Whatcom County is one of several US communities modeling the possibilities for health at the whole community level. Go the the Rippel ReThink Health site for background information.
You can play with the Whatcom model by going to http://forio.com/simulate/rippel/rethink-whatcom.
MODELERS: How can we make this exact model available to new users?
- Enable healthier behaviors.
- Reduce environmental hazards.
- Reduce crime.
- Create pathways to advantage.
- Improve care for physical illness.
- Improve care for mental illness.
- Support Adherence.
- Redesign primary care practices for efficiency.
- Reduce hospital acquired infections. (this is mislabeled in the model’s mouse over)
- Recruit primary care providers in private practice.
- Recruit primary care providers for Safety Net clinics.
- Coordinate Care.
- Create Medical Homes.
- Improve post discharge care.
- Expand hospice.
- Improve hospital efficiency.
- Establish innovation fund.
- Capture and reinvest savings.
- Share captured savings with hospital.
- Share captured savings with physicians.
- Expand insurance coverage for advantaged.
- Expand insurance coverage for disadvantaged.
The items in red are things we are not doing.
The items in blue are the essential changes in how we deliver care based upon what we learned during Pursuing Perfection — Navigator-Coaches, Shared Care Plan, and increased patient competence with Resilience Training.
The items in green are community initiatives.
We implement pretty much everything except we do not count on greater improvement in hospital efficiency. The length of stay in the hospital is already very low and lowering more may harm patients AND ultimately increase costs due to increased re-admissions. For a description of each initiative go here: http://innovation.community4health.com/wiki/community-based-health-levers-wiki/
Over time I will add to that wiki page links to descriptions of how we would implement the initiatives in Whatcom County, WA.
In this model we do not increase insurance coverage for advantaged nor disadvantaged. MODELERS: We definitely need to do that and compare the effects in another model run.
I will run another model where we do not change the green
This is an interesting scenario because 1) we save lives, 2) all providers including the hospital do well during a very significant change in how care is delivered and 3) we decrease per capita costs.
MODELERS: I am interested in understanding the finances a little better. Were does the money come from and where does it go, year by year.
The age stabilized death rate drops significantly and continues to drop. The most important part of the Triple Aim is taken care of–QUALITY.
MODELERS: Please help state the reduction in death rate in understandable terms for me. I believe this says that the rate drops from 7 deaths in 1000 population per year to 6 in a 1000; or a 1/7th drop in death rate. Is that right?
Dying of a hospital acquired infection is a very low QUALITY event. Reducing the fraction of deaths by 2/3s is a remarkable improvement.
To my mind improving preventive and chronic care will both improve QUALITY OF LIFE, beyond just living longer.
This program reduced the per capita COST by $500 year over the first two years and then gradually by $1,200 per year. THAT IS REMARKABLE. Two of the Triple Aims taken care of!
The third component of the Triple Aim is EXPERIENCE OF CARE. One of the worst experiences is to have to deal with care issues urgently, particularly having to go the the emergency department. I think that these data support the third Aim.
This scenario has a net cost savings beginning in year 1 and over 28 years nets 3.03 billion dollars savings to the community.There is an equal savings returned to the payers and in effect available to the community that pays them in premiums, taxes or worse in interest bearing debt.
MODELERS: Do these costs savings occur when the Innovation Fund investments are subtracted or not?
MODELERS: I assume that the payer has the same level of cost savings since we divide the savings equally between the payers and the community?
Each of these four graphs directly below show substantial savings for the insurers. They are in the best position to fund this enterprise from the large savings, to the tune of about $70M per years. The providers are spending most of their half of the savings to fund the improvement initiatives while the payers have theirs to spend on what? or to return to the clients? The need to include the payers in these discussions seems obvious. We should include CMS Region 10, WA State Medicaid leaders, GHC, Regence, Molina, CHPW, etc. in the discussions, possibly in the same room at the same time.