceptions about PC Partnering with other organizations working to advance palliative care

18 18 Questions Thank you! Clare Connors,