Thinking Beyond Our Borders
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DESCRIPTIONAcademyHealth President and CEO Lisa Simpson's presentation for the Richard and Janet Southby Distinguished Lecutreship in Comparative Health Policy at the George Washington University Hospital on April 24, 2012
- 1. Thinking Beyond Our Borders:What We Can Learn about ImprovingCare from Other CountriesDr. Lisa SimpsonPresident and CEOApril 24, 2012
2. Outline Introduction What do international studies tell us abouthealth and health care in the U.S.? Leading Approaches in Other Countries Burgeoning Field of Implementation Science Concluding Thoughts 3. AcademyHealth: ImprovingHealth & Health CareAcademyHealth is a leading national organization serving the fields of healthservices and policy research and the professionals who produce and use thisimportant work.Together with our members, we offer programs and services that support thedevelopment and use of rigorous, relevant and timely evidence to:1. Increase the quality, accessibility and value of health care,2. Reduce disparities, and3. Improve health.A trusted broker of information, AcademyHealthbrings stakeholders together to address the currentand future needs of an evolving health system,inform health policy, and translate evidence into action.3 4. Leveraging >4,500 Diverse,Expert Members & OrganizationsAcademyHealth Interest Groups Behavioral Health Services Research Health Workforce Child Health Services Research Interdisciplinary Research Group on Nursing Issues Disability Research Long-Term Care Disparities Public Health Systems Research Gender and Health Quality & Value Health Economics Translation & Communications Health Information Technology State Health Research and Policy4 3 5. Mission and ProgramsMethods and professional skill-buildingseminars, methods councilAddress the current andElectronic Data Methods (EDM) Forumfuture needs of anChanges in Health Care Financing andevolving health systemOrganization (HCFO)Multi-payer Claims Database (MPCD)Annual Research MeetingAHRQ Knowledge Transfer InitiativeBeacon Evaluation and Innovation NetworkInform health policyNational Library of Medicines HSRProjNational Health Policy ConferencePublic Health Services ResearchAHRQ Healthcare Innovations ExchangeState Coverage InitiativesTranslate evidenceAHRQ Medicaid Medical Directorsinto action Learning NetworkAdvocacy and Public Policy5 6. Conferences Annual Research Meeting (ARM) June 24-26, 2012 in Orlando, FL Over 2,000 attendees Health Policy Orientation October 22-25, 2012 in Washington DC Limited to 50 participants National Health Policy Conference(NHPC) February 4 5, 2013 in DC Over 800 attendees 7. AcademyHealth Focus 2012-2014 Fundamental program areas Generate new knowledge Move knowledge into action Strategic priority areas Health care costs and value Delivery system transformation Public and population health Push audiences Delivery system leaders States 8. ARM Opportunities for Students Registration and hotel discounts Scholarships Meet-the-expert breakfast Networking events Career Coaches Awards for best dissertation & poster 9. Declaring My Biases!1. The US is far too insularin its approach to theworld!2. There is much to belearned from othercountries as we struggleto improve health andhealth care.3. Others in the audienceknow far more than I do! 10. Agenda Introduction What do international studies tell us abouthealth and health care in the U.S.? 11. Dimensions of Comparison Health and outcomes Health care costs Health care utilization 12. Adults Who Report Being Daily Smokers, 2009 THECOMMONWEALTHFUND Percent 40 3028.0 26.2 24.9 21.9 21.5 21.5 21.0 20.4 2019.0 18.1 16.6 16.2 16.1 14.3 100 NETH FR*JPN GER UK OECD NOR SWIZ** DEN NZ** AUS** CAN USSWEMedian* 2008.** 2007.Source: OECD Health Data 2011 (June 2011). 13. Obesity (BMI>30) Prevalence Among Adult Population, 2009 THE COMMONWEALTH FUNDPercent40MeasuredSelf-reported3533.83026.524.624.22523.020 14.715 11.811.211.2 10.010 8.15 3.90 US*NZ** AUS** CAN*UKGER NETH FR*SWENOR* SWIZ** JPNNote: Body-mass index (BMI) estimates based on national health interview surveys (self-reported data)are usually significantly lower than estimates based on actual measurements.* 2008.** 2007.Source: OECD Health Data 2011 (June 2011). 14. Breast Cancer Five-Year Relative Survival Rate, THECOMMONWEALTH 20022007 (or nearest period)FUNDPercent10090.587.186.1 85.282.4 82.1 81.9 80 78.5 60 40 20 0 US CAN SWENETH DENNZ NORUKSource: OECD Health Care Quality Indicators Data 2009. 15. Diabetes Lower Extremity Amputation Rates THEper 100,000 Population Age 15 and Older, 2007 COMMONWEALTHFUND 4036 3021 20 16 1312 12 12 11 1111 109 0 US* DEN SWIZ* FR NZ Median*** SWE CAN NETH** NOR UK* 2006.** 2005.*** Among countries shown.Source: OECD Health Care Quality Indicators Data 2009. 16. Mortality After Admission for Acute Myocardial Infarction* THE per 100 Patients, 2007 COMMONWEALTHFUND 8 6.6 6.3 6 5.14.2 43.3 3.22.9 2.9 2 0NETH**UK US* CANNZNOR DEN SWE* In-hospital case-fatality rates within 30 days of admission.** 2006.*** 2005.Source: OECD Health Care Quality Indicators Data 2009. 17. THEHealth Spending per Capita, 2009COMMONWEALTHFUND Adjusted for Differences in Cost of LivingDollars$7,960$8,000$7,000$6,000 $5,352$5,144 $4,914$5,000 $4,218 $4,363$3,978$4,000 $3,722 $3,445 $3,487 $2,983$3,000$2,000$1,000 $0 NZ AUSUKSWEFRGER CANNETH SWIZ NOR US (10.3%) (8.7%)* (9.8%) (10.0%) (11.8%) (11.6%) (11.4%) (12.0%) (11.4%) (9.6%) (17.4%) % GDP* 2008.Source: OECD Health Data 2011 (June 2011). 18. 18 Health Care Spending per Capita by Source of Funding, 2009Adjusted for Differences in Cost of LivingDollars7,9608,000 9767,000 Out-of-pocket spendingPrivate spending6,000 Public spending 5,3523,189 5,1445,000 8084,363 4,21843 1,568 3,9784,000636 5523,722291 3,487 3,445504646 4245876202,983 693646272,8783,000 188 399454 476 184 4,501 992,000 3,795 3,0723,0813,242 3,1003,033 2,9352,3422,4002,3251,000 0 USNOR SWIZ CANGERFRSWE UKAUS*NZJPN* THECOMMONWEALTHFUND* 2008.Source: OECD Health Data 2011 (June 2011). 19. 19Average Health Care Spending per Capita, 19802009Adjusted for differences in cost of living Dollars 8000 USNOR 7000 SWIZNETH 6000CANDEN 5000GER 4000 FRSWE 3000 UKAUS 2000NZJPN 1000 0 1980198419881992 1996 2000 2004 2008 THECOMMONWEALTHFUNDSource: OECD Health Data 2011 (June 2011). 20. Out-of-Pocket Spending and Problems Paying Medical Bills in Past YearTHE COMMONWEALTH FUNDMore than US$1,000 in Serious problems paying or out-of-pocket costsunable to pay medical bills Percent 60 50 39 4035 36 30 27 24 20 1613 1411 12 11 1078885 6 56 411 0Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries. 21. 21 Average Annual Number of Physician Visits per Capita, 200914 13.212108.2 86.9 6.5 6.3 6 5.7 5.5 5.0 4.6 4.3 4.0 3.9 4 2.9 2 0JPN* GER FR AUSOECD NETH CAN*UKDEN NZ** SWIZ** US*SWE MedianTHE* 2008.COMMONWEALTH** 2007. FUNDSource: OECD Health Data 2011 (June 2011). 22. Patients with a Regular Doctor versus a Medical Home THE COMMONWEALTH FUNDHas a regular doctor or place of carePercent Has a medical home 99 9999 999997 97100100 96 9591 80 74 70 65 6056 535251 4948 48 40 33 20 0UKSWIZ NZ US NOR FR AUS CANGERNETH SWE Patients with a medical home have a regular practice who isaccessible, knows them, and helps coordinate their careSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries. 23. Rated Quality of Care in Past Year as Excellent or Very Good, THE by Medical HomeCOMMONWEALTHFUND Percent 100Medical homeNo medical home88 837977 80 72 72 6562 6059 57 6056 494644 4443 40 383534 2726 20 0 AUS CAN FR GER NETH NZ NOR SWE SWIZUKUSSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries. 24. Waited Less Than a Month to See Specialist THECOMMONWEALTHFUND Percent 10092 88 81 8079 8068 67 6359 60 5247 40 200SWIZUS NETHUKGERNZ FR SWE AUS CAN NORBase: Saw or needed to see a specialist in the past two years.Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries. 25. Shared Decision-Making with Specialists THECOMMONWEALTHFUNDPercent reporting positive shared decision-making experiences with specialists*100 80 79 80 72 67 67 6461 6050 4840 37 40 20 0 SWIZUK NZ NETH US AUSCANGER SWENOR FR* Reported specialist always/often: 1) Gives opportunities to ask questions about recommended treatment;2) Tells you about treatment choices; and 3) Involves you as much as you want in decisions about your care.Base: Seen specialist in past two years.Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries. 26. Cross-Cutting Themes and Implications Outcomes and quality have improved but there is room forimprovement in all countries There is a clear need to contain public spending Per capita spending has risen by 70% since the early90s U.S. is an outlier on access and affordability Cost-sharing and benefit design matters Strong primary care medical homes make a difference inall countries 27. Health care systems: getting more value for money (OECD Report, 2010) There is no health care system that performs systematicallybetter in delivering cost-effective health care. On average, life expectancy at birth could be raised by morethan two years, while holding health care spending steady, if allcountries were to become as efficient as the best performers. Health outcomes are highly disparate across individuals andsuch inequalities can be reduced without sacrificing efficiency There is no one-size-fits-all approach to reforming health caresystems. By improving the efficiency of the health care system, publicspending savings would be large, approaching 2% of GDP onaverage in the OECD. 28. Outline Overview of AcademyHealth How the U.S. Compares: Quality andOutcomes Leading Approaches in Other Countries 29. Strategies in Use OECD: Reliance on market mechanisms andregulations to steer demand andsupply Coverage principles to promote equity Budget and management approachesto control public spending 30. Market Mechanisms Users Price signals Gate keeping & limited choice among providers Providers Mitigating volume incentives Regulating prices Enhancing patient choice User information on quality and price 31. Common International Trends Standardizing and integrating healthinformation technology and other electronicdata innovations Bolstering the research enterprise andintegrating CER into decision-making Engaging patients meaningfully in their careand shifting the perspective of research to bepatient-centeredKalipso Chalkidou, NICE International 32. Engaging Patients American patients who feel engaged by theirproviders are more likely to rate their care as highquality than engaged patients in other countries Low income patients were less likely to feel engagedthan higher income patients American patients are likely to report positive careexperience, even if clinical needs were not met American patients exhibited the greatest disparities incare and engagementR. Osborn and D. Squires, "International Perspectives on Patient Engagement:Results from the 2011 Commonwealth Fund Survey," Journal of Ambulatory CareManagement, April/June 2012 35(2):11828. 33. Divergent Actions, Similar Trends Compared: OECD Health Care Quality Indicators Project and the US National Healthcare Quality Report Found: Choice of breadth or priorities Methods must be developed to both edit indicatorsand preserve core set for longitudinal study Communication, translation, dissemination are key Momentum mattersEdward T. kelley 1 , 2 , Irma Arispe 3 and Julia Holmes 3Beyond the initial indicators: lessons from the OECD Health Care Quality IndicatorsProject and the US National Healthcare Quality ReportInt J Qual Health Care (September 2006) 18 (suppl 1): 45-51. doi: 10.1093/intqhc/mzl027http://intqhc.oxfordjournals.org/content/18/suppl_1/45.long 34. US Activity vs. International Generate the right data and Generate the right data andevidenceevidence Inform patient choice as well as Convergence of payer and traditional decision makers regulator use of CER HIT, electronic data, systematic HIT, electronic data, systematic reviews, real-world reviews, cost-focused analysis, demonstrations, measure international pilots, measure standardization/harmonization standardization/ harmonization Identify the right populations Identify the right populationsand partnersand partners Patient- centered research Patient- centered research, Engage both to make more product developers, health system professionalsinformed and creative ideas PCORI, patient-centered Engage both to make more medical homesinformed and creative ideas Value-based pricing 35. Population Health, Patient Experience, Per Capita Cost HHS implementation in the US IHI Triple Aim Partners 2011 UK (NHS) Australia Sweden Singapore New Zealand Canadahttp://www.ihi.org/offerings/Initiatives/TripleAim/Pages/Participants.aspx 36. Population Health is the health outcomes of a group ofindividuals, including the distributionof such outcomes within the group. Group can be defined by geography orinclude other types such as employees,ethnic groups, disabled persons, etcSource: Kindig and Stoddart. What is Population Health? Am J Public Health.2003 March; 93(3): 380383.36 37. Population Health Churchill had it right! Americans will make the right choice, after Costs have put it on the table Private sector focus ACA 38. Provisions in ACA for Population Health Addresses need for systematicapproach to definition, funding, evidencebase, communication, and need forcooperation. The introduction of a reliable, steadystream of funding for public healthresearch. Encourages development and use ofcommon metrics to measureeffectiveness. Promotes prevention in the health caresystemSource: Bovberg, et al. What directions for Public Health under theAffordable Care Act? The Urban Institute Health Policy Center, November2011. 39. Population Health Because improvement in population health requiresthe attention and actions of multiple actors(legislators, managers, providers, and individuals),the field of population health needs to pay carefulattention to the knowledge transfer and academic-practice partnerships that are required for positivechange to occur. Moves beyond current distinction between publichealth programs & health care delivery Integrated approach supported by multiple aspects ofthe ACASource: Kindig and Stoddart. What is Population Health? AmJ Public Health. 2003 March; 93(3): 380383.39 40. Health in All Policies Approach Increasing awareness that factors outside of the health system affect health status Incorporates Social Determinant perspective Policy Relevance Improved productivity Reduced health care costs (economic security)40 41. Evidence-Generating Orgs 42. How to Act on what we Learn? Though we aregenerating newevidence, aligninginterests andpartnering withstakeholders how dowe translate,disseminate, andimplement what weknow to improve care? 43. Agenda Overview of AcademyHealth How the U.S. Compares: Quality andOutcomes Leading Approaches in Other Countries Burgeo...