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11/18/17
1
DriversofChange2018StrategicImplicationsfortheColoradoMedicalSociety
HealthCare:Top10DriversofChangefor2018
1. Publicinsuranceiscontinuingtogrow.2. Paymentreformisadvancing.3. Consumersaredemandingincreased
technology.4. Newmodelsofcareareemerging.5. Physicianwell-beingiscrucial.
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6. Integrationofbehavioralandphysicalhealthisprogressing.
7. Populationhealthandpublichealthareconverging.
8. Consumersarefacinghigherspending.9. Consumersaredemandingnew(and
expensive)drugs.10. PhysicianscanbringastrongvoicetoD.C.
andDenver
HealthCare:Top10DriversofChangefor2018
1.PublicInsuranceisContinuingtoGrow.
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NewestDataonHealthCoverageinColorado
ExpandedEligibilityPushingMedicaidGrowthMedicaidExpansionEnrollment
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MoreManagedCareinMedicaid?PercentageofMedicaidPopulationinMCOsasofJuly1,2016
Source:2017KaiserFamilyFoundation’sStateHealthFacts
RaysofSunshineamongclouds
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GrowthofMedicareAdvantagePlans
Source:2017KaiserFamilyFoundation
1. Howdothesechangesimpactadministrativeburden?
2. IsColoradoacceleratingtowardcapitation?
3. Howcanpracticesanticipateandleveragebonuses,clinicalmeasuresandotherfinancialincentivesorfinancialpenalties?
QuestionsfortheColoradoMedicalSociety
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2.PaymentReformisAdvancing.
PaymentReform
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• Paymentreformhasbipartisansupportatthefederallevel.
• MedicareandCHIPReauthorizationAct(MACRA)willimpactmostphysicianreimbursementforMedicarestartingin2019.
• ColoradoMedicaidwillbeginpayingprimarycarephysiciansbasedontheirperformancein2018.
PublicInsuranceLeadingtheWay
• InformationfromRAEpresentation.Jeff
PaymentReformAdvances
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•RAEswillbepaid$15.50PMPM.
•RAEswillcontractwithprimarycareproviders;mustoffertopaythematleast$2PMPM.
•HCPFwithholds$4PMPMforRAEtoearnbackifperformancegoalsaremet.
QualityIncentivesinACCPhaseTwo
AdditionalPhaseTwoincentiveopportunities:• Providersshareinfinancialrisk.
• HigherbehavioralhealthcapitationrateifRAEshitperformancegoals.
• Pay-for-performancepooltoencouragehigherstandards.
QualityIncentivesinACCPhaseTwo
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2.7
7.7
14.0
17.1
22.5
28.3
32.4
0
5
10
15
20
25
30
35
2011 2012 2013 2014 2015 2016 2017
LivesCoveredByACCs(inmillions)
IncreasingNumberofLivesCoveredbyACOs
Source:HealthAffairs
LivesCoveredbyACOs(inMillions)
PublicVersusCommercialACOContracts
Source:Authors’analysisofLeavittPartnersACODatabase
ACOLivesPerPayer(inMillions)
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1. Howdomemberspreparefordownsiderisk?2. Whatarethesticks?Whatarethecarrots?3. Howcanmemberskeepupwithrequirementsfor
metrics?4. WhatsupportcanCMSprovide?5. Howcanyoutrainmemberstopreparefor
changes?
QuestionsfortheColoradoMedicalSociety
3.ConsumersareDemandingIncreasedUseofTechnology.
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TechnologyIsAlreadyPartofTheConsumerExperience
2016ConsumerLikelihoodtoUseTelemedicine
ConsumersWantMore
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AnAppleaDay...
1. Willadoptingnewtechnologiesleadtohigherpatienttrust?
2. Howwillmembersensurepatientsafetyandconfidentiality?
3. Howcanmembersincorporatenewtechnologiesintoalargerpatientengagementstrategy?
QuestionsfortheColoradoMedicalSociety
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4.NewModelsofCareAreEmerging.
TheChangingHealthCareDeliveryLandscape
National• Walmart• Lowe’s
Local• Newmarket
entrants• DaVita• Walgreens
Regional• Urban“Centers
ofExcellence”• United
Healthcare
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ARetailCliniconEveryCorner
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TheGrowthofRetailClinics
Source:ConvenientCareAssociation
“Nursepractitionersaremoreindemandthanmostphysiciansasstatesallowdirectaccesstopatientsfortheseincreasingly
popular healthprofessionals.”
ForbesJune2017
TheShiftingHealthCareWorkforce
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1. Howmightpracticesalignorpartnerwithnewcaresettings?
2. Whataretheimplicationsofnewcaresettingsfortraditionaloffices?Hours?Convenience?
3. Withworkforcepatternsshifting,whatstepscanpracticestaketoensurequalityandeffectiveness?
QuestionsfortheColoradoMedicalSociety
5.PhysicianWell-beingisCrucial.
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Source:MedscapeLifestyleReport2017:RaceandEthnicity,BiasandBurnout
LeadingCausesofPhysicianBurnout
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TheReciprocalDomainsofPhysicianWell-Being
Source:2016,StanfordMedicine
1. ImprovingPhysicianLeadership:Aphysician'swellnessisdirectlycorrelatedtowhotheirsuperioris.
2. CultivatingCommunity:Sponsoringlunchtimemeetingswithjustphysicianssotheycanlearnandsharechallenges.
3. SurveyingMembers:UnderstandtheextentofburnoutinColoradoanditsreasons.
ThreeSuggestionsfromMartiSchulte
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1. Whatapproacheswouldmakethebiggestimpactformembers?
2. Aretherespecificprogramsorservicesthatwouldpreventphysicianburnout?
3. HowmightCMS“cultivatecommunity?”
QuestionfortheColoradoMedicalSociety
6.TheIntegrationofBehavioralandPhysicalHealthCareisProgressing.
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DrugOverdoseDeathRatesatAll-TimeHigh
Source:ColoradoHealthInstitute,2015
Age-AdjustedDrugOverdoseDeathRateper100,000,Colorado,2002-2014
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21
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• SIMCohortOne:100• SIMCohortTwo:150• SIMCohortThree:150• ComprehensivePrimaryCareInitiative:71• CPC+:203• ColoradoHealthFoundationPrimaryCarePractices:20• RAEs:550
ColoradoPracticesInvolvedinIntegration
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SixLevelsofIntegratedCare
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1. Whatkindoftrainingandeducationwouldbevaluedforintegration?
2. Howcanyoubetterequipphysicianstointegratepractices?
3. Whatkindofprogramswouldbevaluable?
QuestionsfortheColoradoMedicalSociety
7.PopulationHealthandPublicHealthareConverging.
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Health-RelatedSpending,CityandCountyofDenver
HealthSpendingDwarfsSocialSpendinginDenver
Source:MileHighCapitalStack
SocialandEconomicFactorsAffectHealth
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1. HowshouldCMSpositionphysicianstoparticipateinthisissue?
2. ShouldCMSadvocatefor“non-health”issuesinpopulationhealth?
3. Whereistheopportunityforphysicians,especiallythinkingaboutthisincombinationwithpaymentreform?
QuestionsfortheColoradoMedicalSociety
8.ConsumersareFacingHigherSpending.
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$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
$1,800
$2,000
2002 2004 2006 2008 2010 2012 2014 2016
AverageIndividualDeductible
DeductiblesHeadHigher
Source:MedicalExpenditurePanelSurvey
Source:2017KaiserFamilyFoundation
MoreWorkersCoveredbyHighDeductiblePlans
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ColoradansSkipCareBecauseitCostsTooMuch
1. Ifconsumersaremoreinvolvedinpayingforcare,howwillphysicianpracticesadapt?
2. Istherespecializedtrainingorprogramsthatcouldbenefitpractices?
3. WhatarepotentialrolesforCMSaroundpricingtransparency?
QuestionsfortheColoradoMedicalSociety
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9.ConsumersareDemandingNew(AndExpensive)Drugs.
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1. Whatroledophysicianshaveinofferingalternativesorcounterargumentstoconsumerdemand?
2. Howcanyouhelppreparepracticesforthecomplexreimbursementassociatedwithspecialtypharmaceuticals?
3. Howdopracticesgetinvolved?
QuestionfortheColoradoMedicalSociety
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10.PhysiciansCanBringaStrongVoicetoD.C.andDenver
TheDrivingPrincipleinHealthCareToday?
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“WhileCongresstusslesoverObamacare,theTrumpadministrationisquietlypressingaheadwithplanstogutmajorObama-erarulesandrelaxfederaloversightofswaths
ofthehealthcareindustry.”
“HowtheTrumpadministrationisreshapinghealthcare— withoutCongress.”
September13,2017
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1. WhereshouldCMSshowupinthesediscussions?
2. Isthisapriorityareaforyourmembership?
3. Howcanyoubestrelaythespecificinterestsofyourmembershiptopolicymakers?
QuestionsfortheColoradoMedicalSociety
[email protected] (720)-382-7073
@MicheleLueck