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Healthcare 101 & HLS Symposium Preparation. September 15,2013. Why Healthcare?. H ealthcare spending is exploding. U.S. Healthcare Spending. National Health Expenditures (Billions USD). National Health Expenditures as % of GDP.

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h ealthcare spending is exploding
Healthcare spending is exploding

U.S. Healthcare Spending

National Health Expenditures (Billions USD)

National Health Expenditures as % of GDP

Source: http://www.cms.hhs.gov/NationalHealthExpendData/downloads/proj2005.pdf

retail who buys who pays who chooses
Retail: Who buys? Who pays? Who chooses?

Pretty simple to follow the money

Amazon.com

Consumer

Places Order using Visa

Ships Order

Pay $

Pay $

Bill Cardholder

Check card; bill

Credit Card (Bank)

healthcare who buys who pays who chooses
Healthcare: Who buys? Who pays? Who chooses?

Provider(Physician, Hospital, or Pharmacy)

Wholesaler/distributors

Producer(Pharma/Device)

Pay $ (AWP)

Pay $ (WP)

Ship Product

Ship Product

Payor(Gov’t, private insurance)

Files “Claim”

Pays $ (Reimbursement)

Product or Service

“Co-Pays”

IT’S COMPLICATED

Payment (“Premium”)

Consumer

(Patient)

h ealthcare landscape
Healthcare Landscape
  • Regulatory

Uncertainty

Industry

pharma biotech leading corporations
Pharma/Biotech Leading Corporations
  • Industry lives and dies by patents; patent life is 20 years from filing
  • “+10 years and +$1 billion dollars to bring a drug to market”
there are many types of providers
There are Many Types of Providers

Health Systems/Hospitals/ACOs

Outpatient Clinics

Home Health Agencies

Physician Offices

Rehabilitation Centers

Pharmacies

Hospices

Nursing Homes

hospitals in the us
Hospitals in the US

Source: IBISWorld Industry Report “Hospitals in the US,” July 2013

payors the private market follows the public trends
Payors: The private market follows the public trends

Source: IBISWorld Industry Report “Health & Medical Insurance in the US,” July 2013

regulatory aca increases insurance coverage
Regulatory: ACA increases insurance coverage
  • Roughly 32 million Americans will gain coverage starting in 2014
  • Medicaid expansion (~ 16 million)
    • Citizens with family incomes < 138% of the FPL will be eligible
    • Newly eligible will mainly be childless adults
  • Private coverage through Insurance Exchanges (~ 16 million)
    • Citizens with incomes between 100% and 400% of the FPL will be eligible for premium tax credits
  • Young adults can remain on their parents plan until age 26
    • Has increased coverage by 2 million already
aca also aims to reduce the growth in spending
ACA also aims to reduce the growth in spending
  • Some use policy levers unique to the Federal government
    • Reductions in Medicare payments to private health plans
    • Reductions in the growth of Medicare reimbursement rates
    • Reform of the tax treatment of employer-sponsored insurance
  • Many build on private sector initiatives already underway
    • Integrated, accountable care
    • Bundled payments
    • Increased use of electronic health records
  • It is too early to judge ACA, but private sector developments may already be having an impact
slide20

Healthcare Recruiting at Ross

Pharma / Biotech

Medical Device

Payer / Provider / Retail

Consulting

And many others….

slide21

HLS Symposium – BE PREPARED, BE PROFESSIONAL

  • Formal business attire (bring your name tags!)
  • Be on time
  • Come prepared with some questions
  • Know a little bit about the companies you’re interested in
  • Be nice, humble, and polite to recruiters and other students
  • Stay for the entire event
  • HAVE FUN!!