1	"JJ Parsons" JJ Parsons Presbyterian Healthcare Services Vice President, Business Development & Contracting jparsons@phs.org (505) 923-8512
2	Americans are more likely to want a new direction in health care even compared to the situation in Iraq!
3	Healthcare Needs a Quality Focus “The current healthcare system is economically unsustainable and negatively impacting our nation's ability to compete globally.” Craig Barrett, Intel Chairman, 2006.
4	Market Implications: National and local healthcare reform and legislation Market transparency of quality outcomes Changes in Reimbursement Increase focus by regulators Increased competition by healthcare travel companies Healthcare corporations focused on balanced scorecards
5	Don’t Try this at Home
6	1. National & Local Healthcare Reform & Legislation Massachusetts 2006 - First state to require health insurance and provide universal coverage California Governor introduced $12B universal coverage plan, but failed in Legislature in 2008 New Mexico Governor Richardson seeking healthcare coverage expansion but outlook in Legislature is uncertain
7	Insurance: National Scene Rising healthcare costs Evolving consumer role & interests Importance of technology Increasing government involvement Increasing focus on quality & customers Consolidation
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9	Insurance: New Mexico Market - Overall Increasing role of government including legislative bill and restrictions on profit levels of health plans Higher percentage of individuals covered under government programs; lower reimbursement for these programs increase rate for Commercial market
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11	2. Market transparency of quality outcomes Who are the audiences for health performance information? Consumers…use this information at various points of interaction with the health system, from the time they choose a health plan to the point of selecting a health care provider for a specific service. Employers/Purchasers…want information to use in selecting from among various health plans, including the cost and outcomes of providers and quality standards.
12	Transparency (continued) Health Plans…want to evaluate the price and quality of all physicians, hospitals, and other providers. May also want to benchmark their performance on service and quality measures to their competitors. Providers…Hospitals, physicians, and other health care providers would benefit from more transparent price and quality information as a feedback loop for improved performance efficient or effective referrals. Policymakers…Federal/state officials for oversight and monitoring of provider and health plan performance.
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15	Response: Demand for Increased Transparency Cost (IRS Form 990) Collection practices Community benefit Tax-exempt status Quality IHI: “5 Million Lives Campaign” Leapfrog: 27 Safe Practices Never Events Regulatory
16	3. Changes in Reimbursement: CMS Halts Payments for Never Events CMS – “The right care, for every patient, every time.” October, 2007: 1^st step toward preventing Medicare from paying hospitals for costs of treating a patient who acquires specific conditions during hospitalization. “Never Event” Examples: Objects left in surgery Catheter-associate urinary tract infections Decubitus ulcers
17	4. Increased focus by regulators: Transparency of Patient Satisfaction Data
18	Transparency of Patient Satisfaction Data Consumers will have access to the data Consumers will relate more easily to HCAHPS than to clinical data Some will use HCAHPS data to choose hospitals Will have volume, revenue, and reputation implications HCAHPS will be in the public eye Media coverage Promotion by hospitals themselves Reported for consumers on Hospital Compare Web site (www.hospitalcompare.hhs.gov) Typical public report data are shown as frequencies Hospital performance frequencies National and state average performance frequencies
19	Transparency of Patient Satisfaction Data Public reporting will include the following six domains (March 2008): Communication with Doctors Communication with Nurses Responsiveness of Hospital Staff Pain Control Communication about Medicines Discharge Information The following four questions will also be reported: Cleanliness of Hospital Environment Quietness of Hospital Environment Overall Rating of Hospital Recommend Hospital
20	Don’t Speak in “Quality-ese”
21	5. Increased competition by healthcare travel companies Medical Tourism Plans Blossoming Around the country Why? Reduced costs Ex: Open Heart Surgery in US: $100,000 Wockhardt, India: $7,500 Way in which patient Treated Care outside medical services includes: gourmet meals; laundry services; quality of room; hotel suite like room Access to physician call phones - Opportunity to see new part of the world: “vacation” - Access to procedures not yet approved by FDA Source: ForbesLife
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23	Baldrige Criteria Framework: A Systems Perspective
24	MBNQA Applicants by Stage
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27	PHS Baldrige Journey Timeline
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29	PHS Work System
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32	Presbyterian’s Commitment to Quality Earned two consecutive site visits from National Malcolm Baldrige Quality program. Earned QNM’s Zia in 2004.
33	Perspective on the Future Healthcare will continue to be front page news It will be painful for those not prepared All stakeholder's of the healthcare arena will demand data to make decisions The value equation = quality over cost Will under go many cycles of change Every service will be faster Those who don’t accelerate on the technology journey will not be around Very soon there will be no payment for mistakes Consumer will own their own healthcare data