Charting the course

California has reached a crucial crossroads when it comes to health care. The Patient Protection and Affordable Care Act—aka Obamacare—continues on the path to full implementation. In the meantime, the state grapples with how to foster a system to care for a growing number of patients with tightening resources.

To wit: “Californians are experiencing an unprecedented increase in chronic disease. In addition, racial and ethnic disparities across many health outcomes are widening and health-care costs continue to surpass the rate of inflation.”

Those are the words of the Let’s Get Healthy California Task Force, in its recently released final report. Gov. Jerry Brown appointed the task force to craft a 10-year blueprint for action—charting a course to where the state should be in 2022.

The task force, composed of leaders in various segments of the health-care field, looked at health across the full life span of a person, and it looked at health care as a system with many parts that need to get aligned. It came up with 39 recommendations.

Mike Wiltermood, CEO of Enloe Medical Center, read the group’s report with particular interest.

“It’s ambitious, but we’ve just got to keep plugging away,” Wiltermood said. “It’s clear we have to bring more value to the system, and there’s a lot of good work being done nationwide to provide better care at a lower cost.

“It’s hard for some people not to be cynical about these studies or these efforts, because frankly we’ve been doing these for 40 years. Since the ’70s, we’ve been on this trajectory where, as the population ages and health care gets more and more complex, health care gets more costly. So we go through these cycles where we try to make improvements—we make a big effort and nothing gets done.”

He’s more optimistic this time out. The task force brought together insurance companies as well as physicians—in other words, the payers and the providers. Meanwhile, hospitals and private practices have begun working together more closely, forging the cooperation that will be necessary to implement the task force’s plan.

“As we get specifics of what we need to do to improve health care in the region and in the state,” Wiltermood added, “I think there will be natural incentives to move us forward.”

The task force identified five trends shaping the state of health care in California:

• The rise of chronic health conditions in an aging population;

• Current attempts to transform a health-care system that’s “fragmented, uncoordinated, and financially unsustainable”;

• Significant differences in health across socioeconomic lines;

• The national reform of health care (i.e., the aforementioned Affordable Care Act);

• Rising costs of providing care in a fiscally strapped state.

The report then looks at health care through two prisms: integrated lifelong care (labeled “Health across the Lifespan”) and integrated care system (“Pathways to Health”).

Recommendations for improving personal health include:

• Increasing childhood vaccinations;

• Emphasizing physical fitness;

• Reducing smoking rates;

• Improving the screening and treatment of depression;

• Better managing and preventing of chronic diseases;

• Improving end-of-life care.

Recommendations for a healthier system include:

• Reducing the rate of uninsured Californians from 21 percent to 5 percent;

• Adjusting the rate of increase for insurance premiums to correspond more closely with family income increases;

• Increasing access to primary care;

• Better coordinating a patient’s care via his/her primary doctor;

• Increasing the number of people receiving care in an integrated system;

• Reducing hospital readmissions and cases of hospital-acquired infections;

• Creating healthier and safer communities.

The report included a handful of other goals for which it did not have specific recommendations. Those range from increasing cultural sensitivity to decreasing a specific type of infectious condition called sepsis.

Wiltermood said the massive scope of the 64-page report is “absolutely necessary. We can target specific things, I suppose, and to some degree we can have success … but that’s not a holistic approach to health.”

That assessment applies to both aspects of the report.

When it comes to personal health, Wiltermood appreciated how the task force looked at the entire life span. Healthy Beginnings, as the report labeled childhood and adolescence, affect adulthood. A lifetime of good or ill health affects end-of-life planning.

Then there’s the health-care system itself.

“When we talk about the management of health-care conditions, immediately we have our hands tied because of the disjointed system we have to deal with,” Wiltermood said. “For example, when someone comes into the emergency room, the emergency-room physicians have no knowledge of that person’s history. They often don’t know what their medications are and who their physicians are, because we’re not connected. And so emergency-room physicians often have to start from scratch.”

Reinventing the wheel not only takes more effort, it also costs more.

Electronic medical records—a centerpiece of the Affordable Care Act—will help somewhat, but not entirely. Further integration is needed. From Wiltermood’s perspective, a regional approach makes more sense than a larger, unwieldy system.

“To some degree, we look at this and say all health care is local,” he explained. “The idea of our health system here in Butte County improving end-of-life care through a palliative-care program, for example, and increasing vaccinations among children—there are some things that are very well within reach that I can see us doing, and I believe we do contribute to those things now, without a whole lot of changes to the system.

“[A recommendation] like redesigning the health system is going to take a broader effort. Some of that is going to be contingent on the government and insurance companies managing how they pay for health care, which they do in different ways, and in turn it’s going to take time for us [in the health-care field] to adjust.”