The U.S. Healthcare Revolution
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1 The U.S. Healthcare Revolution The Impact of Obamacare on American Physicians & Nurses Peter Edelstein, M.D. Chief Medical Officer Elsevier Clinical Solutions
2 Metrics Definition of Provider Economic Drivers Provider Needs Prior to ObamaCare With ObamaCare The Near Future 2015 EMEALA ehealth 2015 Week Sales l Riga, Conference Latvia
3 PROVIDER Prior to ObamaCare 2015 EMEALA ehealth 2015 Week Sales l Riga, Conference Latvia Provider = Physician Physician = (Medical) God
4 WHY? 2015 EMEALA ehealth 2015 Week Sales l Riga, Conference Latvia
5 NEEDS 2015 ehealth Week l Riga, Latvia Provider Needs - Medical School - Books & Journals
6 Fee-for- ECONOMIC DRIVER Service 2015 EMEALA ehealth 2015 Week Sales l Riga, Conference Latvia Elsevier 2015 Healthcare Education 2015 Education Without and Clinical Leadership Boundaries: Solutions Forum Leadership s 2015 Sales Next Conference Challenge
7 Definition of Provider Economic Drivers Provider Needs Prior to ObamaCare The Doctor Volume (fee-for-service) Books & Journals With ObamaCare The Near Future 2015 EMEALA ehealth 2015 Week Sales l Riga, Conference Latvia
8 With ObamaCare Healthcare reform in the U.S. is not going away 2015 EMEALA ehealth 2015 Week Sales l Riga, Conference Latvia
9 DRIVERS Popular acceptance that the current US healthcare spending curve is not sustainable The finding of a marketable argument Technology allowing easy, rapid access to information for everyone Popular appreciation of healthcare economics 2015 EMEALA ehealth 2015 Week Sales l Riga, Conference Latvia
10 Popular acceptance that the US current healthcare spending curve is not sustainable
11 The finding of a marketable argument Preventable medical errors persist as the number 3 killer in the U.S. claiming the lives of some 400,000 people each year. a rate of outpatient diagnostic errors of 5.08%, or approximately 12 million US adults every year. 10,000 serious complications resulting from preventable medical errors occur each day ehealth Week l Riga, Latvia
12 Technology allowing easy, rapid access to information for everyone 2015 EMEALA ehealth 2015 Week Sales l Riga, Conference Latvia
13 Popular appreciation of healthcare economics In the Fee-for-Service healthcare model we PAY MORE for POORER QUALITY 2015 ehealth Week l Riga, Latvia
14 ECONOMIC DRIVER In Healthcare, BETTER QUALITY SHOULD COST LESS Volume Value Fee-for-Service VALUE BASED PURCHASING 2015 ehealth Week l Riga, Latvia
15 HHS Secretary Sylvia Mathews Burwell announced that by 2016 the CMS wants 30% of Medicare payments to be linked to payment reform models, and 50% by a coalition of providers, insurers and employers pledged to have 75% of their members business switched to performance-based contracts by Modern Healthcare January 30, ehealth Week l Riga, Latvia
16 Drive quality improvement through cost reduction In Healthcare BETTER QUALITY COSTS LESS 2015 ehealth Week l Riga, Latvia
17 Providers will be at PERSONAL FINANCIAL RISK for their patients health 2015 ehealth Week l Riga, Latvia
18 PROVIDER Physicians Nurses Medical Assistants Physician Assistants Technicians Hospitals & Health Systems Ambulatory Centers SNF & Rehab Home Health 2015 ehealth Week l Riga, Latvia
19 Elsevier 2015 ehealth Education Week and Clinical l Riga, Solutions Latvia 2015 Sales Conference
20 Hospital Readmissions Reduction Program Medicare payment penalty for unacceptably high hospital readmissions within 30 days of hospital discharge Applies to hospital readmission for virtually any medical reason Unacceptably long initial hospital admission to avoid readmission is not allowed Penalized Conditions Myocardial Infarction (Heart Attack) Heart Failure Pneumonia COPD Total Hip Replacement Total Knee Replacement 2015 ehealth Week l Riga, Latvia
21 Hospital Readmissions Reduction Program 2013 Penalty: up to 1% of Medicare Payments 2014 Penalty: up to 2% of Medicare Payments 2015 Penalty: up to 3% of Medicare Payments 2,610 penalty-eligible U.S. Hospitals will suffer a penalty in penalty-eligible U.S. Hospitals will avoid a penalty in 2015 Total fines in 2014: $227,000,000 In 2011, prior to implementation of the Readmission Reduction Program, 39% of U.S. hospitals were operating at a financial loss 2015 ehealth Week l Riga, Latvia
22 Hospital Readmissions Reduction Program Hospitals, doctors, and healthcare experts note that a major contributor to early hospital readmissions is the patient s socio-economic status, which hospitals and doctors cannot control. Joynt KE, Orav EJ, Jha AK. Thirty-day readmission rates for Medicare beneficiaries by race and site of care. JAMA. 2011;305(7) Rathore SS, Foody JM, Wang Y, et al. Race, quality of care, and outcomes of elderly patients hospitalized with heart failure. JAMA. 2003;289(19) 2015 ehealth Week l Riga, Latvia
23 New Healthcare Delivery Models to Address the Financial Risks of Value-Based Purchasing Accountable Care Organizations (ACOs) > 520 ACOs as of one year ago Serve >15% of U.S. population Majority are physician driven Patient Centered Medical Homes (PCMHs) Physician Employment 19% hospital-employed in 2008; 26% in 2013 An additional 20%+ are under group contract Elsevier 2015 ehealth Education Week and Clinical l Riga, Solutions Latvia 2015 Sales Conference
24 New Physician & Nurse Responsibilities Physicians & Nurses must now rapidly learn how to function as Practice Managers, including overseeing contracts & financials Physicians & Nurses must now learn how to consistently implement, deliver & monitor high quality, cost-efficient care Nurses must rapidly expand their clinical capabilities 2015 ehealth Week l Riga, Latvia Elsevier Education 2015 Education and Clinical Leadership Solutions Forum 2015 Sales Conference
25 Definition of Provider Economic Drivers Provider Needs Prior to ObamaCare The Doctor Volume (fee-for-service) Books & Journals With ObamaCare Doctors, Nurses, MAs, Technicians Billers & Coders Hospitals, SNFs, etc. Value (Increased quality, reduced costs) Education Healthcare reform basics; government penalty programs; ACOs, PCMHs business models The Near Future Elsevier 2015 EMEALA ehealth Education 2015 Week and Sales Clinical l Riga, Conference Solutions Latvia 2015 Sales Conference
26 The Near Future Triple Aim Improving the Patient Experience (including Quality & Satisfaction) Improving the Health of Populations Reducing the Per Capita Cost of Healthcare EMEALA 2015 ehealth 2015 Sales Week Conference l Riga, Latvia
27 Population Health Spectrum Well Members Low-Risk Members Moderate Risk Members High-Risk Multiple Disease States Complex Care Prevention Prevention and Disease Management Disease Management Episodic Case Management Inpatient LTC 2015 ehealth Week l Riga, Latvia
28 Elsevier 2015 Education ehealth Week and Clinical l Riga, Solutions Latvia 2015 Sales Conference
29 And analytics aren t just for identifying risks & opportunities among patient populations analytics identify risks & opportunities among providers ehealth Week l Riga, Latvia
30 The Near Future Triple Aim Improving the Patient Experience (including Quality & Satisfaction) Improving the Health of Populations Reducing the Per Capita Cost of Healthcare EMEALA 2015 ehealth 2015 Sales Week Conference l Riga, Latvia
31 Engaged Patients Have Better Clinical Outcomes and Lower Costs of Care. On the whole, Americans are very unengaged in their own health care Preventative Care (Vaccines, Cancer Screening, Diet, Exercise, etc.) Maintenance Care (Heart Failure, Diabetes, HTN, Nephropathy, etc.) Medication Non-Compliance 2015 ehealth Week l Riga, Latvia
32 In general, the failure of patients to engage is not primarily due to a lack of technological capabilities 2015 ehealth Week l Riga, Latvia
33 Requires A Personal Touch. Meaningful Patient Engagement
34 Definition of Provider Economic Drivers Provider Needs Prior to ObamaCare The Doctor Volume (fee-for-service) Books & Journals With ObamaCare Doctors, Nurses, MAs, Technicians Billers & Coders Hospitals, SNFs, etc. Value (Increased quality, reduced costs) Education Healthcare reform basics; government penalty programs; ACOs, PCMHs business models The Near Future The Patient Proactive, Ambulatory Health Maintenance and Prevention PHM and Patient Engagement Elsevier 2015 EMEALA ehealth Education 2015 Week and Sales Clinical l Riga, Conference Solutions Latvia 2015 Sales Conference
35 The U.S. Healthcare Revolution The Impact of Obamacare on American Physicians & Nurses Peter Edelstein, M.D. Chief Medical Officer Elsevier Clinical Solutions
Achieving Health Equity After the ACA: Implications for cost, quality and access
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