Rural Health: Leading Change
Sanne Magnan, MD, PhD
Minnesota Department of Health
June 29, 2010
Minnesota’s Vision
GOALS
• Improve population health
• Improve the consumer/patient experience
• Improve affordability
RESULT
• A better state of health
The Challenge in Health Care
“We spend too much for what we get.”
T. Marmor, J. Oberlander and J. White writing in
Annals of Internal Medicine (April 7, 2009)
In other words, we have a
poor value equation:
the quality for the dollars spent.
Health Affairs, Nov/Dec 2008
Public, Private, Out-of-Pocket Per Capita Spending in OECD Countries, 2005
Health Affairs, Nov/Dec 2008
International Comparison of Health Care
Systems - The Commonwealth Fund, 2010
Minnesota Faces Challenges:
Rising Health Care Costs
Minnesota Faces Challenges:
Rising Health Care Costs (cont.)
Cumulative percent change
120%
100%
80%
60%
40%
20%
0%
2000
Health care cost
2001
2002
2003
MN Economy
2004
2005
Per capita income
2006
2007
Inflation
2008
Wages
Note: Health care cost is MN privately insured spending on health care services per person, and does not include enrollee
out of pocket spending for deductibles, copayments/coinsurance, and services not covered by insurance..
Sources: Minnesota Department of Health, Health Economics Program; U.S. Department of Commerce, Bureau of Economic
Analysis; U.S. Bureau of Labor Statistics, Minnesota Department of Employment and Economic Development
If State Health Care Costs Continue Their Current
Trend, State Spending On Other Services Can’t Grow
8.5%
Annual Ave Growth 2008-2033
9%
8%
7%
6%
5%
4%
3.9%
3%
2%
1%
0.2%
0%
Revenue
Education & All
Other
General Fund Spending Outlook, presentation to the Budget Trends Commission,
August 2008, Dybdal, Reitan and Broat
Health Care
Aging - in the Next Ten Years
From T. Gillaspy, State Demographer
• 2010 to 2020 is a watershed period.
• The “Boom” generation enters
“entitlement age.”
• More than half (55 percent) of
population growth will be seniors age
65+.
• By 2020 labor force growth will be at
record lows.
Health Care Spending Jumps After 55
U.S. Health Care Spending By Age, 2004
$12,000
$9,914
$10,000
$9,017
$8,000
$6,694
$6,000
$2,000
$3,571
$3,496
$4,000
$1,855
$2,165
$2,747
$1,074 $1,445
ra
ge
Av
e
75
+
4
65
-7
4
55
-6
4
45
-5
4
35
-4
4
25
-3
4
15
-2
14
5-
<5
$0
Source: Agency for HealthCare Research and Quality, Medical Expenditure Panel Survey,
data for per capita spending by age group in the Midwest. Excludes spending for long-term care institutions.
America’s Health Rankings, 2009
• We rank first in outcomes.
• We rank seventh in
determinants.
• We dropped from third to
sixth overall.
• Concern for the future:
– “Minnesota ranks lower for
health determinants than for
health outcomes, indicating
that overall healthiness may
decline over time.”
Social Determinants of Health
Most of our
investment
is here.
But it should
be
“upstream.”
What gives me hope?
Building the Vision:
Minnesota Health Reform 2008
• Lays a foundation for redesign of care
and payment.
– Moving upstream: SHIP (Statewide
Health Improvement Program)
– Care redesign and payment reform:
health care homes, baskets of care
– Market transparency: provider peer
grouping, quality reporting
Building the Vision (cont.)
• Public and private partners are
exploring new designs for health
and health care.
Federal Health Care Reform 2010
• It echoes Minnesota efforts on payment
reform and quality:
– Value-based purchasing
– Accountable care organizations (ACOs)
– Bundled payments
– Emphasis on primary care
– “Health homes”
– Administrative simplification
Rural Health is Well Positioned for
Leadership in Reform Efforts
•
•
•
•
•
Visionary
Innovative
Community-based
Collaborative
Agile
Minnesota’s Rural Health Heroes:
Leading Change
• Catherine Eiselt, Madelia
– Home care nurse extraordinaire
• James Gehant, Little Falls
– Physician with community vision and passion
• Greg Meyers, Glenwood
– EMS manager committed to community and region
• Dan Odegaard, Big Fork
– Hospital CEO who thinks beyond the box
• Colleen Spike, St. Peter
– Hospital CEO with a holistic approach to patient care
Minnesota Rural Health Teams:
Leading Change through Collaboration
• Bigfork Valley Surgical Team
– Tenacity
• DHS’s Deaf and Hard of Hearing Services
Mental Health Program
– Dedication to access for all individuals
• Glacial Ridge EMS and Training Department,
Glenwood
– Commitment to service
MN Rural Health Teams: Leading
Change through Collaboration
• Interprofessional Falls Prevention and Education
Program Team – Right Side Up in Otter Tail
County
– Focused on the patient, working together
• Northern Dental Access Center
– Serving a critical need with compassion and respect
for low-income people and families
Opportunities
• Listen to the “patient”
• Focus on individual health and population
health
• Expand non-traditional resources
– Build social capital
• Build health equity
• Re-vision beginning-of-life and end-of-life
• Shift from health care to health
“Leadership from the Inside Out”
Kevin Cashman, 1998
Five Change Mastery Shifts
• From problem focus to opportunity focus
• From short-term focus to long-term focus
• From circumstance focus to purpose focus
• From control focus to adaptability focus
• From doubt focus to trust focus
Leading change, indeed.
THANK YOU FOR ALL YOU DO.
www.health.state.mn.us/healthreform