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Access and quality of care An Owner’s Manual

Access and quality of care An Owner’s Manual. Mehmet Oz, MD Professor and Vice Chairman, Surgery NY Presbyterian- Columbia University. Broader Access: The Problems. High technology cures Prevention solutions Obesity & Mental health How do we measure success Sheldon Greenfield

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Access and quality of care An Owner’s Manual

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  1. Access and quality of care An Owner’s Manual Mehmet Oz, MD Professor and Vice Chairman, Surgery NY Presbyterian- Columbia University

  2. Broader Access: The Problems • High technology cures • Prevention solutions Obesity & Mental health • How do we measure success Sheldon Greenfield • What are the public policy approaches Kimberly Dawn Wisdom Maxine Golub Michael Montijo

  3. New Thinking about Government and Private Sector:Total Expenses of Illness to Industry Source: Integrated Benefits Institute

  4. Heart Replacement Needs 721.000 cardiac deaths annually 41.000 arrhythmia 485.000 coronary artery disease 195.000 other heart diseases 41.000 223.000 88.000 262.000 107.000 sudden cardiac hemodynamic deterioration 352.000 369.000 NHLBI 1994 Morbidity & Mortality Statistics

  5. LVAD (n=68) + + + + + + + + + + + + + + + OMM (n=61) + + + + REMATCH 2002: 108 events; p = 0.0013 1.0 0.8 0.6 0.4 0.2 0.0 408 days Pr [alive] 150 days 0 6 12 18 24 30 36 Time (months) OPM:61 28 17 8 3 VAD:68 41 35 23 9 2

  6. REMATCH Quality of Life P=0.007 P=0.05 P<0.002 P<0.001 *Higher scores are better *Lower scores are better

  7. Minimally invasive……? Percutaneous • Subclavian approach • No Surgery barrier • Who don’t we save

  8. Robots: The Next Generation

  9. 50k More costly Less effective “JUST SAY NO” More costly More effective $100k per QALY 40k $20k per QALY 30k 20k CE ratio with sensitivity analysis Difference in Costs (US$) 10k 0 -10k Less costly More effective “JUST SAY YES” Less costly Less effective -20k -30k -1.5 -1 -0.5 0 0.5 1 1.5 2 2.5 Difference in Effects (QALYs) Displaying cost-effectiveness

  10. We need upbeat messaging

  11. Bones Eyes Lungs Brain Intestines Heart Hair Mouth Fat 2x4s scaffolding Windows Ventilation ducts Fuse box Plumbing system Water main Lawn Garbage disposal Junk in attic The House as an Analogy

  12. How to maintain a House • Don’t call a plumber for every backup • Plunger • Lift back off toilet • Fiddle with floating ball • Get comfortable with some remedies • Light bulbs • Set temperature • Prevention avoids need for overhaul

  13. Biggest 5 life adjustments • Blood pressure • Avoiding cigarettes • Exercise 30 minutes daily • Stress control • Healthy diet that is easy-to-love You control > 70% of how well and long you live

  14. Aging caused by big three • Heart and blood vessels • Stroke, memory, impotence • Immune system • Autoimmune, cancer • Environment and social • Trauma, addictions

  15. Know your heart numbers • Blood pressure • Optimal 115/76, Average 129/86 • Cholesterol (LDL, HDL) • Homocysteine • C-Reactive Protein • Blood sugar

  16. MORE NUMBERS Physical education participation 32% 42% ‘01 ‘99 20% kids eat 5 servings 1 State requires 63% mandate health coordinators

  17. SO WHAT Diabetes Heart Disease High Blood Pressure Cancer FEELING GOOD

  18. Health Corps Program • College graduate volunteer • High Schools • 2 years with training • Stipend & Benefits • Education and Activism • www.healthcorps.net

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