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REDEFINING HEALTH CARE
How do we define “Value” in health care?
REDEFINING HEALTH CARE
Value equals Outcomes?
REDEFINING HEALTH CARE
Value equals Outcomes and Cost?
REDEFINING HEALTH CARE
“Health outcomes achieved per dollar of cost compared to peers.”
Three aspects:
1. Outcomes
2. Cost
3. Competition
REDEFINING HEALTH CARE
Competition in the health care industry today.
Competition is for a “piece of the pie”
Little or no benefit to the patient
REDEFINING HEALTH CARE
Zero-sum Competition
1. Cost Shifting to other participants
2. Costs actually increase
3. Overall no benefit
REDEFINING HEALTH CARE
Zero-sum Competition
1. Cost Shifting to other participants
2. Costs actually increase
3. Overall no benefit
REDEFINING HEALTH CARE
Example - Start
Health Plan, 25%
Employer, 25%
Provider, 25%
Patient Employee,
25%
REDEFINING HEALTH CARE
Example – Provider Mandate
Patient Employee
Provider
Employer
Health Plan
REDEFINING HEALTH CARE
Example – Cost Shift to Payer
Health Plan
Employer
ProviderPatient
Employee
REDEFINING HEALTH CARE
Example – Cost Shift to Employer
Patient Employee Provider
Employer
Health Plan
REDEFINING HEALTH CARE
Example – Cost Shift to Employee
Health Plan
Employer
Provider
Patient Employee
REDEFINING HEALTH CARE
Example – Cost Shift to Employee
Patient Employee
Provider
Employer
Health Plan
REDEFINING HEALTH CARE
Value Based Competition – 8 Aspects
1. The focus should be on value for patients, not just lowering costs.2. Competition must be based on results.3. Competition should center on medical
conditions over the full cycle of care.4. High-quality care should be less costly.
REDEFINING HEALTH CARE
5. Value must be driven by provider experience, scale, and learning at the medical condition level.6. Competition should be regional and national, not just local.
Value Based Competition – 8 Aspects
REDEFINING HEALTH CARE
7. Results information to support value-based competition must be widely available.8. Innovations that increase value must be
strongly rewarded.
Value Based Competition – 8 Aspects
REDEFINING HEALTH CARE
1. Value from patient’s perspective2. Outcomes information must be made available to consumers3. Health care must move away from “Discrete Interventions” to “Cycle Of Care”.
Value Based Competition
REDEFINING HEALTH CARE
1. Providers not only must be willing to be under scrutiny, they must initiate it.2. Fear of litigation lessened if patient is making truly informed decisions.3. Provider re-alignment from Service model to medical condition via the IPU.4. I.T. cannot be seen as an enemy
Changing Roles - Providers
REDEFINING HEALTH CARE
1. Health care structured along medical condition, not service.2. All treatments, test, etc. aligned by medical condition.3. Do not limit by facility nor even geography
The IPU – Integrated Practice Unit
REDEFINING HEALTH CARE
1. No fear of I.T. and have gathered much data2. May have more information about patient’s health habits3. May be best suited as keeper of Medical Record
Changing Roles – Health Plans
REDEFINING HEALTH CARE
1. Need to be main driver2. Demand health plans contract with quality providers3. Providers will have to report to have contracts
Changing Roles – Employers
REDEFINING HEALTH CARE
1. Some government intervention required2. Do not want nationalized healthcare3. Must have universal health care4. Re-examine medical laws such as Stark5. Free up competition – do not restrict specialty hospitals
Policy
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1. How feasible? Is it “Pie-in-the-sky”?2. Providers may be hardest to convince3. But there are many examples of advancement in this area.
Conclusions
