Welcome to Charleston!

1. Welcome to Charleston!

2. It was the best of times…

3. …it was the worst of times. • South Carolina ranked 45th among all US states in health status in 2011. • In 2012 we fell to 46th.

4. What’s driving our low health status? Factor Rank • Diabetes 49 • Children in Poverty 48 • Low Birth weight 47 • High School Graduation Rate 47 • Crime 46 • Lack of Health Insurance 45 • Obesity 42 • Premature Death 42 • Infant Mortality 40 • Smoking 39 Source: America’s Health Rankings, published by the United Health Foundation

5. In order to lower health care costs, SC needs better health and better health care

6. Among the best heart care in country Cut response time for heart attack in half Average door to balloon time in SC is 45 minutes Consistently rated one of best states

7. Hospital infection rate below national average “We won’t stop until we eliminate the threat of health acquired conditions in all hospitals across our state.” Dr. Rick Foster

8. Lead state for safe surgery initiative “SC has a tremendous history of successfully introducing other quality initiatives such as improving the care of heart attack patients and reducing infection. We would like to collaborate with SC hospitals in developing a model to improve surgical safety at a state level that other states can follow." Dr. Atul Gawande

9. SC is #5 in the nation for getting the highest bonuses on average in the VBP program

11. The State of Healthcare: 2013

12. key strategic objectives • Coverage • Insurance Reforms • Delivery System Reforms • Payment Reforms • Transparency • Health IT

13. do you know the difference?

14. implications for hospitals • Achieve solid clinical alignment between hospital and physicians • Deliver superior outcomes • Reduce costs • Develop integrated information systems • Form strategic alliances • Prepare for new payment models

15. implications for hospitals • Achieve solid clinical alignment between hospital and physicians • Deliver superior outcomes • Reduce costs • Develop integrated information systems • Form strategic alliances • Prepare for new payment models Change your business model.

16. The debate isn’t over

17. Supreme Court • Ruled 5-4 on June 28, 2012 to uphold law • Individual mandate, exchanges, insurance rules and other programs still stand • Medicaid expansion is now optional for each state

18. The political question: What will states do?

19. Some background • January 1966--only six states originally participated when the program launched: Hawaii, Illinois, Minnesota, North Dakota, Oklahoma, Pennsylvania • 20 states signed on later that year • 11 states joined in 1967 • 13 more states (southern) joined in 1968-1972 • Arizona last to join in 1982 • Eventually all states participated in basic program and SCHIP (enacted in 1997)

20. Who’s participating? 25 states participating 14 states officially not participating Primarily southern states including South Carolina All but two also not participating in a state-run insurance exchange

21. Who will benefit?

22. Changing their tune • Florida Gov. Rick Scott dropped his staunch opposition • "While the federal government is committed to paying 100 percent of the cost of new people in Medicaid, I cannot, in good conscience, deny the uninsured access to care.” • Arizona Gov. Jan Brewer plans to push for expansion • “Weigh the evidence and do the math. With the realities facing us, taking advantage of this federal assistance is the strategic way to reduce Medicaid pressure on the State budget. We can prevent health care expenses from eroding core services such as education and public safety, and improve Arizona’s ability to compete in the years ahead.”

23. Viewing the debate through different lenses • Uninsured people • Insured people • Employers • Insurers • Physicians • Hospitals • Republicans • Democrats • Business Leaders • Wall Street

24. Two ways to frame the debate • It’s about States’ Rights • The federal government is forcing its will on us • We can’t afford to expand Medicaid • We should fight this intrusion on states’ rights • It’s about Economic Competitiveness • This law was passed by representatives from all 50 states and upheld by the Supreme Court • The other 49 states are offering to pay 90% of the cost of covering the uninsured in our state • We should let them, so our business community doesn’t have to bear the cost

25. has health care ever been so political? • America’s health care system is no stranger to politics • Since WWII, health care policy in America has been inherently political • There’s no reason to think an election will de-politicize the politics of health care, certainly not when tax dollars are funding half of all health expenditures

26. Our nation’s health and health care are badly in need of an overhaul

27. National Health Expenditures Total Annual Costs and Per Capita 1960 – 2010 (in billions) Source: CMS National Health Expenditure Accounts

29. America ranks dead last in health status Source: U.S. in International Perspective: Shorter Lives, Poorer Health, published January 9, 2013 by the Institute of Medicine

30. America ranks dead last, continued Source: U.S. in International Perspective: Shorter Lives, Poorer Health, published January 9, 2013 by the Institute of Medicine

31. Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

32. Obesity Trends* Among U.S. AdultsBRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

33. Obesity Trends* Among U.S. AdultsBRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

34. Obesity Trends* Among U.S. AdultsBRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

35. Obesity Trends* Among U.S. AdultsBRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

36. Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

37. Obesity Trends* Among U.S. AdultsBRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

38. Obesity Trends* Among U.S. AdultsBRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

39. Obesity Trends* Among U.S. AdultsBRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

40. Obesity Trends* Among U.S. AdultsBRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

41. Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

42. Obesity Trends* Among U.S. AdultsBRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

43. Obesity Trends* Among U.S. AdultsBRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

44. Obesity Trends* Among U.S. AdultsBRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

45. Obesity Trends* Among U.S. AdultsBRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

46. Obesity Trends* Among U.S. AdultsBRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

47. Obesity Trends* Among U.S. AdultsBRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

48. Obesity Trends* Among U.S. AdultsBRFSS, 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

49. Obesity Trends* Among U.S. AdultsBRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

50. Obesity Trends* Among U.S. AdultsBRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%