Game Changers in Health Care for 2014

1. Game Changers in Health Care for 2014 Steven M. Berkowitz, MD SMB Health Consulting, Austin, TX 512-415-6095 steve@smbhealthconsulting.com

2. 2012- 2013 Clients- Two Lessons Learned Every System is unique. But… Every System is dealing withthe same issues.

3. So What’s New in Health Care Reform? Same old wine in a brand new bottle?

4. So What’s New in Health Care Reform?

5. You can always count on Americans to do the right thing… • …after they’ve exhausted all the other possibilities !!” • Winston Churchill

6. People do not change until the pain of staying the same… … exceeds the pain of changing. Anonymous

7. The Health Care Team Medicine is a Team effort…. …..Why do we insist on playing Solo!

8. The Evolution of Health Care Reform 1990’s-- Market Correction 2013-- Market Reconfiguration

9. Remember, It’s Not Nice to Fool Mother Nature Health care must follow the same market rules as all other industries

11. What is a Black Swan? • The event is surprise • It has an extreme impact • After the event occurs, it is rationalized by hindsight

12. What is a Black Swan? • The event is surprise • It has an extreme impact • After the event occurs, it is rationalized by hindsight • Examples: • The Internet • Personal computer going to the phone • 911

13. What is a Black Swan? • The event is surprise • It has an extreme impact • After the event occurs, it is rationalized by hindsight • Examples: • The Internet • Personal computer going to the phone • 911 • Maybe some day……. The Chicago Cubs

14. What is a Black Swan? Management Goals: • Cannot predict event • Build robustness against negative events • Acknowledge and exploit positive ones

15. Game Changers for 2014 • The “Viral” Influence of Transparency • The Increasing Trend of Higher Deductible Insurance • The information technology system- EMR, ICD-10 • New Technology- Personalized Medicine-Genomics

16. Game Changers for 2014 • The “Viral” Influence of Transparency • The Increasing Trend of Higher Deductible Insurance • The information technology system- EMR, ICD-10 • New Technology- Personalized Medicine-Genomics

17. Value Based Purchasing The increasingly informed consumer will make health care decisions on the basis of VALUE

18. Value Based Purchasing The increasingly informed consumer will make health care decisions on the basis of VALUE VALUE= Outcomes + Satisfaction Cost The CONSUMER ultimately determines which of the above elements constitute VALUE

19. Read all about it !! April 2005

20. This is Your Life !! Data Transparency in Action Data Transparency

21. Data Transparency That which is measured, tends to improve. That which is measured publicly, tends to improvefaster. “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

22. Core Measures: Heart Attack Heart Failure Pneumonia Surgical Care Improvement HCAHPS

23. CMS Core Measures– the Top Decile

24. Core Measures: Heart Attack Heart Failure Pneumonia Surgical Care Improvement HCAHPS Goal: 100% Compliance !! Standard of Care ? !!

25. Data Transparency and Accountability Transparency is the best thing that’s happened to quality since antibiotics... …by decreasing variance and improving results

26. Percent Who Saw and Acted Upon the InformationChoice of Hospitals Exposure to and Use of Quality Information Kaiser Family Foundation, October 2008

27. 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 Change

28. Data Transparency and Accountability Transparency is the best thing that’s happened to quality since antibiotics... …by decreasing variance and improving results As transparency matures, it will rewrite the book on: Who is your competitor?

29. The Role of Transparency Price Transparency Quality Transparency

30. The Role of Transparency Quality Transparency Price Transparency

31. System Strategic Planning Who is Your Competitor…. The role of Transparency Stage IV Medical tourism Increasing Transparency Stage III The entire nation ? Stage II All hospitals in Oklahoma Stage I The “other guy”

32. Game Changers for 2014 • The Continued Influence of Transparency • The Increasing Trend of Higher Deductible Insurance • The information technology system- EMR, ICD-10 • New Technology- Personalized Medicine-Genomics

33. Total Health Care Spending OECD, 2012

34. Distribution of Health Care Spending Kaiser HRET, 2013

35. Distribution of Health Care Spending Kaiser HRET, 2013

36. Distribution of Health Care Spending Kaiser HRET, 2013

37. Total Premium and Percentage paid by Worker Kaiser HRET, 2013

38. Total Premium and Percentage paid by Worker Kaiser HRET, 2013

39. Percentage of Plans with $1,000 or $2,000 Deductible Kaiser HRET, 2013

40. Average Single Premium Deductible Kaiser HRET, 2013

41. The Role of Transparency Price Transparency: ??? ??? Price Transparency Quality Transparency

42. Reflections on 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 * The actual cost may not be known until the evaluation is completed

43. What Steve Does Not Need to Know • The physician’s reimbursement for the visit • The nurses reimbursement for the visit • The cost of his treatment to the institution • Any other contractual relationships • Physicians • Vendors • Any other arrangements with the insurance company Just tell me: How Much Do I Need to Pay !!

44. Game Changers for 2014 • The Continued Influence of Transparency • The Increasing Trend of Higher Deductible Insurance • The information technology system- EMR, ICD-10 • New Technology- Personalized Medicine-Genomics

45. The Role of Information Systems Health Care Information Systems-- We are so far behind !!! 1 Zettabyte = 1,000,000,000,000,000,000,000 bytes = 10007 bytes = 1021 bytes

46. The Role of Information Systems More Than Meaningful Use Health Care of the Future….. …. We can’t get there from here …. Without Information Systems !!

47. The Role of Information Systems EMR and Evidence Based Order Sets are not just another IT initiative…. …. it is a Clinical Transformation to how we will be practicing better medicine in the future.

48. The Role of Information Systems The EMR will do for health care What the assembly line did for manufacturing

49. The Role of Information Systems More Than Meaningful Use Health Care of the Future….. …. We can’t get there from here …. Without Information Systems !!

50. The Role of Information Systems EMR and Evidence Based Order Sets are not just another IT initiative…. …. it is a Clinical Transformation to how we will be practicing better medicine in the future.