$2.6 T Healthcare economy projected to Grow 80% by 2019
USA Spending on Healthcare IS NOT Performance-Based and IS NOT Correlated to Longer Life Expectancy – Mary Meeker
Geisinger no longer owns hospitalsKaiser’s model is hospitals are cost centersWhat will this mean for University based hospitals with a medical research mission?
Hospitals have the most to lose or possibly win. What will they do?As recently as two weeks ago some of the Pioneer ACOs wanted an easing of the requirements…its too challenging!
Battleground is still physicians – ally with key influencersEducate themLook for solutions not tools
Request a seat at the table – Find projects to leadInfluence the process with research, knowledge of the marketUnderstand the Regs
Understand your marketKey players and dynamics between themHow do participants view one another?
I’ll take a few minutes and talk you through our platform, its components and some of the results we’ve seen. Our platform is made up of 4 primary components that deliver value to numerous end users or personas. Integration capability to aggregate disparte dataFlexible Data warehouse and data model capable of housing clinical and claims dataPerformance Management Engine that turns that data into insightsAnd Application services that deliver value to multiple different personas that are accomplishing different tasks.CMO, Case Manager, Physician, Administrator get relevant insights based on their specific roles.
Understanding the Impact of Accountable Care on Marketing Strategy
NASHVILLE CHAPTER AMERICAN MARKETING ASSOCIATIONWelcome to NAMA’sMay Healthcare SIG
NAMA Non-profit SIGWednesday, May 22nd8:00am – 9:30am“E-mail Marketing for Non-Profits”Emma, 9 Lea Avenue, NashvilleVisit NashvilleAMA.org to registerUpcoming nama Events
Carol MurdockChief Marketing Officer, LumerisToday’s speaker:
NAMA PRESENTATION • May 6, 20131) A National Emergencyand2) The biggest businessopportunity of our lifetime is:“Keep this from happening!”2019$4.6 trillion2001$1.46 trillion2010$2.60 trillion6.6% CAGR
NAMA PRESENTATION • May 6, 2013Source: Mary Meeker, USA, Inc.
NAMA PRESENTATION • May 6, 2013FFS HamsterWheel Care• Medicare RBRVS 1992• “Toxic ReimbursementSystem” 2001Primary Care Model• Primary Care Centers 1920• Institute of Medicine 1978• Barbara Starfield 1992 4 C’sAccountable Primary Care• Esse Health, late 1990’s• Primary Care: 9 C’s, 2012ChronicCareModel• Early 1990’s,• 1998Medical Home• AAP 1967• 2007, 8, 11Accountable Delivery System• IDS or virtually-Integrated Delivery System• Collaborative Payer Model (CPM, 2008)Triple Aim2008+1ACOs 2006HISTORICAL CONTEXT
NAMA PRESENTATION • May 6, 2013November 1, 1999 To Err is Human: Building a Safer HealthSystem – Institute of MedicineMarch 23, 2010 Affordable Care Act (ACA) signed byPresident Obama* June 28, 2012 Supreme Court Declares ACA isConstitutional – Roberts RulingSeptember 6, 2012 Better Care at Lower Cost: The Path toContinuously Learning Health Care inAmerica – Institute of Medicine* January 1, 2014 Major Components of ACA BenefitsBecome Effective*Tipping Point
NAMA PRESENTATION • May 6, 2013Institute of Medicine Reports US Healthcare System Wastes $750 Billion/yr- September 6, 2012If the US Healthcare System was a ……………Further, they went on to say,• BANK– ATMs transactions would take days• HOME BUILDER – Carpenters, electricians and plumbers wouldwork from different blueprints and hardly talk to each other• RETAILER– Prices would not be posted and could vary widely withinthe same store, depending on who was paying• AIRLINE– Individual pilots would be free to design their own preflightsafety checks, or not perform one at all
NAMA PRESENTATION • May 6, 2013Category Estimate of Excess Costs per YearUnnecessary Services $210 billionInefficiently Delivered Services $130 billionExcess Administrative Costs $190 billionPrices That Are Too High $105 billionMissed Prevention Opportunities $55 billionFraud $75 billionLack of Accurate, Timely Information and CollaborationSource: IOM Report, September 2012
NAMA PRESENTATION • May 6, 2013“The U.S. has uniquely screwed up healthcare in a way that is so clever. Wefund things at any price and focus on sickness rather than health…The U.S.healthcare system is the only system I know of where innovation is yourenemy. In every other industry, innovation changes the rules of the game.But in healthcare, innovation is just a clever word that is used to justifydriving up the cost of care per person to an unsustainable price.”Bill Gates, KPCB Summit September 14, 2012
NAMA PRESENTATION • May 6, 20131. Healthcare data will be largely digitized in 3 years2. Connectivity is ubiquitous3. Industry has embraced behavioral economics and aligned incentives todrive outcomes4. Disaggregation(decentralization) of healthcare services is moving them tolowest cost, highest quality, most timely provider5. Country is broke! …..and healthcare is big contributorFive Reasons Why Healthcare Will Be Disrupted in Five Years
NAMA PRESENTATION • May 6, 2013• Ensuring every patient receives…The Right Care,in the Right Setting,at the Right Cost.With Clear Accountability forClinical, Financial, andQuality Outcomes.PopulationHealthManagementLower PerCapita CostsPhysicianSatisfactionEnhancedPatientExperienceTripleAim* + 1*DM Berwick, TW Nolan, and J Whittington, “The Triple Aim: Care, Health, And Cost”, Health Affairs, 27, no.3 (2008):759-769
NAMA PRESENTATION • May 6, 2013Healthcare MarketVerticalIntegrationCollaborativePartnershipsStatus QuoValue-Based HealthcareFFS
NAMA PRESENTATION • May 6, 2013Proprietary and Confidential.Copyright 2013 Lumeris.•••••••
NAMA PRESENTATION • May 6, 20131. Exchanges (Individual, Small Group, Large Group)2. Access to provider clinical information3. Providers developing autonomous risk management capabilities4. Providers direct contracting5. Ascension of new variations of the Integrated Delivery Network model6. Data transparency and provider collaboration7. Accountable care competencies - risk-based contracting and risk adjustment8. Delivering predictable accountable care to multi-geography groups9. Delivering a consistent customer experience across franchise boundaries10. Disincentive to disrupt current FFS model11. Leveraging massive member/patient databases12. Structuring coopetition models in multi-payer, multi-provider approaches to serving patients13. ConsumerismOpportunities and Risks of Accountable Care To Existing Payer/ProviderBusiness Models
NAMA PRESENTATION • May 6, 2013Winners and LosersPayersHealthcare
NAMA PRESENTATION • May 6, 2013RevenueSpecialized ServicesCommercial ServicesGovernment Services$0 - Breakeven BreakevenKPMG Survey June 2012“Key question is whether or not anyorganization can be both committed to non-volume-based care economics while at thesame time working to sustain a volume-drivenreimbursement status quo.” 11 Ed Giniat, National Sector Leader, KPMG Healthcare & Pharmaceuticals.Hospitals Future
NAMA PRESENTATION • May 6, 2013Massive cultural change• Fewer heads in beds – changing ofeconomic models• Pricing transparency – consumerssharing cost burden• Partnering and improvedcollaboration with otherproviders, payers• Fewer independent hospitals• Entrenched fee-for-service modelshifting to risk• Need for increased IT investment –data integration and caremanagementHospital Impact
NAMA PRESENTATION • May 6, 2013Primary Care is KingACA emphasizes importance of primary care in reducing costs• Bundled Payment for Care Improvement Initiative• Comprehensive Primary Care Initiative• Financial Alignment Initiative• FQHC Advanced Primary Practice Demonstration• Independence at Home Demonstration• Medicare Graduate Medical Education program to expand PCP and nursesupplyPhysicians see fewer options and are looking for partners. The percentage of doctorsowning their own practices has dropped from 51% in 2005 to 43% in 2009 andprojected 33% in 2013 (Source: Accenture)
NAMA PRESENTATION • May 6, 2013Payer RelevanceOpportunity• Actuarial analysis• Ability to take insurance risk• Benefit design experience• Compliance and risk management• Risk Adjustment• Claims adjudication• Call center support for• members and providers• Medical management• WellnessChallenges• 15% administration cap• Shrinking Market – Exchanges andSelf-funded• Challenging markets for growth• Changing business model – B to C• Increasing accountability for Qualitymetrics• Access to clinical information• Relevance – a set of services thatphysician networks/patients andemployers will find valuable• Providers considering first dollarrisk (becoming a payer)Collaborate
NAMA PRESENTATION • May 6, 2013Marketing in Uncertain TimesRole is to lead the change and guide the team
NAMA PRESENTATION • May 6, 2013Marketing is StrategyTurn Strategy to Action
NAMA PRESENTATION • May 6, 2013Market DynamicsMichael Porters, Five Forces
NAMA PRESENTATION • May 6, 2013Value of Research• Understand your market• Key players /dynamics• How do participants view oneanother?• Talk to Customers• Physicians• Patients/Members• Employers• Talk to Competitors• Provide data to support or refutethe strategy
NAMA PRESENTATION • May 6, 2013PAY FOR “Clinical”PERFORMANCE(P4P)UPSIDEGAIN SHARING“Shared Savings”DOWNSIDERISK SHARING“Shared Risk”GLOBAL CAPITATIONFFS AnalyticsCare ManagementClaims & Encounter Data AggregationPopulation HealthPlatform & WorkflowCHOICE: Implement Common Population Health ArchitectureorBe Your Own Data and Systems Integrator
The Solution Purpose Built for Accountable CareSolution Packages for ALL Accountable Care ModelsMSSPs • Commercial ACOs • PCMH Programs • CPCi • MAPD• 4.5 Star rated MAPD plan• 69% MCR (before incentives)• # 1 plan in marketProof• 70% of Clinicians and Hospitals• Multi-Payer• 300M Annual TransactionsConnectivity• Innovation & Best Practices• Provider TransformationTransformationAccountable DeliverySystem PlatformPlatform• Cloud-Based Enterprise IT• 22 ACO Core Competencies• 800+ Man-Years Invested
NAMA PRESENTATION • May 6, 2013The Lumeris Solution: Technology Supported by Services
NAMA PRESENTATION • May 6, 2013Culture &GovernanceTransformationCollaborativeContractDevelopmentQuality & CostModelingPrimary Care &CareManagementTrainingPopulationManagementInterventionsPerformanceMeasurement &Assessment