Achieving the Triple Aim: Quality Improvement Methods in ...William Riley, PhD Professor, Science of...
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Achieving The Triple Aim: Quality Improvement Methods and Value in Health Care William Riley, PhD Professor, Science of Health Care Delivery Director, National Safety Net Advancement Center Arizona State University Session 47
Transcript of Achieving the Triple Aim: Quality Improvement Methods in ...William Riley, PhD Professor, Science of...
Achieving The Triple Aim: Quality Improvement Methods and Value in Health Care
William Riley, PhDProfessor, Science of Health Care Delivery Director, National Safety Net Advancement CenterArizona State University
Session 47
• Paradox• Severe Market Failure
Health Care Payment System
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• The Triple Aim• The Value Equation• Health Care Finance• Payment Reform
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Four Forces of Transformation in Health Care
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Oral Health And The
Presenter
Presentation Notes
The problems in the healthcare sector are not unique. In nearly every industry at outset the products and services are expensive and complicated so only the wealthy can afford them (Electricity, Telephones, Cars, Air Travel, and more recently Calculators, Cell Phones, and Personal Computers). The same is true in healthcare today. It is very expensive to receive care from highly trained professionals.
The Value Equation
Value = QualityCost
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Presenter
Presentation Notes
The problems in the healthcare sector are not unique. In nearly every industry at outset the products and services are expensive and complicated so only the wealthy can afford them (Electricity, Telephones, Cars, Air Travel, and more recently Calculators, Cell Phones, and Personal Computers). The same is true in healthcare today. It is very expensive to receive care from highly trained professionals.
• Product or service that can help customs more effectively, conveniently, and affordably to get what they want done.
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Value Proposition
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Value Drivers• Macro Level
• Policy• Financing System• Industry Structure
• Organizational Level • Leadership• Value Proposition
• Micro Level • Process Maps• Statistical Process Control
Components of Value at the Micro-System Level
Culture of Health
Value= Technical Skills + Non-technical skills + Designed Processes
Source: Riley, William, Davis, Stanley and Miller, Kristi,A Model for Developing High ReliabilityTeams. Journal of Nursing Management. 18. 556-563. (2010)
Critical Human Factors for Team skills:
Situational Awareness-MEBeing aware of what is going on around you and understanding what the information means
Communication- YOUSBAR (Out)Closed-Loop Communication (IN)
Shared Mental Model-USCommon understanding of the situation and the plan
Human Factors #1
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Human Factors #2
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Failure Proof
• Failure Proof: When complex system has set of defensive barriers that provide defenses in depth.
• Accomplished By Process Design• Forcing Functions• Countermeasures
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Failure Proof: When complex system has set of defensive barriers that provide defenses in depth: The multiplicity of layers is the factor in HRO’s Protection: The general goal of ensuring safety Defenses: The various means by which protection can be achieved.
Process Design
Premier Perinatal Safety Initiative (PPSI)2006 to 2012
• Initiative to improve perinatal safety in 14 hospitals across 12 states • 7-year prospective design using Quality Improvement Collaborative
(QIC). • Three-part intervention:
1. Standardization of evidence-based care2. Interdisciplinary teamwork training3. Systematic performance feedback coupled with routine education
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Presentation Notes
Labor and delivery pose substantial risks Complications reported in 3-10% of deliveries (Mann et al. 2006; Nielsen et al. 2007; Kozhimannil et al. 2013; Goffman et al. 2014; New Jersey Hospital Association, 2014) Adverse perinatal events are caused by many factors Communication breakdowns & poor teamwork associated with majority of perinatal injury (Simpson & Knox, 2003; Joint Commission 2004), increase risk of error 10-fold (Reason 1995), accounting for approximately 55 percent of all active failures in a hospital setting (Riley et al. 2010a, b, c) Estimated that up to 30% of Perinatal adverse events are preventable (Goffman et al. 2014) Applying reliability principles may reduce unwanted variation in care processes & increase the consistency with which appropriate care is delivered Substantial financial impacts to providers and hospitals arising from malpractice claims and payment (AON Risk Solutions 2013; Strunk 2012; CRICO Strategies 2013)
Care Standardization• Care was standardized
using three bundles• Each hospital created
an interdisciplinary team of a physician and nurse champion who directly led all interventions.
• A train-the-trainer method deployed to sequentially train a team from each hospital, which in turn trained staff in their respective perinatal units.
Findings• Birth outcome and malpractice
claim activity analyzed for:• 185,373 births• 125 perinatal malpractice claims• Malpractice costs: $27,266,019
• Indemnity: $23,151,569• Legal defense: $4,114,449
• Overall, hospitals’ bundle compliance significantly improved from baseline to intervention periods (shown at right)
Reducing maternal AOI harms
Table 2: T-tests for Composite Adverse Outcomes Index (January 2006-December 2012)
Measure Baseline Period* (2006-2007)
Phase 2* (2011-2012)
Change (%) P-value
Adverse Outcome Index
0.055 0.047 -0.008 (-14.5) 0.032
Changes in OB vs. Non-OB Malpractice Activity
• Significant declines in obstetricsclaims activity:
• Number of claims paid• Total malpractice losses paid• Total indemnity losses paid
• No significant declines in non-obstetrics claims activity
QI Techniques to Improve Value
Process MapStatistical Process Control
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Presentation Notes
Tina
Process Engineering and System Design
• System • A set of interdependent component parts
forming a complex whole• System Design
• Assemble and align interdependent components to achieve desired goals
• Process• Series of steps to produce an outcome
Process Engineering: Definition of a Process
1. Series of steps to produce output (product or service)2. Is a value chain3. Organization is only as effective as its processes
Presenter
Presentation Notes
WHAT IS A PROCESS? 1) A sequence of steps which transform some input into a final output 2) A process is almost always cross functional which means it goes across department lines or organizational boundaries (especially in public health) 3) Value chain means every step must add value. Should not have too many steps, or too few steps. 4) An Organization is only as effective as its processes. This is because a system is a set of related processes. 5) A process is repetitive. Most organizational activity is the result of a process. This is because between every input and output in an organization is a process. We do it over an over. If it is a one time occurrence, such as important strategic decisions, problem solving or personnel decision, it may not be repetitive. These are management decisions. In my experience, sometimes PH tries to apply QI to one time decisions. Process System A series of related processes Can you think of an output that is not the result of a process? Can you give examples of services in PH that are the result of a process? Break down into groups and each group identify 5 processes in an org: A) A local public health dept B) A planned parenthood organization C) A famine relief program in western Africa D) A drug abuse resistance program(DARE) E) 2)Almost always cross functional Most processes cross departments in an organization. They span the “white space” on an org chart. Unfortunately, the p;process level is the least understood and least managed level in an organization(you will see why under Organizing function) 3)Is a value chain Each step in a process of creating a service should add value to the preceding step. This is often violated in H.C. and PH. Steps are added to a process that do not meet the goal of process. The purpose of process improvement is to identify and include steps which add value, and exclude steps which subtract value. 4)Organization is only as effective as its processes Organizational goals can only be achieved thru development of logical processes. Individuals certainly effect the process, but problem solving rarely focuses properly on total system process improvement. Actions taken in a single dept. often cause problems elsewhere. So must understand the entire process from input to output.
Process Map
• A diagram with symbols to illustrate process steps and relationships
Example of a Process Map: School Based Immunization Clinic
Process Begins
Process Ends
Send permission letters to parents
Consent form returned?
Review which vaccine is needed
Make clinic appointment
Student registration
Administer vaccine
ObservationAdverse reaction?
Discharge
Yes
Yes
No
No
Contact parent to get form
Observe until stable
Basic Flow ChartProcess Maps
YES NO
NO YES
= task = decision = connects = process beginning and end
Presenter
Presentation Notes
Process maps are among most essential tools of Six Sigma. Simply a series of tasks and decisions connected by arrows to show flow of work. Enlightening information comes from the actual map creation process as people from different parts of the organization hear about what others do and how they do it.
Newborn Screening Kaizen Event
• Ensure that infants who screen positive for metabolic, genetic, or hearing disorders are Referred for diagnostic confirmationReceive appropriate intervention andReceive long-term follow-up services
• It will start at the point that the lab provides a presumptive positive
Source: Kim McCoy Minnesota Health Department
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Tina
Future State Dried Blood Screening Process Current Future
Qty Time Qty TimeTasks 61 12.75 hrs 25 5.60 hrsWaits 21 51 days 7 23 daysHandoffs 36 15Decisions 11 2File/stores 26 8Total time 52.5 days 23.65 days
Source: Minnesota Department of Health, Sept, 2010 Kim McCoy
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Chris
System Design
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• Disruptive Innovation• Zipnosis
• Asynchronous e-health, virtual care visits• 50,000 visits, 31 clinical conditions (URI, UTI,
conjunctivitis, etc.)• 95% compliance with EBM patients, compared with 61%• Average clinician time 2.2 minutes (compared with 21.6
minutes)
Association of American Medical Colleges, 13th Annual Research Conference, May 4, 2017, Arlington, VA
Statistical Process Control
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1. Process Behavior2. Process Stability3. Process Capability4. Process Acceptability
Run Chart of the Average Number of Adverse Events per 1,000 Deliveries by Quarter over 28 Quarters (14 PPSI Hospitals)
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Aver
age
# of
Adv
erse
Eve
nts
per 1
,000
Del
iver
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Year/Quarter
Median = 52.7
*According to run chart technique, observations that fall
Phase I Start Phase I End
Kick off Meeting
Phase II StartSimulation Trainig
Macro Level Value
• Financing• Payment Reform
Health Care Finance
• Prospective Payment• Pays for value
• Retrospective Payment• Pays for volume
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Presenter
Presentation Notes
FFS payment in healthcare is a runaway reactor for when providers get more money by providing more care, then supply creates its own demand. Proverbs 24:18 “Where there is no vision, the people perish.” 50% of care consumed is created by hospital and physician supply, not by demand Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer (Brownlee, 2007).
History of US Government Involvement in Health Insurance
•Medicare and Medicaid (1965)• Medicare: federal health insurance for elderly population over 65 years• Medicaid: federal/state government health insurance welfare for families and individuals with low
income who cannot afford to pay.
•Affordable Care Act (2010)• Officially the “Patient Protection and Affordable Care Act” (PPACA)• Requires most US citizens to have health insurance. • Launched ACO’s
• MACRA (2015)• HHS launched the LAN (on March 25, 2015) to help advance the work being done across sectors to
increase the adoption of quality-based payments and alternative payment models
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The Main Objectives of the ACA
• Increase the affordability of health insurance. • Lower the rate of uninsured persons.• Reform certain health insurance practices in the private sector
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Accountable Care Organizations (ACO’s)
• Established by the ACA.• ACOs are groups of doctors, hospitals, and other health care providers, who come
together voluntarily to give care management to their Medicare patients.
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Goal of the ACO
• The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
• When an ACO succeeds it will share in the savings it achieves for the Medicare program.
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Medicare Offers Three ACO Programs:• Medicare Shared Savings Program
• A program that helps a Medicare fee-for-service program providers become an ACO.
• N = 404 Shared Savings Program ACOs with 7.3 million Medicare beneficiaries (April, 2015)
• Advance Payment ACO Model• Prepayment program for selected participants in the Shared Savings Program.
• N = 35 organizations• Pioneer ACO Model
• Designed for health care organizations and providers that are already experienced in coordinating care for patients across care settings.
• N = 19 organizations. Now closed for enrollment
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• The LAN’s mission is to help achieve better care, smarter spending, and healthier people.
• The Department of Health and Human Services (HHS) is working to transform the nation’s health system to emphasize value over volume.
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DHHS Learning Action Network (LAN)
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To achieve the goal of better care, smarter spending, and healthier people, the U.S. health care system must substantially reform its payment structure to incentivize quality, health outcomes, and value over volume.
• Healthier People
•Such alignment requires the participation of the
entire health care community.
• Smarter Spending
•In order to achieve this, we need to shift our
payment structure to pay for quality of care over
quantity of services.
• Better Care•The LAN seeks to shift our health care system
from the current fee-for-service payment model
to a model that pays providers and hospitals
for quality care and improved health.
• The Health Care Payment Learning & Action Network (LAN) was launched because of the need for:
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Purpose
Presenter
Presentation Notes
The Health Care Payment Learning & Action Network (LAN) was launched because of the need for better care, smarter spending, and healthier people. The LAN is about shifting away from the current fee-for-service model of payment in our health care system (where more services leads to higher payments, regardless of health outcome) to one that pays providers and hospitals for quality care and improved health. In order to achieve this, payment structures need to be shifted to quality of care over quantity of services. The LAN is a collaborative network of public and private stakeholders, working together through various groups in the health care community to create awareness.
Better Care, Smarter Spending, Healthier People
Adoption of Alternative Payment Models (APMs)
These payment reforms are expected to demonstrate better outcomes and smarter spending for patients.
In 2018, at least 50% of U.S. health care payments are so linked.
201850%
In 2016, at least 30% of U.S. health care payments are linked to quality and value through APMs.
201630%
Goals for U.S. Health Care
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Goal
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Presentation Notes
HHS set a goal of tying at least 30 percent of Medicare fee-for-service payments to quality or value through alternative payment models by 2016 and at least 50 percent by 2018. The LAN extends those Medicare goals to the private sector and states. As a public-private effort involving diverse stakeholders across health care, to date over 6,000 individuals are participating in the LAN.
Category 1Fee for Service –
No Link to Quality & Value
Category 2Fee for Service –
Link to Quality & Value
Category 3APMs Built on
Fee-for-Service Architecture
Category 4Population-Based
Payment
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Foundational Payments for Infrastructure &
Operations
B
Pay for Reporting
C
Rewards for Performance
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Rewards and Penalties for Performance
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APMs with Upside Gainsharing
B
APMs with Upside Gainsharing/Downside
Risk
A
Condition-SpecificPopulation-Based
Payment
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Comprehensive Population-Based
Payment
Population-Based Accountability
The framework situates existing and potential APMs into a series of categories.
The Framework is a critical first step toward the goal of better care, smarter spending, and healthier people.
• At-a-Glance
3NRisk-based payments NOT
linked to quality
4NCapitated payments NOT
linked to quality
= example payment models will not count toward APM goal.
N = payment models in Categories 3 and 4 that do not have a link to quality and will not count toward the APM goal. 41
APM Framework
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Presentation Notes
The Framework was established to: [read bullets] Serves as the foundation for generating evidence about what works and lessons learned Provides a road map for payment reform capable of supporting the delivery of person-centered care Acts as a "gauge" for measuring progress toward adoption of alternative payment models Establishes a common nomenclature and a set of conventions that will facilitate discussions within and across stakeholder communities The framework builds on the CMS proposed framework, which includes a trajectory of categories, with Category 1, fee for service without a link to quality, being the predominant model today – and a progression to Category 4, which includes population-based payment models. It is important when we discuss the framework to understand what the framework “is” and what it “is not.” The framework is a MODEL for categorizing payment models The framework is not a tool for establishing categories of delivery systems It is also not the Work Group’s intention to determine which model is the best model to follow. The framework is meant to allow for evolution and innovation in the field while driving toward value-based payments. Category 1: Payment models classified as Category 1 use traditional FFS payments (i.e., payments that are made for units of service) that are not adjusted to account for infrastructure investments, provider reporting of quality data, or provider performance on cost and quality metrics. Category 2: Payment models classified as Category 2 use traditional FFS payments (i.e., payments that are made for units of service), but these payments are subsequently adjusted based on infrastructure investments to improve clinical services, providers reporting quality data, and/or providers performance on cost and quality metrics. Category 2 includes four subcategories: Payments placed in Category 2A involve payments for infrastructure investments that can improve the quality of patient care. Payments placed in Category 2B provide positive or negative incentives to report quality data to the health plan and (preferably) to the public. Payments are placed in Category 2C if they provide rewards for high performance on clinical quality measures. Payments placed in Category 2D reward providers who perform well on quality metrics and penalize providers who do not perform well, thus providing a significant linkage between payment and quality. APMs Built on Fee-for-Service Architecture (Category 3): Payment models classified as Category 3 are based on a FFS architecture, while providing mechanisms for the effective management of a set of procedures, an episode of care, or all health services provided for individuals. Episode-based and other types of bundled payments encourage care coordination because they cover a complete set of related services for a procedure that may be delivered by multiple providers. Clinical episode payments fall into Category 3 if they are tied to specific procedures, such as hip replacement or back surgery. Category 3 includes two subcategories: Category 3A gives providers an “upside” opportunity to share in the savings they generate. Payments in Category 3B involve both upside gainsharing and downside risk based on performance on cost measures. Population-Based Payment (Category 4): Payment models classified as Category 4 involve population-based payments, structured in a manner that encourages providers to deliver well-coordinated, high-quality, person-level care within a defined (4A) or overall (4B) budget. Payments within Category 4 are intended to cover a wide range of preventive health, health maintenance, and health improvement services. Category 4 includes two subcategories: Category 4A payments are population-based, but they are limited to certain sets of condition-specific services (e.g., asthma, diabetes, or cancer), but they remain person-focused in the sense that they hold providers accountable for the total cost and quality of care related to that condition. Payments in Category 4B are capitated or population-based for all of the individual’s health care needs.
The National Safety Net Advancement Center: Advancing
Payment & Care Delivery Reform in the Safety Net
Supported by the Robert Wood Johnson Foundation
• Clinical Care Team Transformation Strategies• Financial Planning, Implementation, and Control
• Clinical Integration Across Settings• Network Structure, Governance, and Operations• Patient Attribution and Activation
• Risk Management and Adjustment Strategies
Safety Net Sectors & Priority Topic Areas
Health Care Safety Net
FQHCs(1,202 serving
23 mil)Community
Mental Health Centers
(2,200 serving 8 mil)
Public County Hospitals
(250 serving 45 mil)
Tribal Health Centers
(678 serving 5.2 mil)
Critical Access Hospitals
(1,325 serving 9.9 mil)
Oral Health Providers
(850 serving 15 mil)
Safety Net Partners
We will be working closely with organizations in 30 states for the six virtual learning collaboratives.
Grantee organizations located in:• Alabama• Illinois• Iowa• New Mexico• New York• Oklahoma
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•Thank You!
Presenter
Presentation Notes
Many talented and well-meaning experts try to approach one sector, ends up working at cross purposes to achieving value. Major improvement can be done from within. I will focus on the strategic and organizational implications.
Expected Outcomes of the Grants
Disseminate evidence on solutions
Capture and synthesize lessons learned from your work
Completing your projects to advance payment and care delivery reform work within your organizations
• What are the biggest issues in health care today?
Health Care SystemSmall Group Discussion
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Most Important Issue to Americans
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Monday, July 18, 2017; Bloomberg Poll
Issue RankingTerrorismImmigrationJobs/unemploymentHealth CareClimate ChangeTaxes
Most Important Issue to Americans
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Monday, July 18, 2017; Bloomberg Poll
Issue Ranking Percent of TotalTerrorism #3 11%Immigration #4 10%Jobs/unemployment #2 13%Health Care #1 35%Climate Change #4 10%Taxes #5 4%
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Presentation Notes
First time in history that respondents have said health care is most important issue
Current Situation
• Paradox of Health Care in the United States• Misalignment between Health Expenditure and Health Status of population
• Discouraging health trends • We are living shorter, sicker lives• One in five of live in neighborhoods with high rates of crime, pollution,
inadequate housing, lack of jobs, and limited access to nutritious food
• Increasing evidence how we can become a healthier, more equitable society
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Presenter
Presentation Notes
Our nation is at a critical moment. There is plenty of data that reveals discouraging health trends: We are living shorter, sicker lives. One in five of us live in neighborhoods with high rates of crime, pollution, inadequate housing, lack of jobs, and limited access to nutritious food. But there is other data that gives us glimpses of an optimistic future. There’s increasing evidence that demonstrates how we can become a healthier, more equitable society. It requires a shared vision, hard work, and the tenacity of many, but we know it is possible.
System Property
• Safety and Quality are based on expertise, commitment of providers• Human Factors (stress, fatigue, interruption, task saturation,
attention limitations)• Poor interdisciplinary team training and communication
failures• Safety and Quality must also be property of the system
• Deliberate design, implementation and monitoring• Forcing Functions and Countermeasures
Performance Management
• All the activities undertaken to ensure that goals of an organization are consistently being met in an effective and efficient manner.
• A comprehensive approach to manage two critical elements of an organization: the behavior and results of an organization.
• Focuses on results at all levels and areas: organization wide, a department, employee, and its processes.
Macro Level Value Creation
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• Advance payment model• Competitive compensation
Value in Health Care
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• System Design• Process Engineering
Presenter
Presentation Notes
Many talented and well-meaning experts try to approach one sector, ends up working at cross purposes to achieving value. Major improvement can be done from within. I will focus on the strategic and organizational implications.
Institute of MedicineCrossing the Quality Chasm (2002)Three Major Quality/Value Problems
• Overuse• 30% of Care is waste
• Underuse• MyGlynn, NEJM, 2003 54% of Care for Adults
• Misuse• Unintended injury
Value Issues
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1. Overuse• Penicillin • 30% of care is waste
2. Underuse3. Misuse
Value Issues
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1. Overuse2. Underuse3. Misuse
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Overall Care Acute Care Chronic Care Treatment Function
Gap between what is known to work and delivered care by broad type of care
Delivered Care Gap
Value Issues
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1. Overuse2. Underuse3. Misuse
1. Patient Safety Epidemic2. Opioid prescriptions over-used 80% at Mayo Clinic1
1. Annals of Surgery July 13 2017
Presenter
Presentation Notes
Opioid prescriptions over-used 80% at Mayo Clinic Over 7,000 surgeries, all 3 hospitals, 25 surgical specialties1
Cause of Low ValueMicro Level
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• Bottleneck• Re-Work• Redundancy• Inventory– 5S• Transport• Defects• Motion– Spaghetti diagram
Value in Health Care
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• The major deterrent to value is an industry structure that is absurdly designed and perpetuated by zero sum paradigm.
• It is inconceivable that a deliberately, methodically designed system would be developed the way our has evolved.
Presenter
Presentation Notes
We gravitate to zero-sum approaches Compete at wrong levels, and at the wrong things. Compete to shift costs to other sector; achieve market power, limit service. This does not create value. It merely shifts costs to one another, erodes quality, fosters inefficiency, creates excess capacity, and drives up administrative costs. The only way to get true value is to focus where value is created at the micro-system level and build up.
Opportunities for Alternative Payment
1. Providers focus on improving population health2. All providers practice at top of their license3. Providers get paid for what they do not do4. Fewer benefit restrictions and limitations
Presenter
Presentation Notes
Marks Comments would be: Providers focus on improving population health: IN OH we do what we know is best based on evidence not reimbursement…For Example: Remineralization. Dentistry is typically paid for volume, and to provide more services. There are very few models in dentistry that pay for value which is a prospective payment system approach. All providers practice at top of their license: Dental Assistants , Med Assistants, Community Dental Health Coordinators provide motivational interviews and change behaviors. Dentists surgically treat disease. Dentists are highly trained surgeons and often perform services that can be provided by lower level professionals. Moreover, lower level professionals can provide some services typically done by dentists. Under a value based payment system all levels of dental professionals can provide most of their care services at their highest level of training. Providers get paid for what they do not do: Reduce risk factors, change behaviors , add protective factors , get patient buy –in and less need for surgical treatment of disease. Under the retrospective fee for service financing system providers only get paid for certain services and do not get paid for certain preventive services and other services that would improve oral health. Fewer benefit restrictions and limitations; in healthcare there are numerous benefit restrictions that limit the services that are paid to a provider that are tremendous quality improvements (which increase value) that are not paid under the patient’s insurance policy coverage. For example, over 50% of Medicare payments are for services in the last 6 months of life, driven in part by the payment for volume system. There is very little payment mechanism for primary care providers to spend sufficient time with patients and families to ensure that patients are provided adequate information about treatment options to make informed decision making about their care. Now we can do what the evidence teaches us is right to do but was previously not paid for; Caries Risk Assessment, Interim Therapeutic Restorations, Multiple FL Varnish applications, Deep Scale and curettage Q 2-3 mos , Behavioral Interviewing to effect behavior change and enhance protective factors…
Barriers for Prospective Payment
1. If payments are actuarially unsound2. If system is complex to administer3. If population is not identified in advance4. Requires an interdisciplinary team5. Requires a care management system 6. Requires a focus on the individual and the population
Presenter
Presentation Notes
Marks Comments would be If payments are actuarially unsound: This needs to be tested and monitored over time If system is complex to administer: Over time standardization and simplification need to be achieved If population is not identified in advance: Pilots and models reviewed and environmental assessments completed Requires an interdisciplinary team; With dentists and dental actuaries on it Requires a care management system: Within and without! Requires a focus on the individual and the population: Person centered care with a population approach
RWJF Culture of Health (CoH)
• To Provide all people the opportunity to live as healthy as possible.• Every person has an equal opportunity to live the healthiest life they
can—regardless of where they may live, how much they earn, or the color of their skin.
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Presenter
Presentation Notes
We believe that striving toward a Culture of Health will help us realize. Still, we know that building this vision of a Culture of Health will take time. It will take fortitude. It will take collaboration. And we certainly cannot do it alone. Nonetheless, we firmly believe the vision is within America’s reach, and we intend to use our Foundation’s influence and reputation to help our nation get there.
The Culture of Health Action Framework
• The broad range of sectors and people involved in building a Culture of Health converge into four interconnected areas
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