Naked Hospital

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    So I ask to consider – what would you do with an extra $30 billion dollars a year?There is a lot you could do – first and foremost help pay for the other things we need to do to address quality – and ensure greater focus on patient care.The first phase of the Index looked at industry data. Now we are gathering numbers in real time from payers, providers and clearinghouses to tell an even more accurate story – and document progress – and savings.I urge you to join our effort – get involved in the Index – and raising awareness of the opportunity to get immediate savings.And help us work together to overcome the few remaining barriers. Today we’re releasing a whitepaper – with the Center for Health Transformation – that looks at these opportunities – and provides a clear roadmap for collaboration.

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    Naked Hospital - Presentation Transcript

    1. Breakfast Sponsor
    2. Briefing:Health System Reform: Update
      Paul Keckley, Ph.D., Executive Director
      Deloitte Center for Health Solutions
      Washington, DC
      Nashville, TN
      August 6, 2009
    3. Center for Health Solutions Research
      2009
      • Monday Health Reform Memo (weekly – ongoing)
      • ROI for Personalized Therapeutics (1/09)
      • Health Care and Public Policy: What Do Americans Really Want (1/09)
      • Reducing Costs While Improving Care in the U.S. Health System: The Health Reform Pyramid (1/09)
      • 2009 Survey of U.S. Health Care Consumers (3/09)
      • Comparative Effectiveness (5/09)
      • Academic Medicine: Sustainability (6/09)
      • Episode Based Payments (Summer 2009)
      • The Long Term Care Market in Medicaid: Ticking Time Bomb (Summer 2009)
      • Wellness and Healthy Living: New Business Models and Opportunities (Summer 2009)
      • Retail Medicine: Update (Summer 2009)
      • Medical Tourism: Update (Summer 2009)
      • The Medical Home: Update (Summer 2009)
      2008
      • Pay for Quality
      • Consumer-Directed Health Plans: Update
      • Medicaid Medical Management
      • The Medical Home
      • Medical Tourism
      • Price Transparency in Health Care
      • Retail Medicine
      • Preparing for ICD-10
      • Retail Pharmacy and Disease Management
      • Connected Care: Technology Enabled Care at Home
      • 2008 Survey of Health Care Consumers
      • Best Practices in Greening in Health Care Organizations
      1
    4. Current context for health reform
      • The U.S. economy is weak—recession began 12/07
      • Unemployment at 9.4%: highest since 1939
      • Banking industry solvency: 19 major banks stress tested
      • TARP program underway: results unknown, $140 billion yet to deploy
      • Containing health costs—key element in economic recovery
      • Fastest growing expense in households, companies and government
      • Only industry with employment increase since 12/07 downturn
      • The new administration—“change…yes we can”
      • Health care, energy, education priorities
      • Access to health insurance—campaign 2008 focus, but costs now a major theme
      2
      Copyright © 2009 Deloitte Development LLC. All rights reserved.
    5. Health costs increased from 5.9 to 16.2% of GDP from 1960 to 2007: Fastest growing expenditure in federal budget
      2008-2018 Forecast:
      • US economy: +4.1% CAGR
      • Health costs: +6.2% CAGR
      • Government spending for health care (Medicare and Medicaid): +7.2%
      • Private sector spending for health care: +5.3%
      • 25% of entire federal budget
      Annual health care expenditures in the United States have gone from $27.5 billion in 1960 to $2.24 trillion in 2007 and are projected to reach $4.35 trillion by 2018. Source: Department of Health and Human Services, Center for Medicare and Medicaid Services, the National Health Expenditures Accounts (NHEA)
      3
      Copyright © 2009 Deloitte Development LLC. All rights reserved.
    6. Since December 2007, 6 million overall jobs have been lost; however, health care jobs have increased 190,000
      Source: Labor Department
      4
      Copyright © 2009 Deloitte Development LLC. All rights reserved.
    7. Consumer inclined toward reform: “The system isn’t working very well…”
      Only 1 in 5 consumers give the U.S. health care system an above-average report card grade; those grading the system “F” outnumber those giving it an “A” by 6 to 1.
      Source: 2009 Survey of US Health Consumers
      5
    8. Consumers believe system is wasteful
      52% of Americans feel that at least half of health costs are wasted.
      Source: 2009 Survey of U.S. Health Consumers
      6
      Copyright © 2009 Deloitte Development LLC. All rights reserved.
    9. Not a system…a federation of interests that’s fragmented, costly
      Administrators/Watchdogs
      Regulators
      Media
      Professional
      Societies/
      Special Interests
      Insurers
      Innovators
      Academic
      Medicine
      Pharma
      BioTech
      Accrediting
      Agencies
      Employers
      HCIT
      Device
      Service Providers
      Disruptors
      Hospitals
      Outpatient
      Facilities
      Long Term
      Care
      Allied Health
      Professionals
      Disease
      Management
      CAM
      Physicians
      Consumers
      7
      Copyright © 2009 Deloitte Development LLC. All rights reserved.
    10. White House puts priority on health reform above energy, education: Reduce costs, cover everyone
      • February 24, 2009 to Joint Session of Congress: Reform energy, education and health care. Pass bill in 2009.
      • May 11, 2009 to Major Trade organizations: Cut CAGR to 4.7%, reduce costs by $2 trillion (2008 – 2018)
      • June 3, 2009: Everything on the table—mandates, employer tax exclusion, employer mandate, public plan, et al. Bill this summer.
      8
      Copyright © 2009 Deloitte Development LLC. All rights reserved.
    11. Funding–follow the money
      • January 23: President Obama signs SCHIP expansion legislation, increasing eligibility to 4,000,000 children and pregnant women; $32.3B funded through increase of 62 cent federal tax on each pack of cigarettes
      • February 17: President Obama signs $787B stimulus package (America’s Recovery and Reconstruction Act) that includes $145B for health care
      • February 26: President announces “down payment on health reform”—a $634B 10-year fund to pay for long-term health reforms; cuts to pharmaceutical companies and Medicare Advantage plans plus increased taxes for those earning more than $250,000
      • March 11: Congress approves $410B appropriation to operate government through September 2009, including modest increases in a few areas of health care—primary care, NIH, National Service Corps
      • April 29: Passage of FY10 budget; targeted investments in health reforms (FDA, bundled payments); 8% overall growth in federal spending for Medicaid and Medicare but effective rate increase of 0.1%; insurance reform
      9
      Copyright © 2009 Deloitte Development LLC. All rights reserved.
    12. Presidential news conference on July 22, 2009:“health insurance reform”
      1 Health reform is necessary to reduce escalating costs of the system that threaten economic recovery. The result of inaction is economic collapse: employers will drop employee benefits coverage or shift financial burdens to employees who cannot afford premiums. The “status quo” is not an option.
      2 Reform of the system must be deficit neutral: added costs for covering “47 million lacking insurance” (there are actually 45.7 million) and changes to the delivery system must be offset by savings or new revenues. The White House believes a combination of two-thirds from savings and one-third from taxes on high income households is the appropriate funding mechanism.
      3 The President supports a public plan option available to uninsured and under-insured individuals and small businesses. Repeating an oft-used phrase, the President supports the public plan option to “keep the plans honest” and provide competition to commercial plans. NOTE: A positive earnings report from “a major plan” released today was referenced as evidence plans benefit at the expense of patients by denying coverage or refusing to pay for needed care.
      4 Agreement among legislators is a “work in progress”: there is agreement that individual mandates, a comparative effectiveness program, health insurance exchanges, fraud reduction, health information technology utilization and integrated delivery systems are key elements. Pressed about partisan issues and defections among moderate Democrats due to the costs of the plan, the President defaulted to the legislative process: messy, necessary, and soon to result in a reform bill. The forthcoming work in the Senate Finance Committee is a key part of the process.
      5 Key industry stakeholders support the need for reform: in his remarks and responses to reporters’ questions, three references to AARP and two each to AMA, ANA and PhRMA were used to suggest the White House has industry support.
      6 To deflect criticism of government intrusion in coverage decisions and payment calculations for providers, the White House supports the development of an independent board to make recommendations. Congress would have 30 days to prevent implementation based on a vote. It would make determinations about advisable diagnostic and therapeutics based on evidence and costs. It would also set payment rates for providers based on its assessment of comparative effectiveness and value. NOTE: Sen. Jay Rockefeller proposed MedPAC as the independent entity; OMB Director had previously proposed a new entity, IMAC (Independent Medicare Advisory Commission).
      7 The President anticipates signing a bill in 2009 but did not state his determination of a bill by the August recess.
      10
    13. Key players: Congressional Committee leadership
      Senate Finance Committee
      Senate Health Education, Labor and Pensions
      CHUCK GRASSLEY:
      Senior Senator from Iowa
      TED KENNEDY:
      Senior Senator from Massachusetts
      MAX BAUCUS:
      Senior Senator from Montana
      House Ways and Means Committee
      House Energy and Commerce Committee
      House Education and Labor
      GEORGE MILLER:
      Member of the U.S. House of Representatives from California's 7th district
      CHARLES RANGEL:
      Member of the U.S. House of Representatives from New York’s 15th district
      HENRY WAXMAN:
      Member of the U.S. House of Representatives from California's 30th district
      11
    14. Key players: Two offices of health reform
      Kathleen Sebelius:
      United States Secretary of Health and Human Services
      Nancy-Ann DeParle:
      Director of the White House Office on Health Reform
      12
      Copyright © 2009 Deloitte Development LLC. All rights reserved.
    15. Some major proposals have emerged: more to come
      13
      Copyright © 2009 Deloitte Development LLC. All rights reserved.
    16. The most delicate issues will be:
      14
      Copyright © 2009 Deloitte Development LLC. All rights reserved.
    17. Key stakeholders engaged in cost containment
      • Reduce spending to 4.7% ($2 trillion reduction over 10 years)
      • Administrative simplification, coordination of care, utilization management key initial focus
      (excerpt from publicly available document)
      15
    18. The reform bill will likely include four strategies to reduce cost to fund improved quality and increased access for uninsured
      It will take 6 years implement major reforms
      Savings can be more than $2 trillion if implementation is accelerated via payment reform, IT adoption
      Net result:
      reduce CAGR
      to 4.5%
      4
      Consumerism
      Focus: CDHPs, transparency, PHRs, incentives, value
      Coordination of care
      Focus: Primary Care 2.0 Model (the new “Medical Home”)
      3
      Comparative Effectiveness/Evidence – based Medicine
      Focus: (1) Personalized medicine, (2) comparative effectiveness; episode based payments to acute organizations
      2
      Health Care Information Technology
      Focus: (1) e-prescribing, (2) care coordination (3) administrative cost reduction
      1
      16
      Copyright © 2009 Deloitte Development LLC. All rights reserved.
    19. The impact of major reforms will vary by sector
      Modest Moderate impact Significant impact
      17
      Copyright © 2009 Deloitte Development LLC. All rights reserved.
    20. Paying for health reform: proposed sources of funding
      18
    21. Contact information
      For more information, please contact:
      Paul H. Keckley, Ph.D., Executive Director, Deloitte Center for Health Solutionspkeckley@deloitte.com202-220-2150
      For more information on the Center's view of health care in the new administration, please visit: www.deloitte.com/us/healthreform
      And visit our website to subscribe to our content:www.deloitte.com/CenterforHealthSolutions/subscribe
      Copyright © 2009 Deloitte Development LLC. All rights reserved.
    22. US Congressman
      Marsha Blackburn
      7th District of Tennessee
    23. BREAK SPONSOR
    24. TRACK SPONSOR
    25. Looking under the covers - Measuring Quality/Value
      A Panel Discussion - August 6, 2009
      John R Morrow
      www.HospitalValueIndex.com
    26. A Panel Discussion - August 6, 2009
      Agenda
      John R. Morrow – The Ratings Guy
      Justin Lansing – Credence Healthcare
      Eddie Pearson – Healthstream
      Miriam Paramore -- Emdeon
    27. A Panel Discussion - August 6, 2009
      What is Value?Why Transparency?
      Transparency is a form of openness, a medium of communication and a measure for accountability; opposite of privacy.
      Banking - R. Levine, policy of transparency improved efficiency
      Corporate – Sarbanes-Oxley Act – confidence in capital markets
      Management – PCAOB –oversight, independence, disclosures
      Media – FOIA provides access
      Politics – ethics, law, policy, economics, media, social new media
      Research – Peer review, double blinded clinical trial
      Sports – World Anti Doping Agency
    28. A Panel Discussion - August 6, 2009
      Transparency in Health Care
      Before HCFA realized it was a purchaser of health care we relied on FOIA for:
      Financial, and Operating Reports
      Clinical experience
      Outcomes
      Mortality
      Complications
      Research
    29. A Panel Discussion - August 6, 2009
      Transparency in Hospitals
      After CMS realized spending, utilization outcomes and experience were all different:
      Ratings outpaced CMS w/Web & social media
      Industry shamed by IOM findings
      Quality differentiation made markets
      Info systems and industry standards drive new insights
      Greater disclosures by CMS forces accountability
      Value based purchasing to determine reimbursement
      Better management embraces disclosure & accountability
    30. A Panel Discussion - August 6, 2009
      What We Can Now See
      Core Process Measures
      Patient Safety Indicators
      HCAHPS – Patient Experience
      Financial reporting
      Clinical reporting – RAMI, RACI,
      Post discharge mortality & readmissions
      Population utilization
    31. A Panel Discussion - August 6, 2009
      What We Want to See and Do
      Institutional – more of the same…faster.
      Purchaser/Employer Sponsored – what’s under the shell, what’s it all mean
      Consumer/Patient/Person –
      How about the real price?
      My personal records and data?
      Everything that John and thepanel can show me…Why Not?
    32. A Panel Discussion - August 6, 2009
      How?
      Defining Value by provider engages the patient/provider relationship
      For routine care, services are a commodity where quality is not always a factor,
      For complicated cases, experience with better outcomes becomes a factor,
      All require disclosure and transparency so the patient can apply their own value judgment and participate in their own decision making about utilization,
      Value incorporates all known aspects of outcomes with a published fair price.
    33. A Panel Discussion - August 6, 2009
      Value is what Value does
      Outcomes
      Mortality & Complication rates
      Patient Safety Indicator rates
      Readmission rates
      Efficiency rates
      Satisfaction & Experience Rates
      Post-discharge functional status SF-36
      Affordability
    34. A Panel Discussion - August 6, 2009
      Value like Transparency
      Creates efficiencies, removes barriers
      Improves communication – EMR/PHR
      Differentiates to the community Form990
      Integrates the patient into the care process
      Builds the foundation of the medical home
      Shares the responsibility and accountability
      Increases compliance; realigns priorities
    35. A Panel Discussion - August 6, 2009
      Your Panel
      Justin Lanning – Credence Healthcare
      Eddie Pearson – HealthStream
      Miriam Paramore – Emdeon
      John Morrow – www.HospitalValueIndex.com
    36. August 6, 2009
      45
      Transparency in Healthcare Miriam Paramore, SVP Strategy & Government Affairs
    37. Emdeon: A Leader inToday’s National Health Information Network
      155 million
      Patients
      350,000
      1,200
      5 billion
      Providers
      Payers
      RCM & Payment
      Distribution
      Healthcare
      Information
      PBM Services
      ePrescribing
      Pharmacies
      55,000
      46
      46
      Emdeon – We make healthcare efficient.
    38. efficient healthcare
      47
      Emdeon – We make healthcare efficient.
    39. Healthcare Reform Is Demanding Price Transparency (Senate HELP Bill)
      48
    40. Healthcare Reform Is Demanding Price Transparency (House Tri-Committee Bill)
      49
    41. What is Transparency Hard?
      50
      Emdeon – We make healthcare efficient.
      Price
      Healthcare is not retail – there is no price at the point of service
      What a hospital charges is not the “price”
      What an insurance company pays is the “price”
      But the consumer can’t buy at that “price”
      Quality
      Data is not digital
      Lack of standards means even digital data is meaningless
      There is no good clinical information exchange
      Consumer-friendly communication of medical terms is difficult
    42. HIMSS Price and Quality Reporting White Paper (coming very soon)
      51
      HIMSS Financial Systems Steering Committee
      6 Public-Private Collaborations
      7 State & Local Initiatives
      5 Value Driven Healthcare Initiatives
      3 Business Coalitions
      Total = 21 separate initiatives
    43. efficient healthcareFunding Healthcare Reform
      52
      Emdeon – We make healthcare efficient.
    44. Where Does the Money Go?
      85%
      15%
      Admin Costs =
      $360 B
      Cost of Care = $2 T
      Total U.S. Healthcare Spend = $2.4 Trillion
      53
    45. “Gang of 6” Letter to President Obama
      54
      54
      Emdeon – We make healthcare efficient.
    46. “Gang of 6” Recommendations
      55
      Utilization of care
      Cost of doing business
      Administrative simplification: Streamlining the claims processing system will allow clinicians and other personnel to spend less time and fewer resources on paperwork, lowering costs for everyone.
      Chronic care
      55
      Emdeon – We make healthcare efficient.
    47. U.S. Healthcare Efficiency Index™Launched December 2008
      56
      56
    48. U.S. Healthcare Efficiency Index™Advisory Council (partial list)
      57
      57
      Emdeon – We make healthcare efficient.
    49. Funding Healthcare Reform – The Duh Factor
      • June 13, 2009 – President Obama announces $313 billion in cuts to Medicare/Medicaid providers
      • Peter Orzag: Cuts will save Medicare patients money “as much as $43 billion in reduced premiums for prescription drug coverage over the next 10 years.”
      $43 billion over 10 years through Medicare/Medicaid cuts
      vs.
      $150 billion over 5 years through HIT
      58
      Emdeon – We make healthcare efficient.
    50. what would u dow/ $150 B?ushealthcareindex.com
    51. Discussion
    52. TRACK SPONSOR
    53. Panel Discussion: PHR, EHR or EMR – A real solution or just Alphabet soup?
      Moderator: Daniel Fell, Partner NDP
      Panelist:
      Steve Starkey, COO/CIO, HMS
      Mikell van derLaan, Manager of Architecture, CHS
      PHR EHR EMR
    54. Discussion
    55. Lunch Sponsor
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