Future Now
The IFTF Blog
Interview Summary - Jennie Chin Hansen, March 23, 2009
HC2020 Interview Summary: Jennie Chin Hansen
Interviewer: Richard * Date: March 23, 2009
1. His/her work
She was initially trained as a nurse – went into healthcare
with a lot of optimism. Got turned off by how hospitals treat
patients & workforce. Has had a career in healthcare, but on
the periphery – worked in a neighborhood health clinic, then
spent 2 years in rural health in Idaho, then spent 25 years
at On Lok, working with the frailest elders. Last 4 years,
been working with AARP and MedPac and on workforce and safety
issues at UCSF/RWJ. Working on a project at UCSF funded by
the Gordon Moore Foundation on patient safety in hospitals;
working with Molly Coye on CalRHIO; and on board of Lumetra
(federally-designated Medicare Quality Improvement Organization
in California). At AARP, has been working on a grant from RWJ
for the Center to Champion Nursing in America
TRENDS/CHALLENGES
2. How optimistic about future of health/healthcare in 2020?
She is an optimist by nature – but the challenges are daunting
and 2020 is not so far away. Opportunity now to leverage the
economic crisis to force the issue of value for money spent.
At least 30% of money spent for healthcare is wasted.
According to the CBO, $720 billion a year is “badly spent” –
there is an opportunity now to “put the dots together” and
bring about real change.
3. Biggest trends or challenges
1) Converting medical care from acute care to managing
chronic diseases, especially obesity. Not just older people,
but people of all ages. Need to move from an acuity model
to one focused on prevention and ongoing chronic care.
Care delivery models must be redesigned form a focus on
professional providing acute care in hospitals to a system
that will lead to a “healthier society” Professionals need
to think about the well-being of the [whole] population, not
just caring for a group of patients.
2) Lack of a public health infrastructure. Need to
“re-invent public health” – imbue health literacy in people
at much earlier ages.
4. Promising Responses
1) “Secularization of healthcare” – development of alternatives
that are convenient, affordable & accessible to ordinary people
– like retail clinics
2) Use of phones to deliver care – reminders, chronic disease
management, GPS applications
3) Health Savings Accounts – are making people more sensitive
to paying for their care, more aware of the real costs of
treatment. More public reporting on costs, quality of health
care alternatives will drive change in buying behavior.
Drivers of change: leadership and culture shift. We need
real financial levels and a broad culture shift.
4) Community-based initiatives: In Nevada City, CA, Carole
Carsen got interested in losing weight and becoming fit.
Made her quest public, involved in her program, “Fat2Fit
Weight Loss Challenge,” which has been endorsed by AARP.
5. Have these trends surfaced before?
6. Challenges/responses not on radar now?
Build-out of a pervasive broadband infrastructure
which needs to be completed in order to leverage full
opportunities for healthcare improvement through IT.
FUTURE SCENARIOS
7. Most preferable scenario
- Basis for payments in healthcare will change –
with incentives for value and more accountability
- Health literacy increases and health information
becomes easier to understand.
- Technology plays a bigger role in health –
- Individuals will own their own health information
8. Most plausible scenario
- “Success of the pragmatic” – some change, but not as much:
- Some reform in payments
- Consumers are somewhat more engaged in their own health and health care
- Patients have taken some additional responsibility
9. Most negative scenario
- Reform efforts fail -- there is polarization between Democrats
and Republicans, resulting in a stalemate – those who like the
current system dig in
10. Wrap-up – other issues
- We need to address demographic and geographic disparities in
health (see “Geography and the Debate over Medicare Reform,”
John E.Wennberg, Elliott S. Fisher, and Jonathan S. Skinner,
Health Affairs, Feb 2002).
- Need to change education for health professionals to expand
access – need to look at the role of the community college in
providing “first level access” to professions. We need to
develop a fully articulated system from community college to
post-graduate. Examples:
- the Oregon Consortium for Nursing Education (eight community
colleges and Oregon Health & Science University School of Nursing
have created a shared curriculum taught on all consortium campuses).
- California Institute for Nursing and Health Care (Berkeley-Doloras
Jones, President and Executive Director)
- Need to promote greater health literacy, starting in childhood.
Health professionals need to “facilitate and catalyze” patients
health, not fix them.