Questions, Ideas & Next Steps

Wikis > Whatcom Base Case Scenerio > Questions, Ideas & Next Steps

Capture audio of all discussions of this material.

Should each slide have an attached (on the web) SBAR–Situation, Background Assessment, Recommendation?

Review with Base Case  and KEY SCENARIOS with: Sue Sharpe, Larry Thompson, Chris Sprowl, Chris Phillips, Regina Delahunt, COGH, Goef Morgan,  Rud Browne and Nancy Steiger…

KEY SCENARIOS to include:

  1. Dual eligibles (as a population sub-group) (is this Poor + Mental Health)?

Create wiki pages for Strategies for every lever. Include SBAR for each lever and analysis provided.

POINTS OF VIEW (relevance stories for each)

  1. Payors (Private, Commercial, State, Federal)Hospital Administrators
  2. Employers
  3. Clinic Administrators
  4. Pubic Health
  5. PCPs
  6. Specialists
  7. Employees (unions)
  8. Consumers
  9. Citizens, Families, Neighbors


  1. What to do in the model with BAD DEPT, which comes from uncompensated care because people are uninsured and UNDER-INSURED as their employers make decisions to decrease and eliminate insurance coverage for working people/families. This is Rud Brown’s big point–this may be the biggest driver for the whole system–the rapid departure of employers as providers of adequate health insurance.
  2. Is there a way to make visible in the model the effects of a global and local recession or depression?
  3. What are the stories of Manchester, Peublo, Alameda, and Whatcom? Where should they be told and for what purposes?
  4. How do we show ROI and Cost Benefits of various scenarios?
  5. How can we model the effects of stress and stress reduction (resilience) on health behaviors as well as on health directly? Associated with higher stress are: Medicare, poverty, high risk behaviors, hazardous environment, high crime, chronic mental illness, chronic physical illness, safety net provider? Could we add to our “definitions” something on the biology and sociology of stress, positivity, and resilience? Fredrickson’s Broaden and Build? Measured by PANUS 10 or Losada rations and correlated with Patient Activation Ratios (PAM)? Can we place Stress in the “Key Dynamics” casual loop diagram? Stress effects Unhealthy Behavior and is Effected by Workplace, Family and Social situations, Economics, access to insurance, Environment. Should we ask RWJF to fund such a model is association with Rippel? Separately?
  6. Should “Seniors” be subdivided to represent 85?
  7. Is it possible to model the effects of increased patient activation and self (home) care as a strategy?
  8. Can we put resilience COACHING into the model? Is it already represented through care coordination, improve routine preventive and chronic physical illness care, improve care for the chronic mentally ill, enable healthier behaviors, improve post-discharge care to reduce hospital readmission, extend the use of hospice care? Coaching would positively  Non-urgent ER visits, ER Visits, Adequacy of Preventive & Chronic Care, Pharma Costs, Office & Outpatient Dept. Visits
  9. Can we put citizens (patients) into the model (visibly) so that their capability, capacity, competence are visible as actors rather than just as consumers. Can we therefore model neighborhood capability–people caring for one another? (McKnight and Block)?
  10. How can we balance or integrate a needs/consumer-centric framework with an abundance/assets-centric framework?

Marc’s key levers:

  1. Resilience and Care Coaching to increase healthy behaviors, decrease visits, and improve medication usage.
  2. Neighborhood & Community Building for resilience, interdependence, self-help and healthy, humane choices–Schools, Churches and Workplaces.


  1. INTERACTING WITH THE CUSTOMERS–Enable healthier behaviors *****
  2. HUMAN RESOURCES–Recruit primary care providers in private practiceRecruit primary care providers for Safety Net clinics
  3. INFRASTRUCTURE–Coordinate health care ***; Provide adherence support for routine care; Improve routine preventive and chronic physical illness care   ***; Improve post-discharge care to reduce hospital readmissions *
  4. SALES
  5. LEARNING IMPROVING–Improve hospital efficiency; Prevent hospital-acquired infections; Redesign primary care practices for efficiency;
  6. DAY TO DAY OPERATIONS–Expand the use of hospice care **
  7. MEASURING ALLOCATING–Capture savings ***; Pay providers for performance (out of captured savings)  ***;
  8. PLANNING–Create medical homes **; Improve care for chronic mental illness  **; Reduce crime; Create pathways to advantage ****; Establish innovation fund  ***; Reduce environmental hazards
  9. MARKET ENVIRONMENT–Insurance coverage expanded as a result of Federal mandate