Transformation of Health Care Update for 2015 Steven M. Berkowitz, MD SMB Health Consulting, Austin,...

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Transformation of Health CareUpdate for 2015

Steven M. Berkowitz, MDSMB Health Consulting,

Austin, TX512-415-6095

steve@smbhealthconsulting.com

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 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

The increasingly informed consumer will make health care decisions on the basis of VALUE

VALUE = Outcomes + Pt Experience

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

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

1996 2000 2004 2006 2008

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

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

The Problem with Transparency is that it Works!

The Good

The Bad

The Ugly

Tremendous resource drain on system

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

Total Health Care Spending

OECD, 2012

Distribution of Health Care Spending

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

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

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

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

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

WSJ, 2013

IMS Institute, 2013

We can see within five years apps moving from novelty to mainstream.

Murray Aitken IMS Institute for Healthcare Informatics

IMS Institute, 2013

More than 50 percent of the 43,000 mobile healthcare apps have been downloaded fewer than 500 times

IMS Institute, 2013

“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

IMS Institute, 2013

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 !!

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

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

To the world you may be just one person,But to one person you may just be the world.

Unknown

Transformation of Health Care Update for 2015 Steven M. Berkowitz, MD SMB Health Consulting, Austin,...

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