Healthcare IT Angel Investor Intro Presenter: Saul Richter. sponsored by

Transcription

1 Healthcare IT Angel Investor Intro Presenter: Saul Richter sponsored by August 2015

2 Agenda What is the problem in healthcare? Why is it so hard to solve? Overview of healthcare change Healthcare spending overview Hospital market overview Physician market overview Risk-sharing overview Medicare overview Medicaid overview Technology opportunities FOR MARKETING PURPOSES 2

3 Challenges + Change = Opportunity Estimated Waste in the US Healthcare System 2010 ($ Billions) The problem is clear Unnecessary Waste Excess Administrative Costs Inefficiently Delivered Svcs Prices That are Too High The solution is less clear Fraud Missed Prevention Opptys Total Estimated Waste of $765 Billion Dollars Source: Institute of Health FOR MARKETING PURPOSES 3

4 Why is Health Care Change so Difficult? Change is clearly needed, but changing/shrinking the pie is not easy too many people make a living off of the pie? Ecosystem is complex and intertwined, and thus organizational motivations are complex as well Money at stake is large (tempting to bad actors) Old habits (Physicians and others) are hard to break 57% of physicians older than 50 Biggest consumers of health care are slowest technology adopters Time will heal his? Many software vendors are motivated to limit connectivity And that is without talking about politics or ethics!! Government share of poor people s healthcare is a can of worms Apportioning of resources presents tremendous ethical issues FOR MARKETING PURPOSES 4

5 A Simple Ecosystem Map. FOR MARKETING PURPOSES 5

6 The Complex Ecosystem FOR MARKETING PURPOSES 6

7 Healthcare Cost Overview Very High Historical Growth Rates Medical Expenses By Sector $ Billions % of % of Growth Infl Adj 1980 Total 2012 Total since 1980 Growth Hospital Care % % 778% 279% Physician and Clinical Services 48 22% % 1084% 389% Prescription Drugs 12 6% % 2085% 747% Nursing Care Facililties 15 7% 152 6% 892% 320% Other Health Care 9 4% 138 6% 1523% 546% Dental Services 13 6% 111 5% 726% 260% Home Health Care 2 1% 78 3% 3171% 1137% Other Medical Products 14 6% 95 4% 586% 210% Other Professional Services 3 2% 76 3% 2096% 751% % 2, % 982% 352% Source: Centers for Medicaid and Medicare, National Health Expenditures, 2014 release. $1 in 1980 is $2.79 in 2012 dollars FOR MARKETING PURPOSES 7

8 Healthcare Costs in More Detail FOR MARKETING PURPOSES 8

9 Healthcare Costs Grew Consistently More than CPI FOR MARKETING PURPOSES 9

10 Who Pays the Bill? FOR MARKETING PURPOSES 10

11 Spending as % of Total Federal Spending FOR MARKETING PURPOSES 11

12 Finally Slowing Down? FOR MARKETING PURPOSES 12

13 Hospital Market Overview Fewer than 1400 hospitals over 200 beds FOR MARKETING PURPOSES 13

14 Hospital Dynamics Hospital Admissions and days decreasing Consolidation needed Need to re-invent themselves and trim costs Risk-sharing model is coming FOR MARKETING PURPOSES 14

15 Hospital EHR Adoption has grown rapidly Epic & Cerner Dominate FOR MARKETING PURPOSES 15

16 Hospital EHR Market Share FOR MARKETING PURPOSES 16

17 Strengths Hospital as a Startup target Tremendous and acknowledged need for change Innovation offices often driving these changes Large systems investing in technology and reinventing themselves Open to SaaS business (generally over security hurdles) Challenges Many hospitals still struggling with EHR transition EPIC (and others) play poorly with others Epic claims they do everything Market is not as large as perceived Gap between leaders and followers 1,000 hospitals at $8k of MRR is $100m opportunity but is high penetration rate Large numbers of IT priorities vying for limited resources Hair on fire tremendous change going on at once Innovation often centrally regulated making for long sales cycles FOR MARKETING PURPOSES 17

18 Physicians Market Office Sizes FOR MARKETING PURPOSES 18

19 Hospitals Buying up Practices aggressively Trends driving this IT costs Risk-sharing Needed revenue flow Many others FOR MARKETING PURPOSES 19

20 Physician EHR Penetration FOR MARKETING PURPOSES 20

21 Outpatient (physician Office) EHR Share FOR MARKETING PURPOSES 21

22 Physician Market Dynamics Practices were damaged by the recession and aftermath but are slowing coming back Physicians weigh options to help shield them from market forces Emerging practice models will vary by geographic area one size will not fit all Physician care remains highly fragmented even with the expansion of hospital employment More than 40% of physicians still practice in groups of fewer than five even in more competitive urban markets Group practice membership grew by 17% from 2003 to 2010 and appears poised to continuing growing FOR MARKETING PURPOSES 22

23 Strengths Physicians a Startup target Large market 900,000 Physicians (48% Primary/52% Specialist) 230,000 offices (3,000 large practices) Average salaries above $200k Government incentives have driven EHR penetration rapidly into large and small offices Large offices are good targets and are investing in technology Challenges Small offices often have no technical capabilities Generally small doctors have their hair on fire and have no full time managers Long sales cycles Large percentage of docs over 50 Many doctors are less efficient with EHRs and view them as negative FOR MARKETING PURPOSES 23

24 Rapid Era of Change Makes Things More Complex There are two major changes that are in process, but underlying these two fundamental changes are many more moving parts Shift from Pay-per-service to Shared Risk Models Increasing focus on closer case management and more tools to promote wellness and proper treatment Payments models changing rapidly Shift from Analog to Digital Driven by government carrots and sticks, as well as shared risk models FOR MARKETING PURPOSES 24

25 Simplified version of the change FOR MARKETING PURPOSES 25

26 Anatomy of Shared Risk in Health Care FOR MARKETING PURPOSES 26

27 Risk Sharing Continuum FOR MARKETING PURPOSES 27

28 Risk-Sharing = Bundled Payments = Value-based payments FOR MARKETING PURPOSES 28

29 Accountable Care? FOR MARKETING PURPOSES 29

30 Accountable Care Organizations FOR MARKETING PURPOSES 30

31 Accountable Care Organizations FOR MARKETING PURPOSES 31

32 As of May 2014: 338 MSSP ACOs 4.9 million assigned beneficiaries in 47 states ACO s happening fast FOR MARKETING PURPOSES 32

33 How Does Shared Savings Work? FOR MARKETING PURPOSES 33

34 Accountable Care Circle FOR MARKETING PURPOSES 34

35 Technology needed for Population Health = Care Management = Care Coordination FOR MARKETING PURPOSES 35

36 The Deeper Level of Healthcare Policy Changes State health insurance exchanges (HIX) Limited to small companies, Federal assistance if plan is "unaffordable Increased role of Clinical Quality Measures in MU EHR Incentive Payments & Penalties Pharmaceutical Company Fees Accountable Care Organizations (acceleration into DSRP) DSRP: Delivery System Reform Incentive Payment Hospital Readmission Penalties Medicaid Coverage Expansion (optional) Premium Subsidies (income based) Coverage Mandate Comparative Effectiveness Research Minimum Essential Coverage Medicare FOR MARKETING PURPOSES 36

37 Medicare Overview Medicare Part A (Hospital Insurance) Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part B (Medical Insurance) Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. Medicare Part C (Medicare Advantage Plans) A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for- Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage. Medicare Part D (prescription drug coverage) FOR MARKETING PURPOSES 37

38 Medicare Cost Analysis FOR MARKETING PURPOSES 38

39 Medicare Advantage Growth FOR MARKETING PURPOSES 39

40 Medicare Growth Spending Slows (Projected) FOR MARKETING PURPOSES 40

41 Medicaid Overview FOR MARKETING PURPOSES 41

42 Medicaid Enrollment FOR MARKETING PURPOSES 42

43 Medicaid Costs FOR MARKETING PURPOSES 43

44 Federal/State Breakdown by State FOR MARKETING PURPOSES 44

45 Politics Medicaid Expansion FOR MARKETING PURPOSES 45

46 Opportunities: Big Data in Health Care FOR MARKETING PURPOSES 46

47 Big Data and Healthcare: Big Opportunity FOR MARKETING PURPOSES 47

48 Big Data in Pharma Big Opportunities Predictive modeling of biological processes and drugs becomes significantly more sophisticated and widespread. Patients are identified to enroll in clinical trials based on more sources for example, social media than doctors visits. Trials are monitored in real time to rapidly identify safety or operational signals requiring action to avoid significant and potentially costly issues such as adverse events 2 and unnecessary delays. Instead of rigid data silos that are difficult to exploit, data are captured electronically and flow easily between functions, for example, discovery and clinical development, as well as to external partners, for instance, physicians and contract research organizations (CROs) FOR MARKETING PURPOSES 48

49 Biggest Healthcare Myths? Consumers drive change Consumerism may play a role but how large is uncertain Telemedicine is around the corner By the time it happens, investing opportunities may be slim Mobile will change everything Key population is not yet mobile Change will be slow Hardest Problems to solve Changing people s motivations FOR MARKETING PURPOSES 49

50 Mobile Health debunked by McKinsey McKinsey Myth 3: Mobile health is the game changer Mobile health the practice of healthcare supported by mobile devices is often hailed as the future of digital services in healthcare. Still, our survey shows that demand for mobile healthcare is not universal. It is therefore not the single critical factor in the future of healthcare digitization. Of course, there is certainly demand for mobile healthcare applications, and it is strongest among younger people. Health systems should therefore create mobile solutions that target this audience for example, apps that focus on prenatal health or those that could be classified as lifestyle apps. Beware of solutions that could have a lot of impact but are not of interest to the segment in question digital applications to manage chronic conditions typically found in older people, for example. FOR MARKETING PURPOSES 50

51 Best Research Sources Best in KLAS Evaluates software platforms Good amount of free info Kaiser Health Government (Medicaid) McKinsey Industry Associations AMA, JACHO See links at end of presentation FOR MARKETING PURPOSES 51

52 Areas of Opportunity We like smaller niches adjacent to competitive areas Hospital Feedback Re-admissions Big Data in Healthcare Medication Adherence Hospital Operations FOR MARKETING PURPOSES 52

53 Sample Small Market Hospital Satisfaction Measurement HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Voluntary collection of HCAHPS data for public reporting began in 2006 and public reporting of HCAHPS scores began in Since July 2007, hospitals subject to IPPS payment provisions ("subsection (d) hospitals") must collect and publicly report HCAHPS data in order to receive their full IPPS annual payment update (APU). IPPS hospitals that fail to report the required quality measures, which include the HCAHPS survey, may receive an APU that is reduced by 2.0 percentage points. FOR MARKETING PURPOSES 53

54 Telehealth Opinions in 2013 Klas in FOR MARKETING PURPOSES 54