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NationalNational HealthHealth andand
Health CareHealth Care ReformReform
Ron Manderscheid, PhDRon Manderscheid, PhD
Global...
Some Framing IssuesSome Framing Issues
 Stepping Out of Our Comfort ZoneStepping Out of Our Comfort Zone
 Making New Sys...
Some Reform DriversSome Reform Drivers
 Economic Meltdown (Health ReformEconomic Meltdown (Health Reform mustmust bebe
re...
President’s 8 Principles of ReformPresident’s 8 Principles of Reform
 Protect Families’ Financial HealthProtect Families’...
Sobering StatisticsSobering Statistics
 Current Cost of Health Care: $2.3 T/yr.Current Cost of Health Care: $2.3 T/yr.
 ...
We Have Been One-DimensionalWe Have Been One-Dimensional
Focus Only on Disease:Focus Only on Disease:
No Disease DiseaseNo...
We Need to Become TwoWe Need to Become Two
DimensionalDimensional
Focus on Disease and Health:Focus on Disease and Health:...
Model of Wellness and IllnessModel of Wellness and Illness
(1981)(1981)
New Thinking:New Thinking:
Wellness
Illness
Recove...
ImplicationsImplications
 Illness DimensionIllness Dimension  Illness CareIllness Care
 Wellness DimensionWellness Dim...
Wellness EvolutionWellness Evolution
 Preventive and Promotion InterventionsPreventive and Promotion Interventions
for Pe...
Moving Further UpstreamMoving Further Upstream
 Healthy People 2020 FrameworkHealthy People 2020 Framework
emphasizes hea...
Healthy People 2020 ModelHealthy People 2020 Model
Some Key Behavioral HealthSome Key Behavioral Health
“Needs”“Needs”
 Need to implement more consumer control ofNeed to im...
Expected LegislationExpected Legislation
 Senator Kennedy and Senator Baucus:Senator Kennedy and Senator Baucus:

Insura...
Key UnknownsKey Unknowns
 Impact of massive change on the healthImpact of massive change on the health
infrastructure.inf...
Some Key Questions for UsSome Key Questions for Us
 How will we develop and implement healthHow will we develop and imple...
Some Key Questions for UsSome Key Questions for Us
 FQHCs represent one medical/healthFQHCs represent one medical/health
...
American Recovery andAmerican Recovery and
Reinvestment Act of 2009Reinvestment Act of 2009
(Conference Version)(Conferenc...
Looking ForwardLooking Forward
 Representative Patrick Kennedy hasRepresentative Patrick Kennedy has
announced a White Ho...
 What Are Your 2-3 Key Action Vectors?What Are Your 2-3 Key Action Vectors?
Contact InformationContact Information
 Ron Manderscheid, PhDRon Manderscheid, PhD
 Director, Mental Health and Substanc...
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National Health and Health Care Reform

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National Health and Health Care Reform

  1. 1. NationalNational HealthHealth andand Health CareHealth Care ReformReform Ron Manderscheid, PhDRon Manderscheid, PhD Global Health Sector, SRA Intl., Inc.Global Health Sector, SRA Intl., Inc. && Bloomberg School of Public Health, Johns Hopkins UniversityBloomberg School of Public Health, Johns Hopkins University
  2. 2. Some Framing IssuesSome Framing Issues  Stepping Out of Our Comfort ZoneStepping Out of Our Comfort Zone  Making New System AssumptionsMaking New System Assumptions  Developing Key Action VectorsDeveloping Key Action Vectors
  3. 3. Some Reform DriversSome Reform Drivers  Economic Meltdown (Health ReformEconomic Meltdown (Health Reform mustmust bebe related to National Economic Recovery)related to National Economic Recovery)  New Front Office in Washington (New ApproachNew Front Office in Washington (New Approach to Health Reform—President’s 8 Principles)to Health Reform—President’s 8 Principles)  New Approach to Entitlement Programs (SSA,New Approach to Entitlement Programs (SSA, Medicare, Medicaid)Medicare, Medicaid)  Addressing Chronic Disease (Current ModelAddressing Chronic Disease (Current Model Doesn’t Work!— http://www.pfcd.org )Doesn’t Work!— http://www.pfcd.org )
  4. 4. President’s 8 Principles of ReformPresident’s 8 Principles of Reform  Protect Families’ Financial HealthProtect Families’ Financial Health  Make Health Coverage AffordableMake Health Coverage Affordable  Aim for UniversalityAim for Universality  Provide Portability of CoverageProvide Portability of Coverage  Guarantee ChoiceGuarantee Choice  Invest in Prevention and WellnessInvest in Prevention and Wellness  Improve Patient Safety and Quality CareImprove Patient Safety and Quality Care  Maintain Long-Term Fiscal SustainabilityMaintain Long-Term Fiscal Sustainability
  5. 5. Sobering StatisticsSobering Statistics  Current Cost of Health Care: $2.3 T/yr.Current Cost of Health Care: $2.3 T/yr.  Current Cost of Chronic Care: $1.6 T/yr.Current Cost of Chronic Care: $1.6 T/yr.  Estimate of Waste in System: $685 B/yr.Estimate of Waste in System: $685 B/yr.  Expenditures on “Health”: 5%Expenditures on “Health”: 5%  17% are uninsured (34% for MH/SU). 80% of17% are uninsured (34% for MH/SU). 80% of public mental health consumers arepublic mental health consumers are unemployed.unemployed.  US ranks in the low 30s on basic healthUS ranks in the low 30s on basic health measures—behind Slovakia and Cuba.measures—behind Slovakia and Cuba.
  6. 6. We Have Been One-DimensionalWe Have Been One-Dimensional Focus Only on Disease:Focus Only on Disease: No Disease DiseaseNo Disease Disease
  7. 7. We Need to Become TwoWe Need to Become Two DimensionalDimensional Focus on Disease and Health:Focus on Disease and Health: HealthHealth No Disease DiseaseNo Disease Disease No HealthNo Health
  8. 8. Model of Wellness and IllnessModel of Wellness and Illness (1981)(1981) New Thinking:New Thinking: Wellness Illness Recovery
  9. 9. ImplicationsImplications  Illness DimensionIllness Dimension  Illness CareIllness Care  Wellness DimensionWellness Dimension  Promotion ofPromotion of Wellness and Wellbeing (sometimesWellness and Wellbeing (sometimes called Positive Health or Healthcalled Positive Health or Health Promotion)Promotion)  Representative Patrick Kennedy: “Stop itRepresentative Patrick Kennedy: “Stop it where it starts!”where it starts!”
  10. 10. Wellness EvolutionWellness Evolution  Preventive and Promotion InterventionsPreventive and Promotion Interventions for Personsfor Persons  Preventive and Promotion InterventionsPreventive and Promotion Interventions for Populationsfor Populations  Population “Health Coaches”Population “Health Coaches”  Population InsurancePopulation Insurance
  11. 11. Moving Further UpstreamMoving Further Upstream  Healthy People 2020 FrameworkHealthy People 2020 Framework emphasizes health determinants andemphasizes health determinants and interventions to address them; health careinterventions to address them; health care is a secondary objective.is a secondary objective.
  12. 12. Healthy People 2020 ModelHealthy People 2020 Model
  13. 13. Some Key Behavioral HealthSome Key Behavioral Health “Needs”“Needs”  Need to implement more consumer control ofNeed to implement more consumer control of health care and health (upstream factors)health care and health (upstream factors)  Need practical integration models:Need practical integration models:  25 years lost to premature death25 years lost to premature death  MH/SU comorbiditiesMH/SU comorbidities  Comorbidities with physical illnessesComorbidities with physical illnesses  Need to update an aging workforceNeed to update an aging workforce  Need “comparative effectiveness” resultsNeed “comparative effectiveness” results  Need to stem erosion of financial toolsNeed to stem erosion of financial tools  Need care coordinators and peer counselorsNeed care coordinators and peer counselors
  14. 14. Expected LegislationExpected Legislation  Senator Kennedy and Senator Baucus:Senator Kennedy and Senator Baucus:  Insurance Coverage: 47 million +18/20 million (?)Insurance Coverage: 47 million +18/20 million (?)  System Reform: Medical/Health Home ModelSystem Reform: Medical/Health Home Model  Financing: Medicaid and SCHIP expansions,Financing: Medicaid and SCHIP expansions, potentially Medicare, paid through employers who dopotentially Medicare, paid through employers who do not insure employees and recoup of HHS funds.not insure employees and recoup of HHS funds.  Senator HarkinSenator Harkin  Cover promotion and prevention interventions inCover promotion and prevention interventions in insurance benefitsinsurance benefits
  15. 15. Key UnknownsKey Unknowns  Impact of massive change on the healthImpact of massive change on the health infrastructure.infrastructure.  Phase-in period that will be required.Phase-in period that will be required.
  16. 16. Some Key Questions for UsSome Key Questions for Us  How will we develop and implement healthHow will we develop and implement health promotion/disease prevention services?promotion/disease prevention services? Or disease prevention services for theOr disease prevention services for the chronic physical diseases?chronic physical diseases?  As the medical/health home is developedAs the medical/health home is developed —major role for primary care—how will we—major role for primary care—how will we change?change?
  17. 17. Some Key Questions for UsSome Key Questions for Us  FQHCs represent one medical/healthFQHCs represent one medical/health home model. Are we working with them?home model. Are we working with them? Do we plan to do so? Other approaches toDo we plan to do so? Other approaches to the medical/health home?the medical/health home?  What would be different if principal fundingWhat would be different if principal funding for services were fully through anfor services were fully through an insurance model (by person)? How are weinsurance model (by person)? How are we going to get there?going to get there?
  18. 18. American Recovery andAmerican Recovery and Reinvestment Act of 2009Reinvestment Act of 2009 (Conference Version)(Conference Version)  Prevention and Wellness Fund: $1 BPrevention and Wellness Fund: $1 B  Comparative Effectiveness Res.: $1.1 BComparative Effectiveness Res.: $1.1 B  Federally Qualified Health Centers $2.5 BFederally Qualified Health Centers $2.5 B  HHS IT Initiatives $2 BHHS IT Initiatives $2 B  Workforce Training $500 MWorkforce Training $500 M
  19. 19. Looking ForwardLooking Forward  Representative Patrick Kennedy hasRepresentative Patrick Kennedy has announced a White House Conference onannounced a White House Conference on Mental Health and Neuroscience.Mental Health and Neuroscience.  We all hope that this will represent anWe all hope that this will represent an outstanding opportunity for behavioraloutstanding opportunity for behavioral healthcare.healthcare.
  20. 20.  What Are Your 2-3 Key Action Vectors?What Are Your 2-3 Key Action Vectors?
  21. 21. Contact InformationContact Information  Ron Manderscheid, PhDRon Manderscheid, PhD  Director, Mental Health and Substance Use ProgramsDirector, Mental Health and Substance Use Programs  Global Health Sector, SRA Intl., Inc.Global Health Sector, SRA Intl., Inc.  6003 Executive Blvd., Suite 4006003 Executive Blvd., Suite 400  Rockville, MD 20852Rockville, MD 20852  240-514-2607 (V)240-514-2607 (V)  240-514-2601 (F)240-514-2601 (F)  301-787-1414 (C)301-787-1414 (C)  ronald_manderscheid@sra.comronald_manderscheid@sra.com  www.sra.comwww.sra.com  Enhancing human health around the world, everyday.Enhancing human health around the world, everyday.

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