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Champion And Healthcare
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Champion And Healthcare

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The healthcare reform law will have far-reaching impacts in areas of ...

The healthcare reform law will have far-reaching impacts in areas of

Coverage
Insurance Reform
Insurance Mandates
Health Insurance Exchanges

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  • What’s going on in the HC industry. People that influence the HC paradigm the most … Shifting to a Patient Centric ModelThrough govt work - Health ReformGovernmentProvidersHealth PlansLife Sciences4 main areas that influence and change the way healthcare is delivered … Access to Care: legislativeReduce uninsured SustainabilityImprove OutcomesCoodinated CareSharing HIE – allow docs to have info about the patientsReducing Active Health management – Shifting to a patient centric model – a major driver is health reform & ARRA – 4 areas We believe that there is a healthcare paradigm shift that is about to occur.For decades, the US has been an illness-based model of healthcare. We are now shifting to a wellness / health maintenance model.It’s odd that HC organizations need to be reminded to involve their patients in their own healthcare decisions.Access to CareReadmission Rates – Health Reform Bill - Mentioned 50 timesHospitals – 2013- above 75% - tile2013 – Preventable diseaseReimbursements – reduced …Major Points: HC Providers above 75 percentile - The proposal drafted by Democratic Chairman Max Baucus was designed to reduce costs, regulate insurers and expand coverage.

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  • 1. Champion – Helping our Clients Address the Issues Facing the Healthcare Market Place
    Michael Hudak
    Champion Solutions Group
    http://www.championsg.com/champion.nsf/solutions/healthcare+solutions
    800-771-7000 x 344
  • 2. The healthcare reform law will have far-reaching impacts
    Cost: $940B over 10 years
  • 3. The reform law is just the latest upheaval hitting healthcare
    Legislative reform
    Will bring $938B into the healthcare industry by 2019
    Stimulus: ARRA - HITECH
    REGULATED CHANGE
    Health IT market expands 31% as providers move to EMR
    Standards
    7 times more medical codes
    Estimated $10B conversion costs
    New delivery models and
    reimbursement approaches
    Community Care NC delivers $150M annual savings
    MARKET DRIVEN
    Employers & Consumers
    AT&T announces $1B write-off
  • 4. We expect intense disruption in the next 18 – 36 months
    PCMH demonstration programs – Pilot, scale and expand
    ACO pilots in the private sector
    OCT 2013:
    ICD-10 Mandate Effective
    ICD-10 & HIPAA 5010 Conversion: ~$2B for Providers, ~$7B for Plans
    STANDARDS
    STIMULUS: ARRA / HITECH
    MU Stage 2: TBD – Advanced Care Processes
    MU Stage 1: Electronic capture and sharing; e-Prescribing; Clinical decision support
    Form Standards and Policy Committees
    Develop “Meaningful Use” definitions
    MU Stage 3: TBD – Improved Outcomes
    $380M for Health Information Exchanges
    $340M Regional Extension Centers
    $1.1B for Comparative Effectiveness
    LEGISLATION: Patient Protection and Affordable Care Act
    Bundled PaymentsPilots
    No Denials, Rescissions or Caps
    2014: Individual and Employer Mandates Begin
    Closing Medicare “doughnut hole” on Drug Reimbursement
    Imposition of 85% MLR Floor
    2014: State Run Insurance Exchanges for Consumers and Small Business
    $500M for Comparative Effectiveness
    Increased Fraud & Abuse Funding
    Mar 2010: PPACA
    Feb 2009:ARRA Enacted
  • 5. Reimbursement Rates (2008)
    Hospital Operating Margin by Year
    25%
    Commercial Plans
    20%
    Medicare
    15%
    Medicaid
    100%
    10%
    91%
    5%
    89%
    0
    -5%
    -10%
    -15%
    ‘01
    ‘02
    ‘03
    ‘04
    ‘05
    ‘06
    Medicare
    Medicaid
    Commercial
    Healthcare Provider pressures: lower costs, better quality
  • 6. Adjacent industries are entering the healthcare ecosystem to meet the changing needs of patients and communities
    Retail clinicswill continue to expand their services. They may offer services such as health insurance and telemedicine.
    Medical device manufacturers will sell directly to consumers in homes, packaging wellness and care management services with devices.
    PROVIDERS
    Banks will grow participation in health savings accounts and in payment-related transactions and services.
    HEALTH PLANS
    PHARMAS
    Networking providers will expand focus on hand-held devices and network services including UC2, selling devices to physicians’ offices, hospitals and long-term care facilities.
    Communications service providers will actively pursue health information exchange opportunities, as the enabling platform for information exchange and telemedicine.
    PBM’swill expand significantly, pursuing HIE networks, being visible at point of care and adding non-traditional medical services.
    6
  • 7. Healthcare Provider Challenges
    Government budgets at national, state and regional levels under extreme pressure
    Healthcare related expenses often represent the largest budget item
    Healthcare access, quality and related public services highly politicized
    Costs to serve chronic conditions and elderly are largest portion of costs
    Fraud presents significant drain on cost, typically 3-8% of total HC costs
    Providers look for approaches to engage patients, improve service and quality and address system inefficiencies
    Delivery systems are:
    Competing for patients/physicians on basis of reputation for quality, safety, convenience
    Fostering connections between in-patient and outpatient settings
    Driving operational and productivity improvements to control costs
    Deploying more comprehensive measurement and information mgt systems
  • 8. Helping clients address their challenges today
    • Align behind health reform.
    • 9. Engage in pilots now - success helps to drive momentum.
    • 10. View your business holistically.
    • 11. New business models are a certainty. Partnerships are key.
    • 12. Lead collaboratively. Share best practices.
    Let’s build a smarter healthcare system together
  • 13. Healthcare ObjectivesImproving patient outcomes while managing costs and privacy
    Integrate and transfer medical information from various systems
    Improve real-time collaboration among care teams to consult on patient care
    Reduce medical errors and promote patient safety
    Connect IT at the hospital with remote patient care environments
    Enable effective compliance practices with myriad and ever-changing regulations
    Support staff training and continuing medical education
  • 14. Personalized
    Healthcare Value
    Retrospective to Prospective to Predictive Care Management
    Collaboration and Automation
    Information compliance, availability and security
    Integration /
    Interoperability
    EMRs, Images, Records, Forms Lifecycle Management
    Health Integration Framework
    Helping clients become smarter along three key dimensions
    Deliver collaborative carefor prevention and wellness
    Achieve better quality and outcomes
    Improve operational effectiveness
    10
  • 15. Health Industry Shifts to a Patient Centric Model
    Access to Care
    Reduce Costs
    Affordability
    Reduce the Uninsured
    Sustainability of Healthcare Systems
    Efficiencies/Health IT
    Transparency
    Consumerism
    Quality Initiatives
    Coordinated Care
    Shared Information/HIE
    Fitness and Wellness
    Chronic Disease Management
    Protocol Adherence
    Active Health Mgt
    Improve Outcomes
  • 16. Partnering with Champion
    Our team of specialists would like to partner with your team to ensure that we fully understand your IT and business roadmaps. We would like to help your team extend these investments out into your partner and patient facing systems as well as into clinical systems.
  • 17. Optimizing hospitals
    The core infrastructure is the foundation for your systems and Champion would like to ensure your team is leveraging best practices and are maturing your processes so you can spend less time managing your infrastructure and more time supporting the key initiatives of the business.
    Following a Core IO assessment Champion’s Healthcare Group can also offer a ½ day best practices assessment to ensure you are optimizing your investments with the Connected Health Framework.
  • 18. Proof of Concept Offerings
    Business Productivity Online Services
    VoIP (Office Communications Services)
    Secure Healthcare Instant Messaging
    Automated Workflow
    Windows 7 Optimized Desktop Services
    Customer Relationship Management
    Chronic Condition Management
    Caregiver Collaboration
    Patient Experience
  • 19. Future Healthcare discussions
    Unified Intelligence System
    Coordinated Care Platform
    Chronic Condition Management
    HIPAA 4010 to 5010 / IDC9 to IDC10
    Policy and Procedure Management
    UC Caregiver Collaboration
    CMS Core Reporting
    Home Health
    Virtual Desktop Infrastructure
    Windows 7 / Windows 2008 R2
    Compliance Mgmt - Exchange 2010
    Extending SharePoint 2010
    Line of business integration - Office 2010