Download The Patient First A Health System for All

4/26/2013
The Patient First
A Health System for All
Governor Alejandro García Padilla Administration
Estado Libre Asociado de Puerto Rico
The health system of each nation is a
reflection of its history, politics, economy
and national values.
The Healing of America
T. R. Reid
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Health System Model
 Puerto Rico like the US mainland maintains an aggregate of
different and separate health systems.
 An arrangement of fragmented providers and payers without
an unifying overseeing or administrative structure
Affordable Care Act
"...We know that our families, our economy, and our
nation itself will not succeed in the 21st century, if we
continue to be held down by the weight of rapidly rising
health care costs and a broken health care system."
President Barack Obama weekly address
May16, 2009
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PR: Health Profile
Puerto Rico: life expectancy
2008-2010
78.73
2007-2009
78.45
2006-2008
78.27
2005-2007
77.88
2004-2006
masculino
femenino
ambos sexos
77.56
2003-2005
77.24
2002-2004
77.18
2001-2003
76.91
2000-2002
76.64
1999-2001
76.25
65
70
75
80
85
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Principals causes of death in PR: 2000-2010
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Puerto Rico ($3324)
country
France
Belgium
Sweden
Ireland
Australia
UK
Puerto Rico
Iceland
Finland
Spain Japan
N. Zealnad
Italy
per capita expenditure
3974
3969
3758
3718
3670
3433
3324
3309
3251
3076
3035
3022
2964
infant mortality
3.4
4.28
2.74
3.81
4.55
4.56
8.1
3.18
3.4
3.37
2.21
4.72
3.36
life expectancy
81
79.2
80.9
78.2
81.6
79
78.73
80.7
79
80
82.1
80.4
80.2Adapted UN Statistics 2012
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Current health care financing
APORTACIÓN
FEDERAL*
APORTACIÓN
ESTATAL
55%
45%
55%
45%
ADM
(Administrative Cost)
50%
50%
PDP –Prescription Drug Program
(EAP – Enhance Allotment Plant)
55%
45%
CHIP
68.5%
31.5%
MMIS
90% Diseño
75% Implementación
10% Diseño
25% Implementación
HIT – ADM
90%
10%
FONDO
MEDICAID
(MAP – Medial Assistance Program)
ACA
(Accountable Care Act)
* Reembolso solicitado luego del gasto incurrido por Puerto Rico- “Cash basis”
Dinero Asignado (CAP’s) y reembolsado a PR- Basado en año Fiscal Federal
FFY11
FFY12
FFY13
FFY14
(Proyectado)
331,258,539*1
276,100,000
309,200,000
315,384,000*2
ACA
(Accountable Care Act)*3
212,097,473
596,965,684
700,296,132
700,000,000
ADM
(Administrative Cost)
24,726,461*4
26,059,759*5
25,130,000
26,000,000
PDP –Prescription Drug Program
Part D
23,716,209
CHIP
99,566,548
MMIS
2,973,725*7
HIT – ADM
1,798,000
FONDO
MEDICAID
(MAP – Medial Assistance Program)
CAP (Tope)
79,237,963
Utilizados 14,468,795
127,444,846
44,156,704
132,659,456*6
44,156,704
150,000,000
A determinar por el
sistema a implementar
Se utilizo de los fondos
del FFY11
Se utilizo de los fondos
del FFY11
0
*1 Incluye fondos ARRA mas sobrante administrativo
*2 Estimado proyectando un incremento de un 2%
*3 Los fondos ACA entraron en vigor a partir del 1ro de Julio de 2011. Comprende el último trimestre del año fiscal federal. ACA esta disponible solo para población Medicaid y
excluye la población CHIP. Se proyectan anualmente para solicitar los fondos a CMS luego que se agota el CAP asignado a MAP.
*4 Utilizado para costos administrativos de 62,500M. El sobrante se utilizo para MAP como es permitido
*5 Incluye 3,459,759 del fondo ACA
*6 PR en el FFY12 utilizó el “rebasing” de CMS pudiendo acceder a mas fondos federales por proyección de gastos para la población CHIP. Para el FFY13 se esperan solicitar 30M
adicionales
*7 Se comenzaron a utilizar en el FFY12 y es hasta Junio 30 del 2013
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PR: Health Profile
 As a country we invest 1 of every 4 dollars of
our budget in health care
 One of every two puertoricans has a chronic
illness such as Diabetes, Asthma or Cancer
 Alarming number of overweight and obese
individuals:
 65% of adults are overweight or obese
 22% of children are overweight or obese
Quality in Health Care
Institute for Healthcare Improvement
Dr. Don Berwick
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The Campaign “Planks” -Six Changes That Save Lives
1.
2.
3.
4.
5.
6.
Deployment of Rapid Response Teams
Delivery of Reliable, Evidence-Based Care for Acute
Myocardial Infarction
Medication Reconciliation
Prevention of Central Line Infections
Prevention of Surgical Site Infections
Prevention of Ventilator-Associated Pneumonias
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Does Improving Safety Save Money?
103 ICUs Working on Central Line Infections:
•82% Reduction in Mean Rate
•1,578 Lives Saved
•81,020 Hospital Days Saved
•Over $165,000,000 in Costs Averted
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The “Triple Aim”
 Improve Individual Experience
 Improve Population Health
 Control Inflation of Per Capita Costs
The root of the problem in health care is that the business models of almost all
US health care organizations depend on keeping these three aims separate.
Society on the other hand needs these three aims optimized (given appropriate
weightings on the components) simultaneously.
--- (Tom Nolan, PhD)
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The “Triple Aim”
Population
Health
Experience
of Care
Per Capita
Cost
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The Triple Aim Requires…
 Transparent Measurement
 Public Health Interventions
 Design and Coordination of Care at the Patient Level
 Guaranteed Access to Care
 Financial Management System
AND an “Integrator”
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The Patient First
A Health System for All
Governor Alejandro García Padilla Administration
Estado Libre Asociado de Puerto Rico
Our Goals
A health system that integrates in a
coordinated manner the institutional
and regulatory governmental
mechanisms, private healthcare
resources and citizens participation in
welfare activities
A country wide project that patient
centered and regards access to health
care as a fundamental right of every
citizen
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Our Vision
We aspire to a health care system where
each individual which resides in Puerto Rico
will have a basic benefits health insurance,
provided through universal access models of
integrated care; including effective health
promotion, prevention and protection
programs and financed through multiple
alternatives and limited third party
participation.
Concrete Actions
Establishment of a regional integrated health care system
2. Creation of a Regulatory and Evaluation Board of the health care system
3. Full implementation of Health Information Technology (HIT)
4. Universal access to the health care system
5. Creation of new and effective health promotion and prevention programs
6. Promote mental health; prevent related conditions , with emphasis on our
youth.
7. Coordinated quality care for the elderly
8. Assure the availability of cost effective medications
9. Promote an adequate health workforce
10. Provide adequate funding for the PR Medical Center
11. Sponsor a summit dialogue concerning malpractice insurance alternatives.
1.
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Regional Integrated Health Care System
 Administrative entity which will group providers with the
objective of offering coordinated health care services to a
defined population while being responsible for the well
being of the population and the financial health of the system
 Health care will be integrated and coordinated through the
different levels of care while deriving efficiency through
strong education and health information technology.
Regional Integrated System
Primary
• MD
• RN
• TS
Secondary
• MD
• RN
• Coord
Tertiary
• MD
• RN
• Naviga
tor
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Strategic Map of the Proposed Integrated
Health Care System
El siguiente modelo presenta las acciones a desarrollar para garantizar un sistema de salud integrado, eficiente y
enmarcado en principios de equidad y universalidad.
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