This document outlines a model for an economically sustainable community health system. It discusses four key cycles: 1) the health delivery cycle involving patient focus, preparation/capacity building, and health activities; 2) the catalyzed economic cycle involving creating and transferring value; 3) the dynamic response cycle involving adjusting to demand; and 4) steps for transitioning to this new model. The overall goal is to connect personal and economic health through a system focused on prevention, wellness, and predictable care.

1. Toward an
Economically Sustainable
Community Health Model
Realizing the Vision:
Transition and Transformation
August 24, 2010
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2. Key Topics
• Health Delivery Cycle
• Catalyzed Economic Cycle
• Dynamic Response Cycle
• Getting from Here to There
Systemic Reality
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3. Health Delivery Cycle
Patient Preparation and
Focus Capacity-building
Health-aimed
Activities
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4. Delivery Cycle – Capacity
Preparation & Capacity-building
• Research
• Undergraduate + Pre-med
• Schools of Medicine + Pharmacy
• Specialist Training
• Internship
• Funding: Grants vs Loans
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5. Delivery Cycle – Activities
Health-aimed Activities
• Intake + Screening
• Consults + Coaching
• Prevention + Wellness
• Chronic + Persistent
• Acute + Critical
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6. Delivery Cycle – Patients
Collaborative Patient-focus Anchors
Hospitals, Virtual Expert Clinics,
Community Health Centers…
• Doctors, Dentists, Pharmacists
• Specialists, Nutritionists,
Naturopaths, PTs
•Technology + Transparency
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7. Catalyzed Economic Cycle
Value
Create Value
Payment Types
Transfer
Value
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8. Economic Cycle – Create
Create Value
Capital + Labor + Health =
Private & Public Productivity for
Employers & Workers…
 Greater Regional & State
Competitiveness for
More & Better Jobs
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9. Economic Cycle – Transfer
Transfer Value (Intermediaries)…
• Subscribe  Risk Pools
• Self Pay  Risk Share &
Admin/HRA/HBC & Stop-loss Ins
• Taxes  Govt Pmt & Care Pgms
• THEME—Shared Learning &
Accountability
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10. Economic Cycle – Payment
Value Payment Types
• FFS: Intake, Consult, Coach
• Progress/Episode Payments
Based on US & Regional COPs
(Costs/Outcomes/Paths)
• Manageable Annuities
• Stop-loss Triggers
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11. Dynamic Response Cycle
Less Demand: More Demand:
Expensive Care Quality Health Culture
Redeploy Funds to: Apply Funds from:
More Predictable Care Acute Care Culture
Increase in:
• Self-management
• Sustainable Community Health
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12. Response Cycle – Demand
More Demand For:
More Predictable, Less Costly…
• Screening, Consults, Coaching
• Prevention & Wellness Quality
Shift Funds From:
Old Actuarial Model for
Expensive Acute Care Culture
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13. Response Cycle – Activity
Increased Activity in:
• Self-management
by Patients and Families
• Sustainable Population Health
• Community Coordination, Support
 New “Claims Experience”
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14. Response Cycle – Sources
Less Demand For:
Expensive, Less Predictable…
• Acute & Critical Care Culture
• Catastrophic Care
Shift Funds to:
More Predictable, Less Expensive
Health Culture, Situation Awareness
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15. Getting from Here to There
• Reliable Transition & Transformation
• Knowledge Transfer & Integration from…
– Risk Assess/ Healthy Behavior Cr/ MCO Admin
– Collaborative Pharmacy—Asheville/ Jt Comm of
Pharmacy Practitioners/ Piedmont Care
– Hosp Anchors/ Comm Hlth Cntrs/ Med Village
• Action Learning & Research: Impact Value
– Connect Personal Health & Economic Health
– Widen & Accelerate Forward Movement
– Strategy, Tactics, Systemic Operations
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