The Way Ahead (Putting Purpose to our Connecting)

1. The Way Ahead (Putting Purpose to our Connecting) Carl W. Taylor JD Fraser Institute for Health and Risk Analytics

2. Telehealth Before Sequestration?

3. Where Did We Begin? • Fragmented silos of episodic FFS care with some risk in some markets • Push for EHR and connectivity with only a vague notion of why • Explosion in the aging and chronic population • No accountability for costs • Disconnect between wellness as a preference and illness as a business

4. PPACA Is An Attempt To Try Something New

5. The First Barrier: Them vs. Us

6. The Second Barrier: Us vs. Us

7. The Third Barrier: Usvs. Them

8. The Health Reform Uncertainty • There is a difference between Risk and Uncertainty • We have always had risk in healthcare but now we have uncertainty

9. And The Current Future • PPACA’s Contribution • Supreme Court ruling and election gives certainty for today but leaves a Medicaid hole for some states • Medicare Advantage cuts may impact benefits/MLR • CMS driven ACOs with likely un-eveness in performance and higher market costs • CMS Duals Office- Un-eveness on its journey • Health Insurance Marketplaces (f/k/a exchanges) will emerge in some form but with what populations • CMS –CMMI will test a wide variety of programs to save money will any of them work

10. Reform Has Forced Consolidation Across All Players

11. And Created A Dilemma for Physicians

12. And The Doctor Question • It is 3 a.m. in the morning I just finished delivering Mrs. Jones baby- what am I paid?

13. The Fears • Will any of this work • Can we balance the 3 R’s (risk, reward and regulation) • Who wins and more importantly how do I win

14. When Choosing A Path Becomes Confusing

15. Some Options 1. Wait and do nothing-Keep The As Is State 2. Build an expanded enterprise to create more leverage and market dominance- Some ACOs fall into this category. 3. Build a risk bearing broader bio/psycho/social clinical enterprise where all professions are focused on coordinated quality and outcomes to overcome our common challenges……

16. Our 9 Common Challenges • 1. We Must Re-invent the Physician Practice • 2. We Must Improve Our Access/Understanding of Data • 3. We Must Accelerate The Adoption of Successful Programs to Improve Patient Adherence and Physician Skills • 4. We Must Improve Quality and Consistency of Outcomes Across All Domains

17. Common Challenges Together • 5.We must reduce readmissions • 6. We must keep mom at home • 7. We must deliver more healthy babies and raise healthier children • 8. We must create interdisciplinary approaches to dealing with complexity • 9. We must reach the unreachable

18. Telehealth Under Health Reform

19. Our Future Is Now World

20. The Rise of Connected Knowledge

21. And Then How Do We • Embrace, absorb, deploy or reject the 40,000 or so apps for healthcare?

22. We will navigate from episodic encounters to continuous interactions. Narrow networks will prevail not only by offering quality and cost advantages but by achieving them through the appropriate use of emerging technology What I Think I Think

23. A Confidential Secret: We Can Make This Work

24. If We Can Re-Language The Solution

25. Questions Contact: Carl Taylor FIHRA cwtaylor1@gmail.com cwtaylor1 Skype