1 Navigating the Healthcare MazeRaleigh Professional Women's Forum Mary C. Edmondson, MD Medical Director, HD Reach March 8, 2017 When I saw the title of this talk, I thought about what you wanted to learn about today my first reaction was I'm really in trouble here. Navigating a maze suggests to me that someone, maybe many of you, have experienced your healthcare as a confusing environment An experience where you struggled to find the right questions Much less know how to get accurate answers So you can decide what YOU need to do.
2 We are all in this together, so lets have a conversation…How much do I need to worry about healthcare reform? Managing effort Managing choice: using data to make decisions Quality improvement and you
3 Disclaimer/disclosures
4 We are a very healthy nation, but…
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6 Why is this? What’s being done about it?Healthcare innovations increase rather than decrease cost: treatment guidelines, inconvenience Supply and demand are misaligned: cost shifting to patients and providers, cost transparency Provider side is labor intensive: provider extenders, EMR, delivery innovation, quality improvement efforts US population is not incentivized to improve health: provider-bundled payments for quality processes, increasing patient cost based on risk factors/behaviors
7 Quality Improvement: The Cystic Fibrosis ExperienceHuge gap between what we know (evidence base for treatment) and execution of effective disease specific treatment CF QI efforts Increased length of life by 20 years over a 18 year time period by systematically implementing existing treatments Treatment algorithms, training and incentivizing providers in specialized care, learning from the centers with the best outcomes The pivotal gains were made when the center’s patient outcomes became transparent AND the patient/family community became engaged in the QI process QI efforts are low cost and risk
8 What can you manage? Effort/Choice Preventive Measures TreatmentPalliative Care Treatment Preventive Measures
9 Effort Discretionary energy and timeEducate yourself, determine what important to you Commit to your goals, define what success looks like to you Develop a real plan to achieve SMART goals Deal with roadblocks Follow up / make change to plan as needed
10 Choice: Make data driven decisionsExample: Hypertension (HTN) Most common outpatient diagnosis Lots and lots of data about HTN Prevalence increases with advancing age Lifetime risk of hypertension is 90% for people who were normotensive at age 55 or 65 years, and survived to their 80s. You hope you will live long enough that someday this will be a problem for you
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12 Is trying to get BP controlled important?
13 What are the odds that I can actually achieve control?
14 What options do I need to consider if I want to achieve control?Lifestyle Modifications No salt Limit alcohol Exercise Normal BMI Pharmacologic Treatment Treatment guidelines: Rationale for Recommendation of Thiazide-Type Diuretics as Preferred Agent Eliminate medications like NSAIDS Follow-up and Monitoring Home BP monitoring
15 Decisions about drugs: Efficacy and side effectsDiuretics ACEI Most effective Moderately effective Low potassium At high doses n/a High potassium In combo forms Sporadic Cardiac ectopy Occurs but no increased mortality No data Elevated glucose 11.8%, no impact on CVD 8.1%, no impact on CVD Gout In men Sexual dysfunction In men, no mention re women Hip fracture Risk decreased in women Cough 2X greater risk in women
16 Out of pocket cost 4 MD visits: $30 each= $120/yearMedications: $10/mo., $100/year Monitoring: BP cuff at home $50 Electrolytes twice a year $20 Total Year 1 costs=$290
17 10 Life changes to reduce a risk factorChange diet, lose weight Exercise regularly Change alcohol use to one glass of wine per evening on the weekends only No Motrin for aches and pains Remember to medication in the morning Go to the bathroom frequently during the morning-schedule fewer meetings in the morning Check my BP once a week and chart it Decide what to do if BP is higher than usual Figure out how to get 3 month prescription refilled Manage anxiety about having a chronic medical issue
18 The Book of Me Your own personal evidence baseTrack your own health care information Basic information, emergency contacts, power of attorney forms Insurance / pharmacy information Medication/Allergy list Medical Problem List, Surgeries, when done and why Test results Sign up to look at your on line medical records. Its up to you to guarantee their accuracy, so correct errors and request updates. Track your personal goals: need to be SMART, behaviorally specific goals
19 Healthcare is going to get a lot more complicated before it gets betterExponential growth of information and patient derived data Advent of personal genetic data and personalized medicine The provider-patient relationship is changing: provider-extenders, automation (provider learning curve to adopt), teams rather than individual relationships, less direct personal contact with team leader (maybe 15 minutes for complicated decision making)…Use your time and your providers time together very wisely!
20 Disease-Specific Quality Improvement vs. Research InnovationHuge gap between what we know (evidence base for treatment) and execution of effective disease specific treatment Give feedback about healthcare processes Ask if you have a choice to participate in QI projects I'm really optimistic!
21 It’s worth it! Effort/Choice Preventive Measures TreatmentPalliative Care Treatment Preventive Measures