Game Changers Coming Soon in Healthcare Delivery. Jan Slater JD, MBA

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1 Game Changers Coming Soon in Healthcare Delivery Jan Slater JD, MBA

2 What s New in Healthcare Same old wine in a brand new bottle?

3 So What s New in Health Care Reform?

4 Game Changers Viral influence of transparency. Shift of medical care from in-patient to outpatient settings with team based care. Increasing trend of higher deductible insurance. Information technology systems. New Technology - Personalized Medicine - Genomics.

5 What Do We Know Will Happen? In the future: Managed care in some form will continue Hospitals and physicians will no longer be paid by volume of services provided P4P will be the new model If providers don t find alternatives to the current system, they will not survive.

6 People do not change until the pain of staying the same changing. exceeds the pain of Anonymous

7 The Role of Transparency The Viral Influence of Transparency: the First Game Changer Price Transparency Quality Transparency

8 The Viral Influence of Transparency: In the future the consumer will make health care decisions on the basis of VALUE VALUE = Outcomes + Satisfaction Cost The CONSUMER ultimately determines which of these elements constitute VALUE

9 Read all about it!! April 2005

10 The Role of Transparency Quality Transparency Price Transparency Quality Transparency

11 Core Measures: Heart Attack Heart Failure Pneumonia Surgical Care Improvement HCAHPS

12 2014 Clinical Quality Measures: Emergency Department Throughput Stroke VTE AMI CAP Surgical Outcomes New Born Care More HCAHPS

13 Transparency of Cost and Quality Transparency is the best thing that s happened to cost and quality since antibiotics...by decreasing variance and improving results Dr. Steven Berlowitz

14 That which is measured, tends to improve. That which is measured publicly, tends to improve faster.

15 What we concluded was that even when hospitals know their performance is not good, that's not sufficient motivation for them to do something. Making it public made a big difference in motivating them to improve. Dr. Steven Berkowitz

16 What is Quality to the Healthcare Consumer? More responsive and patient centered healthcare Treatments at home and in out-patient settings: Enabled by technology and home health care Fewer inconveniences and cost related to illness Less disability, pain and discomfort due to interventions

17 If the other guy s getting better, then you d better be getting better faster than that other guy s getting better Or you re getting worse. Tom Peters

18 The Role opriceansparency Price Transparency Price Transparency Quality Transparency

19 The Increasing Trend of Higher Deductibles From 1999 to 2013, average annual employer and worker contribution for health insurance increased 300% Out-of pocket cost for healthcare increased from $400 in 2006 to $1200 in 2013 Greater costs will be pushed to consumers who will become more: health literate responsible purchasers of healthcare

20 Influence of Cost on the Purchase of Healthcare Jan has the flu and feels bad! Jan has great insurance but a $3,000 deductible What does she do? Treatment Options: Approximate* Out of Pocket Wait Emergency Department $ hrs Urgent Care hr PCP visit hr (if available) Local Pharmacy min Self Treat.. rest, OTC meds... 10? None * The actual cost may not be known until the evaluation is completed.

21 Overcoming Inaccurate perceptions of Rural Healthcare Inaccurate perception that rural healthcare can t provide the same value as urban healthcare Get the word out about value services Excel on core measures and HCAPS Reduce readmissions Reduce hospital acquired conditions Find innovations to distinguish yourself

22 Current System vs New Models Currently patients with chronic conditions: See several physicians No coordination of care Leads to repeated hospital admissions

23 One Successful Model: Patient Centered Medical Home (PCMH) PCMH: short waits, responsive primary care, team based care, high tech solutions Team make up: PAs, RNs, pharmacists, dietitians, mental health professionals and case managers Emphasis on care coordination and preventive medicine Use of data bases of medical information to screen for diseases and flag needed preventive measures Great improvements in patients and healthcare professionals satisfaction

24 Examples of Quality Improvement Healthcare providers take on the problem of patient non-compliance Reduce readmissions of CHF patients with athome technology Reduce diabetic amputations with frequent visits to wound clinics High risk patient care teams; where high risk, high cost patients will receive specialized team care

25 Examples of Quality Improvement continued Chronic disease specific clinics Alignment of rural and urban hospitals for care coordination Choosing Wisely initiative to legitimized our ability to cut back on what's unnecessary. Continuous Improvement; Toyota Lean and Six Sigma process imporovement

26 Information Technology; EMR, HIE Healthcare providers required to install electronic medical records ( EMR ) by 2014 Health Information Exchanges ( HIEs ). Patient s medical information available to all treating providers where ever the patient goes Greater savings by reducing duplicated tests and interventions Promotes evidence based medicine Using the EMR in this manner is the Clinical Transformation to how we will be practicing better medicine in the future The EMR will do for health care what the assembly line did for manufacturing

27 New Technology- Personalized Medicine- Genomics A person s genetic make up (Genotype): Pre-determines individual risk of contracting diseases. Identifies likelihood of a beneficial response to medications/interventions. Low cost genetic mapping will be used to create individualized treatments and medication dosages.

28 zed Medicine-- Changer Personalized Medicine Game Changer Traditional Model Patient develops symptoms and accesses health care system Personalized Model Testing is done upfront on patient s DNA History Physical Exam Testing Lifetime Risk of Specific Disease Unique Response to Medications Diagnosis of Established Disease Likely Diseases Predicted Treatment based upon statistical evidence Treatment based upon the individual needs

29 Putting Together IT and Genomics Evidence Based Medicine Increasing medical knowledge- research Increasing individual knowledge- cell phone Increasing penetration of the Internet Increasing speed and power of computers Enhanced data capture - ICD 10

30 Won t All This Run Up Costs? Skeptics doubt it is possible to improve quality and reduce costs Without financial reform the pressure of P4P requires keeping a foot in both the volume boat and the value boat which are traveling in opposite directions How to retool the organization to jump entirely into the value boat but keep it steadfast on the volume course?

31 The American Healthcare System is Repair- Centric and NOT Prevention-Centric. We wait for train wrecks and then clean them up. What if we prevented the train wreck in the first place?? You can fix a problem at step 1 for $1 or fix it at step 10 for $30. W. Edward Deming

32 How to Cut Costs Focus on what costs the most: Hospitalizations, ED visits, care for the frail, high-risk elderly and patients with multiple high-risk chronic conditions. Use "upstream" interventions, to save on "down-stream" costs. Invest in future wellness to prevent train wrecks.

33 Future of Rural Healthcare Is Bright Growing need for community-based hospitals, clinics and healthcare organizations Negotiate with payors to innovative with P4P Greater collaboration between hospitals and physicians Financial and structural integration Focus on providing VALUE

34 You can always count on Americans to do the right thing after they ve exhausted all the other possibilities!! Winston Churchill