HEALTH SYSTEM PRIORITIES

Transcription

1

2 2

3 3 Five Priorities for Health Systems OUR DISCUSSION TODAY Exchanges Data Analy0cs Market Posi0oning Pricing Efficiency

4 4 Exchanges Over 125,000 in 2014 and over 550,000 in 2019 Over 520,000 by 2017 Over 330,000 in 2014 Between 487,000 and 696,000 subsidy- eligible Californian's. Over 1 million New Yorkers, including 615,000 individuals and 450,000 small businesses Will serve 2 out of every 5 Minnesotans, more than 1.2 million

5 5 Exchanges THE END OF BAD DEBT? Assumed Exchange Particpation Platinum 2% 50 Gold 4% 100 Silver 20% 500 Bronze 74% 1,850 Total 100% 2,500 Exchange Personal Responsible Portion Platinum 10% 5 Gold 20% 20 Silver 30% 150 Bronze 40% 740 Total 915 Uncollectability of Exchange PRP Platinum 20% (1) Gold 25% (5) Silver 30% (45) Bronze 50% (370) Total (421) Bad Debt on Exchange Revenues (421) Bad Debt as a % of non- Charity Gross Revenues 6.9% (4,000) Total Bad Debts (4,421)

6 6 Exchanges

7 7 Medicaid Expansion COVERAGE GAP IN SOME STATES Income > 100% of the federal poverty level - - about $11,500 a year as a single person or about $23,500 for a family of able to buy a private health insurance plan in the Marketplace and may get lower costs based on your household size and income. Income > $11,500 a year as a single person or about $23,500 for a family of 4, you may not qualify for lower costs for private insurance based on your income. However, you may be eligible for Medicaid, even without the expansion, based on your state s exis0ng rules. Many adults in those states with incomes below 100% of the federal poverty level fall into a gap. Their incomes are too high to get Medicaid under their state s current rules. But their incomes are too low to qualify for help buying coverage in the Marketplace.

8 8 Data Analytics INFORMATION Total claims experience Clinical Data Health Status Outcomes Providers u0lized

9 9 Data Analytics RE- DEFINING MARKET SHARE

10 10 Data Analytics MEMBERSHIP

11 11 Data Analytics CARE PLANNING / PREDICTIVE MODELING Iden0fy risk at the pa0ent level, not just a popula0on Iden0fy best prac0ces from large clinical databases Provider agreement & compliance

12 12 Data Analytics TECHNOLOGY ARTIFICIAL INTELLIGENCE Neural Networks Virtual neurons create rela0onships and pacerns Gene0c Algorithms Mimicking natural processes with search func0on Fuzzy Logic Ability to qualify data without exactness Rule Based System Strict code adherence

13 13 Market Positioning COMMODITY ENTITY OR AT- RISK Solu0on Shop Focused Factory

14 14 Market Positioning SOLUTION SHOP Clayton Christenson, The Innovators Prescrip0on Diagnose and Recommend Fee- for- service Speed and accuracy Pa0ent centered, pa0ent specific Most oien exper0se quadrant

15 15 Market Positioning FOCUSED FACTORY Ms. Raji Kumar, CEO Dallas Medical Center from William Skinner s 1974 concept Value- added, outcomes based High expecta0on for Quality zero defects Customer sa0sfac0on Most oien expected and experience quadrants

16 16 Market Positioning

17 17 Pricing COMMODITY ENTITY OR AT- RISK

18 18 Pricing COMMODITY ENTITY OR AT- RISK

19 19 Pricing COMMODITY ENTITY OR AT- RISK

20 20 Efficiency TECHNOLOGY ARTIFICIAL INTELLIGENCE Duplica0on Unnecessary Preventable Fraud

21 21 Efficiency LABOR MANAGEMENT

22 22 Health Systems Managing Risk

23 23 Health Systems Managing Risk

24 24 4 th ANNUAL INSURANCE INDUSTRY CONFERENCE Tony Colarossi FHFMA Partner Healthcare Consul0ng