Jennifer Moody, Principal AmeriMed Consulting 301 Commerce Street, Suite 3131 Fort Worth, TX 76102

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1 Jennifer Moody AmeriMed Consulting Concierge Medicine Health Tourism Hospital Medicine Medical Home Micro-specialization Pharma to Patient Physician Integration 8. Retail Healthcare 9. Social Media & Technology 10. Workforce Modification 7.

2 Many hybrid models of concierge medicine emerging from pure cash panels to add-on options and executive medicine Concierge medicine can skew community needs assessments but as physician shortages loom in some markets, may become a popular model for those who can afford the care Much health tourism focused on medicine leaving the US plastic surgery and dental in Asia or South America, transplants and replacements in India Some focused on medicine coming TO the US cancer care, pediatric subspecialty care, bariatrics Within US borders, some markets may have an opportunity to create a destination for specific specialties particularly plastic surgery and dermatology Social media and savvy consumers create opportunities for new markets for care relationships Ten years ago, most hospitals were asking what is a hospitalist? Today, the question is what physicians still practice both inpatient AND outpatient medicine? Creation of specialty hospitalist programs can solve some community need issues orthopedics is a great example when existing practices won t address care or payor access issues

3 Principles of the model: Personal physician for every patient Physician directed medical practice Whole person orientation Coordinated/integrated care Quality assured by evidence-based medicine Enhanced access (expanded hours, wider communication options, open scheduling) Payment for service that recognizes differences in overall types of care/coordination of such Gatekeeper models all over again? Maybe not. Distinctions include open access without financial penalties to home physician Some physician specialties oppose the model Micro-specialization or the tendency for subspecialties to further sub-specialize is on the rise and is, in fact, the norm with new physicians entering the workforce Examples Sub-specialized orthopedic surgery Sub-specialized general surgery Even carve-outs in traditionally non-sub-specialized fields like gastroenterology Be aware of Federal compliance issues with micro-specialized physician needs Pharmaceutical companies are now forming their own relationships with consumers, independent of physicians Address education, product safety, care costs, treatment regimens, wellness Direct to consumer screening programs Examples: Disease management for rheumatology Behavior modification in endocrinology Home infusion training for hematology

4 The only big difference in old integration strategies and the new ones lies in the motivation Then managed care contracting Now - CMS encouraging bundled payment and a trend towards Accountable Care Organizations (ACOs) to share responsibility for outcomes Physician employment by hospitals doubled between 1994 and 2009 Hospitals must work to not alienate referring specialists and maintain balance Finances still driving decisions for both parties Hot trend for hospitals, easily expanded to physician offices onsite retail presence in hospital, online retail presence via recommended products Examples: Primary care physician recommending durable medical equipment, nutritional supplements Dermatologist partnership with hospital with onsite med-spa with skincare products Endocrinologist with diabetic supplies (from testing equipment to food products to accessories) New generation of consumers seeks content Peer-to-peer referrals via social networks force physicians to manage their online presence Major players (AT&T, Verizon, Sprint, Microsoft) forging partnerships for health delivery Physicians have the opportunity to build a practice or referral network via social media and direct consumer networking, content delivery, remote consultation Will be important integration component with other trends discussed Medical Home, Retail Healthcare, Pharma to Patient

5 Trends in standard workforce now commonly bleed over to physician workforce Job sharing yes, even with physicians Flexible benefits Employment models Variable incentives Important to monitor current trends in the standard workforce. The bleed-over to the physician workforce today is a short cycle so practices must be prepared to turn on a dime to meet Gen X and Millennial physician demands. Jennifer Moody, Principal AmeriMed Consulting 301 Commerce Street, Suite 3131 Fort Worth, TX jmoody@amerimedconsulting.com

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