Healthcare Realities, Paradigms and Solutions
Dan Hecht
Chief Executive Officer, MDVIP
Unique moment in time where the
Healthcare Perfect Storm is brewing…
Healthcare “Perfect Storm”

AC
A
The Health Care Fiscal Cliff
Source: Congressional Budget Office

◦ $2.7 Trillion Dollars
spent on Healthcare
in 2012
◦ in...
The Health Care Fiscal Cliff
The entirety of the growth of government spending as a
share of GDP is Health Care…
The Health Care Fiscal Cliff
…If you don’t count Interest on the Debt
The Health Care Fiscal Cliff
Source: OECD, WHO

• In 2009, the United
States government
(federal and state)
spent more per...
The Health Care Fiscal Cliff
• Spending does not
equate to better
health
• US ranks at the
bottom in life
expectancy
• Hea...
Healthcare “Perfect Storm”
The Boom of the Baby Boomers
• There are 72 Million People who were born from 1946 to 1964

• >10,000 Boomers will turn 65...
The Boom of the Baby Boomers
• Pressure to improve the consumer experience
◦ Only 58% Satisfied with Doctor/Patient Relati...
Life after the Affordable Care Act

AC
A
Life after the Affordable Care Act
• Intent of the Affordable Care Act is to:
◦ Expand Access to More Americans

◦ Control...
Expanding Access
• Introduce 30 million uninsured Americans into the
Healthcare system
◦ Expanding Medicaid and Provide In...
Lessons from Massachusetts;
Patient Access

• Why?
◦ Added more people (demand) without addressing
Physician/Provider Supp...
Healthcare “Perfect Storm”
◦ Healthcare Costs continue to Rise at an Unsustainable Pace
◦ Patient access to Physicians wil...
Primary Care Realities

More Patients
More Elderly Patients
More Complex Patients
More Changes in Healthcare
More Dependen...
Primary Care Realities

Physician Satisfaction
Primary Care Realities
• Mayo Clinic National Study – released August 20,
2012, in the Archives of Internal Medicine

– Ab...
Physician Realities
• Over 77% of physicians are pessimistic about the
future of the medical profession

• Over 84% agree ...
Primary Care Realities

Physician Satisfaction

Patient Satisfaction
Patient Perspective

2/3
of patients
are dissatisfied
– Poor

Communication
– Limited Doctor Time
– Long Waits

Driving fo...
Primary Care Realities

Physician Satisfaction

Patient Satisfaction

Medical Outcomes
Health Outcomes: Wrong Direction

65 percent of Americans are overweight or obese
Half the country is expected to be pre-d...
75%
of U.S. healthcare dollars go to the
treatment of chronic diseases.

>50% of those costs
could be prevented!
So… What is the future of healthcare?
What are your options?
Options
• Status Quo

◦ Traditional conveyor belt medicine – ACOs, other
government pilots (CPCI)
• Employment with Larger...
The view we see now…
Status Quo
Government View
MDVIP View
Focus on the Patient : Physician relationship
What is Retainer Medicine?
• Patient pays an annual membership to join a physician’s
practice
- Range $1500 to >$20,000

•...
Who is MDVIP?
• National leader in Personalized Primary Care
Medicine
• Early pioneer and visionary
• New approach to prim...
How does MDVIP work?
• A consumer selects a nearby MDVIP-affiliated doctor as
their personal primary care physician who wi...
MDVIP Wellness Program
The MDVIP Wellness Program includes enhanced evaluations, diagnostics and
one-on-one in-depth consu...
Emphasis on Prevention
Prevention

Early Detection

Opportunity to
Intervene With
Risk Factor
Modification

Earliest
Oppor...
How is MDVIP different?

Conventional Practice

MDVIP Practice

Treats Sickness

Helps People Stay Healthy

Avg. 2,400 Pat...
Advantages

 24/7 availability
 Same/next day
appointments
 No wait waiting
rooms
Convenience

 >640 doctors in
40 sta...
Primary Care Realities
MDVIP

Physician Satisfaction
Physician Satisfaction Scores:>95%

PatientScores:>95%
Satisfaction
P...
Study Objective
• To assess the impact of the MDVIP model of
personalized preventive care on hospital utilization
rates ov...
Methodology
• Intellimed reports utilization by state and payer (i.e., for
Medicare and non-Medicare).
◦ The Intellimed da...
Medicare Rates
Medicare Discharges /1000
MDVIP vs. Non-MDVIP

600
500

71%

71%

74%

75%

$450,000

79%

$400,000

Discha...
SAVING$
For 2010, in Just 5 States, MDVIP Saved:
$109.2 Million for Medicare
$10.2 Million for Commercial
$119.4 Million T...
Readmission Rates
MDVIP Medicare Average Readmission Rates vs. 2009 Medicare Rates

21.7%
21.7%

97%
18.5%

95%
15.5%

91%...
Study Objective
• To assess the impact of the MDVIP primary care
model that focuses on personalized preventive
healthcare ...
Methodology
• Random Patient Selection
– NCQA methodology for PCMH chart selection used

• ICD – 9 codes used: Atrial Fibr...
Results
• All patients

- 67% with BP < 130 / 80
- Average cholesterol of 178
- 85%-90% these measures were better
All of ...
Study Objective
• As the physiology of cardiac biomarkers is better
understood there is interest in multimarker approaches...
In Press – July 2013
Multimarker approach for identifying and documenting mitigation of cardiovascular risk
Marc S. Penn, ...
Multimarker approach for identifying and
documenting mitigation of cardiovascular risk

• We reviewed data from over 95,00...
Percent Patients at Risk
Adding MPO Identified
Risk Based on Total LDL

10,453 pts that are at High Risk (11%)

3,365 pts ...
Clinical Summary
• Decreased Hospital utilization

• Decreased readmissions
• Savings to the system

• Better Outcomes
MDVIP Employer Program
- Flexible benefit/payment for the employer
Employer
MDVIP Benefit Options
1

2

Executive Wellness...
Paradigm Shifts
The Rule of 3’s
Prevention First
There is Joy and Immense Value
in Primary Care!
By Doctors, For Doctors
MDVIP is saving primary care…
• You have the time to proactively focus on prevention, wellness
and...
Healthcare realities, paradigms
and solutions to navigate…

AC
A Storm”
“The Perfect
The “Retainer” Landscape
MDVIP
Maximum of 600 Pts.

Pure Personalized Care
Delivers Comprehensive
Prevention Services

Mix...
Dan Hecht, - Breaking Paradigms in Healthcare
Dan Hecht, - Breaking Paradigms in Healthcare
Dan Hecht, - Breaking Paradigms in Healthcare
Upcoming SlideShare
Loading in...5
×

Dan Hecht, - Breaking Paradigms in Healthcare

328

Published on

Cleveland HeartLab 2013 Symposium

Published in: Health & Medicine, Business
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
328
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
3
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • About two-thirds of patients worldwide are dissatisfied with their doctors, according to two recent studies from data analytics software developer SSI and market research firm The Research Intelligence Group. http://www.fiercepracticemanagement.com/story/patients-peeves-consistent-across-borders/2011-07-20#ixzz1bpURnDchPoor communication.Limited time with doctors. Patients&apos; dissatisfaction with physician communication appears to be a direct outcome of doctors not spending enough time with patients (44 percent), according to researchers. Long waits. long wait times rank as the top reason patients wouldn&apos;t recommend their doctors to others. Patients in the United States (46 percent) are especially bothered by physicians&apos; lack of punctuality.Patients search for care anywhere they can find it which eliminates opportunity for dr-pt relationship
  • 75% of our healthcare dollars go to the treatment of chronic diseases50% are preventable (lifestyle changes)Graph from http://www.cdc.gov/features/dsDiabetesTrends/
  • The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America&apos;s health plans to measure performance on important dimensions of care and service. Altogether, HEDIS consists of 75 measures across 8 domains of care. Because so many plans collect HEDIS data, and because the measures are so specifically defined, HEDIS makes it possible to compare the performance of health plans on an &quot;apples-to-apples&quot; basis.HEDIS measures address a broad range of important health issues. Among them are the following:           Asthma Medication UsePersistence of Beta-Blocker Treatment after a Heart Attack Controlling High Blood Pressure Comprehensive Diabetes Care Breast Cancer Screening Antidepressant Medication Management Childhood and Adolescent Immunization Status Childhood and Adult Weight/BMI Assessment
  • NCQA methodology for PCMH chart selection used – go back a month and a day from today. Pick the next 36 patients with one of the 4 ICD – 9 codes for inclusion.104 pts under 65 yrs old (Commercial); 253 pts over 65 yrs old (Medicare)
  • The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America&apos;s health plans to measure performance on important dimensions of care and service. Altogether, HEDIS consists of 75 measures across 8 domains of care. Because so many plans collect HEDIS data, and because the measures are so specifically defined, HEDIS makes it possible to compare the performance of health plans on an &quot;apples-to-apples&quot; basis.HEDIS measures address a broad range of important health issues. Among them are the following:           Asthma Medication UsePersistence of Beta-Blocker Treatment after a Heart Attack Controlling High Blood Pressure Comprehensive Diabetes Care Breast Cancer Screening Antidepressant Medication Management Childhood and Adolescent Immunization Status Childhood and Adult Weight/BMI Assessment
  • Dan Hecht, - Breaking Paradigms in Healthcare

    1. 1. Healthcare Realities, Paradigms and Solutions Dan Hecht Chief Executive Officer, MDVIP
    2. 2. Unique moment in time where the Healthcare Perfect Storm is brewing…
    3. 3. Healthcare “Perfect Storm” AC A
    4. 4. The Health Care Fiscal Cliff Source: Congressional Budget Office ◦ $2.7 Trillion Dollars spent on Healthcare in 2012 ◦ in 1965, Congress estimated that real Medicare spending in 1990 would be $12 billion ◦ Actual 1990 spending was $110 billion
    5. 5. The Health Care Fiscal Cliff The entirety of the growth of government spending as a share of GDP is Health Care…
    6. 6. The Health Care Fiscal Cliff …If you don’t count Interest on the Debt
    7. 7. The Health Care Fiscal Cliff Source: OECD, WHO • In 2009, the United States government (federal and state) spent more per person on health care than all but one other country in the world • Post-ACA, U.S will likely become #1
    8. 8. The Health Care Fiscal Cliff • Spending does not equate to better health • US ranks at the bottom in life expectancy • Health Outcomes in the US are on par with those experienced in Cuba and Slovenia
    9. 9. Healthcare “Perfect Storm”
    10. 10. The Boom of the Baby Boomers • There are 72 Million People who were born from 1946 to 1964 • >10,000 Boomers will turn 65 yrs. old in the U.S. everyday until December 31st, 2029 • This is the generation that will transform the institutions of aging and healthcare
    11. 11. The Boom of the Baby Boomers • Pressure to improve the consumer experience ◦ Only 58% Satisfied with Doctor/Patient Relationship ◦ <8 minutes visit time – and becoming more likely to see an “extender” vs. a doctor. - Boomers are less healthy than the previous generation - Earlier on-set of disease, less physically active, more obese ◦ Expect a Healthcare system to address their goals - Look Better, Feel Better, Treated like a Person
    12. 12. Life after the Affordable Care Act AC A
    13. 13. Life after the Affordable Care Act • Intent of the Affordable Care Act is to: ◦ Expand Access to More Americans ◦ Control Unsustainable Healthcare Costs ◦ Improve the Quality of Care
    14. 14. Expanding Access • Introduce 30 million uninsured Americans into the Healthcare system ◦ Expanding Medicaid and Provide Income-based Subsidies on the “Exchange” ◦ Legal Mandate for all individuals to have health insurance - An “Exchange” is a Government-regulated Insurance Marketplaces for individuals to purchase health insurance - Goal is to provide affordable Health Insurance for all people
    15. 15. Lessons from Massachusetts; Patient Access • Why? ◦ Added more people (demand) without addressing Physician/Provider Supply ◦ New Patients are not economically viable to the practice
    16. 16. Healthcare “Perfect Storm” ◦ Healthcare Costs continue to Rise at an Unsustainable Pace ◦ Patient access to Physicians will become more challenging ◦ Teams will replace Doctor-Patient relationships ◦ Care will become less personalized and more focused on “Population Management” ◦ Care will remain focused on treatment (sick care) vs. prevention (keep you well) “America's health care system is neither healthy, caring, nor a system.” -- Walter Cronkite
    17. 17. Primary Care Realities More Patients More Elderly Patients More Complex Patients More Changes in Healthcare More Dependence on Extenders Less Reimbursement Less Time
    18. 18. Primary Care Realities Physician Satisfaction
    19. 19. Primary Care Realities • Mayo Clinic National Study – released August 20, 2012, in the Archives of Internal Medicine – About 1 in 2 physicians are burned out based on measures of emotional exhaustion, depersonalization of patients and low sense of personal accomplishment – Emergency, family and internal medicine physicians suffering highest rates of burnout – Negative consequences for both physicians and patients
    20. 20. Physician Realities • Over 77% of physicians are pessimistic about the future of the medical profession • Over 84% agree that the medical profession is in decline • 58% of physicians would not recommend medicine as a career • Over 82% of physicians believe they have little ability to change the healthcare system • 80% of physicians rate the physician morale as negative Source: A Survey of Americas Physicians: Practice Patterns and Perspectives, The Physicians Foundation/Merritt Hawkins 2012
    21. 21. Primary Care Realities Physician Satisfaction Patient Satisfaction
    22. 22. Patient Perspective 2/3 of patients are dissatisfied – Poor Communication – Limited Doctor Time – Long Waits Driving force for – Urgent Care – Emergency Rooms – Pharmacy Clinics – Medical Tourism Based on studies from SSI and The Research Intelligence Group, 2011.
    23. 23. Primary Care Realities Physician Satisfaction Patient Satisfaction Medical Outcomes
    24. 24. Health Outcomes: Wrong Direction 65 percent of Americans are overweight or obese Half the country is expected to be pre-diabetic or diabetic by 2020.
    25. 25. 75% of U.S. healthcare dollars go to the treatment of chronic diseases. >50% of those costs could be prevented!
    26. 26. So… What is the future of healthcare? What are your options?
    27. 27. Options • Status Quo ◦ Traditional conveyor belt medicine – ACOs, other government pilots (CPCI) • Employment with Larger Group or Hospital • Personalized Preventive Care/ Direct Pay / Retainer medicine – e.g. MDVIP
    28. 28. The view we see now… Status Quo
    29. 29. Government View
    30. 30. MDVIP View Focus on the Patient : Physician relationship
    31. 31. What is Retainer Medicine? • Patient pays an annual membership to join a physician’s practice - Range $1500 to >$20,000 • Guaranteed to be cared for by your personal doctor • Receive a higher level of services beyond those covered by insurance - Services vary across different models • Typically smaller practice sizes to provide a better experience
    32. 32. Who is MDVIP? • National leader in Personalized Primary Care Medicine • Early pioneer and visionary • New approach to primary care focused on helping people stay healthy • National network of more than 670 carefully selected primary care physicians in 41 states & DC • More than 200,000 members and growing rapidly • Wholly-owned subsidiary of P&G MDVIP is designed to put the needs of the patient first to provide the best care available!
    33. 33. How does MDVIP work? • A consumer selects a nearby MDVIP-affiliated doctor as their personal primary care physician who will address all “sick care” needs AND provides our wellness program. • There is an annual membership fee, ranging from $1500 to $1800, to become a patient in the doctor’s practice. • The annual membership fee provides wellness and preventive care services that go beyond what health insurance covers. • The foundation for MDVIP care is the MDVIP Wellness Program.
    34. 34. MDVIP Wellness Program The MDVIP Wellness Program includes enhanced evaluations, diagnostics and one-on-one in-depth consultation with your MDVIP doctor focused on the most critical elements of your health, including: Heart Health Diabetes Weight Management Respiratory Sleep Vision Hearing Bone Comparable to an Executive Physical Advanced Lab Panel
    35. 35. Emphasis on Prevention Prevention Early Detection Opportunity to Intervene With Risk Factor Modification Earliest Opportunity to Intervene With Screening Optimal Health Genetic Risk Factors Detectable Pathophysiologic Abnormality Treatment Symptoms
    36. 36. How is MDVIP different? Conventional Practice MDVIP Practice Treats Sickness Helps People Stay Healthy Avg. 2,400 Patients/Practice Max. 600 Members/Practice 30 - 35 Patients/Day 10-12 Patients/Day <8 Minute Appointments 30 Minute Appointments (Minimum) Addresses Symptoms Holistic Approach Avg. 2 Weeks for Appointment Same/ Next Day Appointments Emergency Call Service 24/7 Doctor Availability
    37. 37. Advantages  24/7 availability  Same/next day appointments  No wait waiting rooms Convenience  >640 doctors in 40 states and rapidly growing Travel Reciprocity  Age range defined by the doctor* Family Care Medical Centers of Excellence
    38. 38. Primary Care Realities MDVIP Physician Satisfaction Physician Satisfaction Scores:>95% PatientScores:>95% Satisfaction Patient Satisfaction Proven primary care model shown to: Medical Outcomes • Reduce Hospitalizations • Manage Chronic Conditions effectively
    39. 39. Study Objective • To assess the impact of the MDVIP model of personalized preventive care on hospital utilization rates over a five-year period. – Elective and non-elective, emergent and urgent, avoidable and unavoidable admissions • To evaluate readmission rates for the MDVIP model as compared to benchmarks. Klemes et al, Am J Manag Care. 2012;18(12):e453-e460.
    40. 40. Methodology • Intellimed reports utilization by state and payer (i.e., for Medicare and non-Medicare). ◦ The Intellimed database has data from the five mandatory reporting states: VA, FL, AZ, NV & NY. • Hospital discharge rates per 1,000 persons were analyzed. • Average readmission rates from 2008-2010 for acute MI, pneumonia and CHF were compared to 2009 Medicare readmission rates available from the Dartmouth Atlas Project. Klemes et al, Am J Manag Care. 2012;18(12):e453-e460.
    41. 41. Medicare Rates Medicare Discharges /1000 MDVIP vs. Non-MDVIP 600 500 71% 71% 74% 75% $450,000 79% $400,000 Discharges / 1000 $350,000 400 $300,000 $250,000 300 $200,000 200 $150,000 $100,000 100 $50,000 0 $0 2006 Membership 10,835 2007 Membership 13,780 MDVIP 2008 Membership 18,321 2009 Membership 22,445 2010 Membership 27,064 Medicare Klemes et al, Am J Manag Care. 2012;18(12):e453-e460.
    42. 42. SAVING$ For 2010, in Just 5 States, MDVIP Saved: $109.2 Million for Medicare $10.2 Million for Commercial $119.4 Million Total $2,551 per patient $300 Million/Year for Medicare Nationally > $34 Million/Year for Commercial Nationally Klemes et al, Am J Manag Care. 2012;18(12):e453-e460.
    43. 43. Readmission Rates MDVIP Medicare Average Readmission Rates vs. 2009 Medicare Rates 21.7% 21.7% 97% 18.5% 95% 15.5% 91% State Average (5 Reporting States) MDVIP 0.5% Acute MI 0.8% CHF 1.4% Pneumonia Greater Than 90% Reduction! Klemes et al, Am J Manag Care. 2012;18(12):e453-e460.
    44. 44. Study Objective • To assess the impact of the MDVIP primary care model that focuses on personalized preventive healthcare and compare the rates of HEDIS effectiveness of care measures from the MDVIP model to national health plan results including: – Comprehensive diabetic care – Cholesterol management for members with cardiovascular conditions – Preventive measures (mammograms, pap smears, colonoscopies and osteoporosis testing) Seligman et al. IJPCM Vol 2 No 4 Dec 2012 pp. 775-779.
    45. 45. Methodology • Random Patient Selection – NCQA methodology for PCMH chart selection used • ICD – 9 codes used: Atrial Fibrillation, Diabetes Mellitus, Hypertension, Hyperlipidemia Study Population: • n = 357 patients (10 practices, 15 physicians) – 209 men (58.5%); 148 women (41.5%) • Two years of patient data was collected. Seligman et al. IJPCM Vol 2 No 4 Dec 2012 pp. 775-779
    46. 46. Results • All patients - 67% with BP < 130 / 80 - Average cholesterol of 178 - 85%-90% these measures were better All of had DXA,than the top 10% of HMO/PPO PSA, colonoscopy, mammogram benchmarks of HEDIS measures. • Diabetes patients - Average HgA1c of 6.7% - 70% with LDL < 100 - 90% had retinal and foot exams Seligman et al. IJPCM Vol 2 No 4 Dec 2012 pp. 775-779
    47. 47. Study Objective • As the physiology of cardiac biomarkers is better understood there is interest in multimarker approaches to determine risk and where a patient may be on a spectrum of risk. • To assess the MDVIP Annual Wellness Panel and determine if it identifies more patients at risk for disease than a covered lipid panel alone.
    48. 48. In Press – July 2013 Multimarker approach for identifying and documenting mitigation of cardiovascular risk Marc S. Penn, MD, PhD, FACC& Andrea Klemes, DO, FACE+ & Summa Cardiovascular Institute, Summa Health System, Akron, OH *Cleveland Heart Lab, Cleveland, OH + MDVIP, Boca Raton, FL Running title : Multimarker approach and cardiovascular risk
    49. 49. Multimarker approach for identifying and documenting mitigation of cardiovascular risk • We reviewed data from over 95,000 patients who had the MDVIP multimarker annual wellness panel. • Analyses were done looking at numbers of normal and abnormal biomarkers.
    50. 50. Percent Patients at Risk Adding MPO Identified Risk Based on Total LDL 10,453 pts that are at High Risk (11%) 3,365 pts at Very High Risk (4%) 100 100 100 80 80 80 60 60 60 40 40 40 20 20 20 0 0 0 Low Risk High Risk Low Risk High Risk Low Risk High Risk
    51. 51. Clinical Summary • Decreased Hospital utilization • Decreased readmissions • Savings to the system • Better Outcomes
    52. 52. MDVIP Employer Program - Flexible benefit/payment for the employer Employer MDVIP Benefit Options 1 2 Executive Wellness 3 Condition Management Employee Wellness Flexible Employer contribution [full/partial or employee funded] Offered to executives as an alternative approach to executive physical at a fraction of the cost Offered to identified high risk or high cost employees/dependents with specific medical conditions or risk factors Offered to all employees and/or dependents as yearround comprehensive care to keep employees healthy Benefits to the Employee/Employer:  24 hr physician availability  travel reciprocity  lower claims costs  same/next day appointments  efficient on-line enrollment  improved productivity  coordinated care with specialists  payroll deduction or credit card payment  healthier employees  keep current primary care physician and see MDVIP affiliated physician ONLY for the wellness exam
    53. 53. Paradigm Shifts The Rule of 3’s Prevention First There is Joy and Immense Value in Primary Care!
    54. 54. By Doctors, For Doctors MDVIP is saving primary care… • You have the time to proactively focus on prevention, wellness and early detection. • You have fewer patients so there is more time for patient physician interaction resulting in better outcomes. • There is greater patient and physician satisfaction. • You have control over your life professionally, personally and financially. Love Practicing Medicine Again!
    55. 55. Healthcare realities, paradigms and solutions to navigate… AC A Storm” “The Perfect
    56. 56. The “Retainer” Landscape MDVIP Maximum of 600 Pts. Pure Personalized Care Delivers Comprehensive Prevention Services Mixed Models Varying Numbers of Pts. May Mix Concierge w/ Standard May or May Not Deliver a Physical Examination Structured As Delivering May or May Not Be Structured Non-Covered Services as Delivering Non-Covered Svcs Access Models From 50 to 300 Pts Pure Concierge Practice May or May Not Deliver a Physical Examination Not Delivering Non-Covered Services Compatible with Medicare and Insurance May Charge Flat Fee for All May Opt Out of Medicare Opts Out of Medicare and All Insurance A National Network Individual Local Practices One or Several Practices

    ×