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the faces of health care reform Slide 2 reform in america Slide 3 employer-sponsored health care 1940s1940s Slide 4 government-sponsored health care To provide coverage for the elderly as well as poor women and children, Congress enacted Medicare & Medicaid in the mid- 1960s. 1960s1960s Slide 5 What I am proposing will require employers to provide basic health insurance for their employees. In the past, we have taken similar action to assure workers a minimum wage, to provide disability and retirement benefits. We should go one step further and guarantee that all workers will receive adequate health insurance protection. President Richard Nixon February 18, 1971 1970s1970s employer mandatefrom a republican?? Slide 6 The Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986 requires hospitals to screen and stabilize (treat) every patient who comes to the hospital ED seeking care, regardless of the patients ability to pay and regardless of what it costs the hospital to provide the care. 1980s1980s health care for allthrough an unfunded mandate Slide 7 government-centric reform? 1990s1990s Slide 8 Dole and his fellow Republicans argued for a market-based system designed around an individual mandate and the creation of state insurance exchanges. 1990s1990s no thanks! Slide 9 20062006 medicare expanded Slide 10 the affordable care act 20102010 Slide 11 strategic directions coverage delivery system reforms payment reforms transparency health IT Slide 12 implications for hospitals achieve solid hospital-physician (clinical) alignment measure, report and deliver superior outcomes reduce costs form strategic alliances Slide 13 implications for physicians apply evidence-based practices to achieve best clinical results deliver the right careat the least cost coordinate your patients care with other providers learn to manage risk in partnership with hospital and physician colleagues Slide 14 To repeal, or not to repeal Slide 15 players in the repeal drama Slide 16 You must never confuse faith that you will prevail in the endwhich you can never afford to lose with the discipline to confront the most brutal facts of your current reality, whatever they might be. making sense of health care reform: the stockdale paradox Slide 17 reform in south carolina Slide 18 We have to contend with the politics of health care reform, but our future is in redesigning care Slide 19 Transmit Transport Treat mission lifeline Slide 20 heart attack patients given pci within 90 minutes of arrival Collaboration accelerates performance improvement! Slide 21 mission lifeline data 5/1/2015 2010, American Heart Association 21 Slide 22 average door to balloon time Time in minutes improvement rate: 33% Slide 23 state comparisons Hospital Compare latest data Slide 24 Slide 25 Slide 26 stop bsi collaborative Slide 27 Baseline and Remeasurement Rates for STOP BSI Collaborative 36% reduction21% reduction Slide 28 safe surgery 2015 Goal: 100% of South Carolinas acute care hospitals using the surgical checklist in every operating room for every surgical patient by 12/31/2013 Slide 29 Most recent data year Baseline year South Carolina was recently ranked by the federal government (AHRQ) as one of five states making the greatest improvements in the quality and safety of health care. -published by AHRQ report in 2010 ahrq 2010 data reports Slide 30 the faces of health care reform