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Transformation of Health CareUpdate for 2015
Steven M. Berkowitz, MDSMB Health Consulting,
Austin, TX512-415-6095
2012- 2014 Clients- Two Lessons Learned
Every System is unique.
But… Every System is dealing with the same issues.
So What’s New in Health Care Reform?Same old wine in a brand new bottle?
So What’s New in Health Care Reform?
You can always count on Americans to do the right thing… …after they’ve exhausted all the other possibilities !!” Winston Churchill
People do not change until the pain of staying the same…
… exceeds the pain of changing.
Anonymous
Medicine is a Team effort….
…..Why do we insist on playing Solo !
The Health Care Team
The “Viral” Influence of Transparency The Increasing Trend of Higher Deductible Insurance The Implementation (or Not) of the ACA Practicing Medicine on the Smart Phone
Game Changers for 2015
The “Viral” Influence of Transparency The Increasing Trend of Higher Deductible Insurance The Implementation (or Not) of the ACA Practicing Medicine on the Smart Phone
Game Changers for 2015
The Good
The Bad
The Ugly
Transparency… This Train’s Left the StationThe Good, the Bad, and the Ugly
The Good
The Bad
The Ugly
Huge gains in quality and satisfaction
Quality, ExperienceTransparency
Transparency… This Train’s Left the StationThe Good, the Bad, and the Ugly
The increasingly informed consumer will make health care decisions on the basis of VALUE
VALUE = Outcomes + Pt Experience
Cost
Value Based Purchasing
Read all about it !! April 2005
“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.”
Judith Hibbard, Health Affairs 2003
Data Transparency
That which is measured, tends to improve.That which is measured publicly, tends to improve faster.
Core Measures: Heart Attack Heart Failure Pneumonia Surgical Care Improvement
HCAHPS
CMS Core Measures– the Top Decile
Core Measures: Heart Attack Heart Failure Pneumonia Surgical Care Improvement
HCAHPS
Core Measures: Heart Attack Heart Failure Pneumonia Surgical Care Improvement
HCAHPS
Overall Hospital Rating
Patient Experience- HCAHPs
Pain ManagementQuietness of Hospital
Patient Experience- HCAHPs
Transparency is the best thing that’s happened to quality since antibiotics...
…by decreasing variance and improving results
Data Transparency and Accountability
Percent Who Saw and Acted Upon the Information
Choice of Hospitals
0
5
10
15
20
25
30
1996 2000 2004 2006 2008
Saw
Acted
Kaiser Family Foundation, October 2008
Exposure to and Use of Quality Information
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
Transparency is the best thing that’s happened to quality since antibiotics...
…by decreasing variance and improving results
As transparency matures, it will rewrite h book on:
Who is your competitor?
Data Transparency and Accountability
Stage IThe “other guy”
Stage IIIThe entire nation ?
Stage IVMedical tourism
Incr
easin
g Tra
nspar
ency
Stage IIAll hospitals in Oklahoma
System Strategic PlanningWho is Your Competitor…. The role of Transparency
Step 1- Demographic need
Step 2- Financial feasibility
Step 3- Build it and they will come !
Strategic Planning- The Old WayThe Impact of Transparency
Step 1- Demographic need
Step 2- Financial feasibility
Step 3- The need to excel in public data◦ Outcomes ◦ Pt Experience ◦ Cost
Step 4- Only then, will they continue to come !!
Strategic Planning- The New WayThe Impact of Transparency
The Good
The Bad
The Ugly
Huge improvement in quality and experience
Quality, ExperienceTransparency
Transparency… This Train’s Left the StationThe Good, the Bad, and the Ugly
The Problem with Transparency is that it Works!
The Good
The Bad
The Ugly
Tremendous resource drain on system
Quality, ExperienceTransparency
Huge improvement in quality and experience
Transparency… This Train’s Left the StationThe Good, the Bad, and the Ugly
Hospital and physician group FTEs◦ Data abstraction, collection and reporting◦ Clinical reviews by staff◦ The increasing role of the physician in performance
improvement
Hospital and physician capital costs◦ IT Systems
The law of diminishing returns:◦ The high cost of marginal improvement
The Cost of Transparency
The Good
The Bad
The Ugly
Tremendous resource drain on system
Unintended consequences of price transparency
Price Transparency
Huge improvement in quality and experience
Transparency… This Train’s Left the StationThe Good, the Bad, and the Ugly
The “Viral” Influence of Transparency The Increasing Trend of Higher Deductible Insurance The Implementation (or Not) of the ACA Practicing Medicine on the Smart Phone
Game Changers for 2015
Total Health Care Spending
OECD, 2012
Distribution of Health Care Spending
Kaiser HRET, 2013
Kaiser HRET, 2013
Average Single Premium Deductible
A Game Changer for 2014 and Beyond:What About Price Transparency?
What About Price Transparency?
Higher Deductibles
Cost ShiftingInsurance Exchanges
There will be a demand for price transparency by the consumer more than ever before
If you oppose price transparency….
.… What are you hiding ??
From the Standpoint of the Consumer
High Deductibles
Health Literacy
Defined Contribution
Plans
The Perfect Storm for Price Transparency
The Perfect Storm for Price Transparency
Steve has a URI symptoms and feels bad!Steve has great insurance but a $3,000 deductible
What does he do?
Treatment Options: Approximate*: Out of Pocket Wait Emergency Department $ 300 2-3 hrs Urgent Care 150 1 hr PCP visit 120 1 hr (if available)
Local Pharmacy 80 30 min Self Treat.. rest, OTC meds... 10 ? none
Reflections on Price Transparency
* The actual cost may not be known until the evaluation is completed
For outcomes and patient experience:
Transparency has:
IMPROVED the performance of all participants
Decreased the variance amongst participants
The Impact of Transparency
For price:
Transparency may:
LOWER the price for all participants
Decrease the variance amongst participants
The Special Challenges of Price Transparency
The very process that made transparency successful for quality and patient experience may be detrimental for price
One needs to strike a balance between how much the consumer needs to know about price
The Challenges of Price Transparency
A Potential DangerPrice Transparency
Consumer advocacyDisclosure of proprietary
information
Price Transparency
How much does the consumer have to pay for the services rendered?
Smart Price TransparencyWhat Does the Consumer Need?
A tool for Smart Price Transparency---
For a given medical situation:
What is the total cost “out the door” ?*
*In a relatively time-sensitive, simple, standardized, c comparable format
Smart Price TransparencyWhat Does the Consumer Need?
On the Road to Smart Price TransparencyThe Role of the Health Plan
Health Plan
Patient
Physicians
Hospitals
Imaging/ Lab
Others
Delivery System
The “Viral” Influence of Transparency The Increasing Trend of Higher Deductible Insurance The Implementation (or Not) of the ACA Practicing Medicine on the Smart Phone
Game Changers for 2015
US residents required to have health care◦ Penalties for non-compliance
New members receiving health care◦ Expanded Medicaid◦ Health Insurance Exchanges◦ Effects on hospital utilization and reimbursement
Pay for performance◦ Changes in measurements from process to outcomes◦ PQRS for Physicians◦ Increasing use of bundling and episode of care programs◦ Emphasis on Accountable Care Organizations and PCMH◦ The future of the Sustainable Growth Rate (SGR)
Billing and Information Technology◦ Updated HIPAA requirements◦ Meaningful Use Phase II◦ Conversion to ICD-10
Key Issues with the ACA into 2015
The “Viral” Influence of Transparency The Increasing Trend of Higher Deductible Insurance The Implementation (or Not) of the ACA Practicing Medicine on the Smart Phone
Game Changers for 2015
Practicing Medicine on the Smart Phone
Practicing Medicine on the Smart Phone
Telephone Emails Internet Calendar Brickbraker Notes GPS Apps…….
2014- And now……
Not Just a Phone, A Smart Phone
2013- Total smart phone base 2 billion 2013- Smart phones made in world 1 billion 1.2 billion people using Apps in 2012 Forecast to grow to 4.4 billion by 2017 56 billion Apps downloads in 2013 800,000 mobile Apps in Apple App Store
Practicing Medicine on the Smart Phone
Practicing Medicine on the Smart Phone
Health Literacy and the Role of Social Media
“If it’s on the Internet, it must be true”
“Where did you hear that? ”
“On the Internet”
The Roll of Apps on the Smart Phone
IMS Institute, 2013
The Roll of Apps on the Smart Phone
WSJ, 2013
The Roll of Apps on the Smart Phone
IMS Institute, 2013
The Roll of Apps on the Smart Phone
IMS Institute, 2013
The Roll of Apps on the Smart Phone
IMS Institute, 2013
We can see within five years apps moving from novelty to mainstream.
Murray Aitken IMS Institute for Healthcare Informatics
The Roll of Apps on the Smart Phone
IMS Institute, 2013
More than 50 percent of the 43,000 mobile healthcare apps have been downloaded fewer than 500 times
IMS Institute, 2013
The Roll of Apps on the Smart Phone
“I am not aware of any scientific literature that proves the benefit [of mobile apps]. While there are a lot of industry sponsored white papers we really need to see randomized control studies – which is the gold standard for calling an intervention evidence based. Even a prospective case control or cohort studies would be a good start.”
Sameer Badlani, MD – University of Chicago Medicine
The Roll of Apps on the Smart Phone
IMS Institute, 2013
The cultural need for speed and immediacy Technology on site Telemedicine
The Future Practice of Medicine
The cultural need for speed and immediacy Technology on site Telemedicine
The Future Practice of Medicine
Old Model New Model
• Patient goes to doctor• Test results take time• Patient schedules a follow up appt
• Doctor comes to patient• Technology on site• Results immediately available to
both parties• Immediate feedback to patient
The Cultural Need for Speed and Immediacy
The Roll of Apps on the Smart PhoneFaster, Faster, Faster !!
The cultural need for speed and immediacy Technology on site Telemedicine
The Future Practice of Medicine
Old Model New Model
• Patient goes to doctor• Technology on central site
• Doctor comes to patient• Technology at site
Technology on Site
The Roll of Apps on the Smart PhoneTechnology on Site
The cultural need for speed and immediacy Technology on site Telemedicine
The Future Practice of Medicine
The Future Practice of Medicine
The Future Practice of Medicine
The Future Practice of Medicine
Old Model New Model
• Physician in control• Face to face visits
• Joint responsibility• Remote access for both
The New Physician-Patient Relationship
Patient Physician
The New Physician-Patient Relationship
The “Viral” Influence of Transparency The Increasing Trend of Higher Deductible Insurance The Implementation (or Not) of the ACA Practicing Medicine on the Smart Phone
Game Changers for 2015
To the world you may be just one person,But to one person you may just be the world.
Unknown
