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Thinking Beyond Our Borders
 

Thinking Beyond Our Borders

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AcademyHealth 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 ...

AcademyHealth 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

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    Thinking Beyond Our Borders Thinking Beyond Our Borders Presentation Transcript

    • Thinking Beyond Our Borders:What We Can Learn about ImprovingCare from Other Countries Dr. Lisa Simpson President and CEO April 24, 2012
    • Outline Introduction What do international studies tell us about health and health care in the U.S.? Leading Approaches in Other Countries Burgeoning Field of Implementation Science Concluding Thoughts
    • AcademyHealth: Improving Health & 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, and 3. 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
    • Leveraging >4,500 Diverse, Expert Members & Organizations AcademyHealth 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 Policy 4 3
    • Mission and Programs Methods and professional skill-building seminars, methods councilAddress the current and Electronic Data Methods (EDM) Forumfuture needs of an Changes in Health Care Financing andevolving health system Organization (HCFO) Multi-payer Claims Database (MPCD) Annual Research Meeting AHRQ Knowledge Transfer Initiative Beacon Evaluation and Innovation NetworkInform health policy National Library of Medicine’s HSRProj National Health Policy Conference Public Health Services Research AHRQ Healthcare Innovations Exchange State Coverage InitiativesTranslate evidence AHRQ Medicaid Medical Director’sinto action Learning Network Advocacy and Public Policy5
    • 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
    • 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
    • ARM Opportunities for Students Registration and hotel discounts Scholarships Meet-the-expert breakfast Networking events Career Coaches Awards for best dissertation & poster
    • Declaring My Biases! 1. The US is far too insular in its approach to the world! 2. There is much to be learned from other countries as we struggle to improve health and health care. 3. Others in the audience know far more than I do!
    • Agenda Introduction What do international studies tell us about health and health care in the U.S.?
    • Dimensions of Comparison Health and outcomes Health care costs Health care utilization
    • Adults Who Report Being Daily Smokers, 2009 THE COMMONWEALTH FUND Percent 40 30 28.0 26.2 24.9 21.9 21.5 21.5 21.0 20.4 20 19.0 18.1 16.6 16.2 16.1 14.3 10 0 NETH FR* JPN GER UK OECD NOR SWIZ** DEN NZ** AUS** CAN US SWE Median* 2008.** 2007.Source: OECD Health Data 2011 (June 2011).
    • Obesity (BMI>30) Prevalence Among Adult Population, 2009 THE COMMONWEALTH FUND Percent 40 Measured Self-reported 35 33.8 30 26.5 24.6 24.2 25 23.0 20 14.7 15 11.8 11.2 11.2 10.0 10 8.1 5 3.9 0 US* NZ** AUS** CAN* UK GER NETH FR* SWE NOR* 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).
    • Breast Cancer Five-Year Relative Survival Rate, THE COMMONWEALTH 2002–2007 (or nearest period) FUND Percent 100 90.5 87.1 86.1 85.2 82.4 82.1 81.9 80 78.5 60 40 20 0 US CAN SWE NETH DEN NZ NOR UKSource: OECD Health Care Quality Indicators Data 2009.
    • Diabetes Lower Extremity Amputation Rates THE per 100,000 Population Age 15 and Older, 2007 COMMONWEALTH FUND 40 36 30 21 20 16 13 12 12 12 11 11 11 10 9 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.
    • Mortality After Admission for Acute Myocardial Infarction* THE per 100 Patients, 2007 COMMONWEALTH FUND 8 6.6 6.3 6 5.1 4.2 4 3.3 3.2 2.9 2.9 2 0 NETH** UK US* CAN NZ NOR DEN SWE* In-hospital case-fatality rates within 30 days of admission.** 2006.*** 2005.Source: OECD Health Care Quality Indicators Data 2009.
    • THE Health Spending per Capita, 2009 COMMONWEALTH FUND 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 AUS UK SWE FR GER CAN NETH 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 Health Care Spending per Capita by Source of Funding, 2009 Adjusted for Differences in Cost of LivingDollars 7,9608,000 9767,000 Out-of-pocket spending Private spending6,000 Public spending 5,352 3,189 5,1445,000 808 4,363 4,218 43 1,568 3,9784,000 636 552 3,722 291 3,487 3,445 504 646 424 587 620 2,983 69 364 627 2,8783,000 188 399 454 476 184 4,501 992,000 3,795 3,072 3,081 3,242 3,100 3,033 2,935 2,342 2,400 2,3251,000 0 US NOR SWIZ CAN GER FR SWE UK AUS* NZ JPN* THE COMMONWEALTH FUND* 2008.Source: OECD Health Data 2011 (June 2011).
    • 19 Average Health Care Spending per Capita, 1980–2009 Adjusted for differences in cost of living Dollars 8000 US NOR 7000 SWIZ NETH 6000 CAN DEN 5000 GER 4000 FR SWE 3000 UK AUS 2000 NZ JPN 1000 0 1980 1984 1988 1992 1996 2000 2004 2008 THE COMMONWEALTH FUNDSource: OECD Health Data 2011 (June 2011).
    • Out-of-Pocket Spending and Problems Paying Medical Bills in Past Year THE COMMONWEALTH FUND More than US$1,000 in Serious problems paying or out-of-pocket costs unable to pay medical bills Percent 60 50 39 40 35 36 30 27 24 20 16 13 14 11 12 11 10 7 8 8 8 5 6 5 6 4 1 1 0Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries.
    • 21 Average Annual Number of Physician Visits per Capita, 2009 14 13.2 12 10 8.2 8 6.9 6.5 6.3 6 5.7 5.5 5.0 4.6 4.3 4.0 3.9 4 2.9 2 0 JPN* GER FR AUS OECD NETH CAN* UK DEN NZ** SWIZ** US* SWE Median THE* 2008. COMMONWEALTH** 2007. FUNDSource: OECD Health Data 2011 (June 2011).
    • Patients with a Regular Doctor versus a Medical Home THE COMMONWEALTH FUND Has a regular doctor or place of care Percent Has a medical home 99 99 99 99 99 97 97 100 100 96 95 91 80 74 70 65 60 56 53 52 51 49 48 48 40 33 20 0 UK SWIZ NZ US NOR FR AUS CAN GER NETH SWE Patients with a medical home have a regular practice who is accessible, knows them, and helps coordinate their careSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries.
    • Rated Quality of Care in Past Year as “Excellent” or “Very Good,” THE by Medical Home COMMONWEALTH FUND Percent 100 Medical home No medical home 88 83 79 77 80 72 72 65 62 60 59 57 60 56 49 46 44 44 43 40 38 35 34 27 26 20 0 AUS CAN FR GER NETH NZ NOR SWE SWIZ UK USSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries.
    • Waited Less Than a Month to See Specialist THE COMMONWEALTH FUND Percent 100 92 88 81 80 79 80 68 67 63 59 60 52 47 40 20 0 SWIZ US NETH UK GER NZ 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.
    • Shared Decision-Making with Specialists THE COMMONWEALTH FUND Percent reporting positive shared decision-making experiences with specialists* 100 80 79 80 72 67 67 64 61 60 50 48 40 37 40 20 0 SWIZ UK NZ NETH US AUS CAN GER SWE NOR 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.
    • Cross-Cutting Themes and Implications Outcomes and quality have improved but there is room for improvement in all countries There is a clear need to contain public spending  Per capita spending has risen by 70% since the early 90’s U.S. is an outlier on access and affordability  Cost-sharing and benefit design matters Strong primary care “medical homes” make a difference in all countries
    • Health care systems: getting more value for money (OECD Report, 2010) There is no health care system that performs systematically better in delivering cost-effective health care. On average, life expectancy at birth could be raised by more than two years, while holding health care spending steady, if all countries were to become as efficient as the best performers. Health outcomes are highly disparate across individuals and such inequalities can be reduced without sacrificing efficiency There is no “one-size-fits-all” approach to reforming health care systems. By improving the efficiency of the health care system, public spending savings would be large, approaching 2% of GDP on average in the OECD.
    • Outline Overview of AcademyHealth How the U.S. Compares: Quality and Outcomes Leading Approaches in Other Countries
    • Strategies in Use OECD: – Reliance on market mechanisms and regulations to steer demand and supply – Coverage principles to promote equity – Budget and management approaches to control public spending
    • 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
    • Common International Trends Standardizing and integrating health information technology and other electronic data innovations Bolstering the research enterprise and integrating CER into decision-making Engaging patients meaningfully in their care and shifting the perspective of research to be patient-centered Kalipso Chalkidou, NICE International
    • Engaging Patients  American patients who feel engaged by their providers are more likely to rate their care as high quality than engaged patients in other countries  Low income patients were less likely to feel engaged than higher income patients  American patients are likely to report positive care experience, even if clinical needs were not met  American patients exhibited the greatest disparities in care 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):118–28.
    • 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 indicators and 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
    • US Activity vs. International Generate the right data and  Generate the right data and evidence evidence – 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 populations and partners and partners – Patient- centered research – Patient- centered research, Engage both to make more product developers, health system professionals informed and creative ideas – PCORI, patient-centered  Engage both to make more medical homes informed and creative ideas – Value-based pricing
    •  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
    • Population Health is…  …the health outcomes of a group of individuals, including the distribution of such outcomes within the group.  Group can be defined by geography or include other types such as employees, ethnic groups, disabled persons, etc…Source: Kindig and Stoddart. “What is Population Health?” Am J Public Health. 2003 March; 93(3): 380–383. 36
    • Population Health Churchill had it right! – Americans will make the right choice, after… Costs have put it on the table – Private sector focus – ACA
    • Provisions in ACA for Population Health Addresses need for systematic approach to definition, funding, evidence base, communication, and need for cooperation. The introduction of a reliable, steady stream of funding for public health research. Encourages development and use of common metrics to measure effectiveness. Promotes prevention in the health care systemSource: Bovberg, et al. “What directions for Public Health under theAffordable Care Act?” The Urban Institute Health Policy Center, November2011.
    • Population Health • “Because improvement in population health requires the attention and actions of multiple actors (legislators, managers, providers, and individuals), the field of population health needs to pay careful attention to the knowledge transfer and academic- practice partnerships that are required for positive change to occur.” • Moves beyond current distinction between public health programs & health care delivery • Integrated approach supported by multiple aspects of the ACASource: Kindig and Stoddart. “What is Population Health?” AmJ Public Health. 2003 March; 93(3): 380–383. 39
    • “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
    • Evidence-Generating Orgs
    • How to Act on what we Learn? Though we are generating new evidence, aligning interests and partnering with stakeholders… how do we translate, disseminate, and implement what we know to improve care?
    • Agenda Overview of AcademyHealth How the U.S. Compares: Quality and Outcomes Leading Approaches in Other Countries Burgeoning Field of Implementation Science
    • What is implementation science? Research relevant to the scientific study of methods to promote the uptake of research findings into routine healthcare in both clinical and policy contexts.http://www.implementationscience.com/
    • What is in a name? Implementation science Improvement science Delivery system research Dissemination and implementation research Quality improvement research
    • Pipeline from research to practice to policy
    • The Translational Pathway Innovation Pilot testing Rigorous assessment Replication and spread Scale-up
    • Focus on Adoption, the “Triple S”Scale up, Sustainability, Spread US – AHRQ – PCORI – CMMI – Million Hearts – VA – NIH – Dissemination and implementation activities; NCATS/CTSA International
    • Focus on Adoption, the “Triple S”Scale up, Sustainability, Spread Cochrane Effective Practice and Organisation of Care (EPOC) Group – Reviews of interventions designed to improve professional practice and the delivery of effective health services. Health evidence Canada – Facilitate the adoption and implementation of effective policies/programs/interventions at the local and regional public health decision making levels across Canada.
    • A New International Society on Research on How to Improve Care An inclusive approach: mental health healthcare, treatment for substance abuse, the work of allied health professions, and preventive healthcare. Open to researchers from all traditions: rigorous methods, focused on improving healthcare, knowledge that can be transferred across settings. Improvement science, behavioral medicine, knowledge translation Start international debate, shared vision, seek funding opportunities and engage stakeholders. Now seeking comment online.
    • Outline Overview of AcademyHealth How the U.S. Compares: Quality and Outcomes Leading Approaches in Other Countries Burgeoning Field of Implementation Science Concluding Thoughts
    • Future Challenges  Ensuring rigorous methods match policy and practice needs.  Key requirements for creating comparable indicators that address the needs of policy-makers are: – appropriate methods of summarizing complex information; – a narrative that picks out the key issues and uncertainties; – a diagnosis of why the reported variations are arising; and – an assessment of implications for policy action.http://www.euro.who.int/en/what-we-do/data-and-evidence/health-evidence-network-hen/publications/2012/health-system-performance-comparison-an-agenda-for-policy,-information-and-research-2012
    • Future Challenges (cont)  Harmonize and coordinate federal efforts to fund research  Build a high performing comparative effectiveness research system to achieve rapid-learning potential of electronic health records, databases, data sharing, networks  Support a rapid-learning culture for the US health care systemEtheredge, Lynn. “Creating a High-Performance Systemfor Comparative Effectiveness Research.” HealthAffairs. 29; No. 10 (2010): 1761-1767
    • Wither AcademyHealth? Continued focus on – Evidence generation – Evidence translation Engage & learn from international colleagues – Update to 2009 report on CER efforts – Delegation to Beijing to attend 2nd Global Symposium on Health Systems Research – Your thoughts?
    • Questions?Lisa Simpson, MB, BCh, MPH, FAAP President and CEO