1. Impending Advancements in Healthcare
Quality and Outcomes in the United
States
By: Erik Hollander, MBA
Milwaukee, WI (United States)
May 2016, Upper Austria
6. Terms - Defined
• Medicare
– Medicare is the federal health insurance program
for people who are 65 or older, certain younger
people with disabilities, and people with End-
Stage Renal Disease (permanent kidney failure
requiring dialysis or a transplant, sometimes
called ESRD).
• Part A (Hospital)
• Part B (Medical)
• Part C (Medicare Advantage Plan)
• Part D (Prescription Drug Coverage)
Source: Adapted from: https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-
medicare.html
7. Terms – Defined (Con’t)
• Medicaid
– Medicaid is a joint federal and state program that
helps with medical costs for some people with
limited income and resources. Medicaid also
offers benefits not normally covered by Medicare,
like nursing home care and personal care services.
Source: Adapted from: https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicaid/medicaid.html
8. FQHC
• Federally Qualified Health Center (FQHC)
– Federally qualified health centers (FQHCs) served
the “underserved” with a special pay structure
and are reimbursed/compensated through our
government
– Supported through Health and Human Services
(HHS) / Health Resources & Services
Administration (HRSA)
– US (21,726,965) / WI (284,072) = 1.3%
Sources: Adapted from: http://www.hrsa.gov/index.html
http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Introduction/qualified.html
http://kff.org/other/state-indicator/total-patients-served-by-fqhcs/
9. History of HC in US
Source: Adapted from: A Brief History: Universal Health Care Efforts in the US: transcribed from a talk given by Karen S/ Palmer, MPH, MS in San
Francisco at the Spring, 1999 PNHP meeting
Source: Adapted from: PBS Healthcare Crisis: Healthcare Timeline,
Source: Adapted from US Dept. of Health and Human Services, Historical Highlights, 2014
Source: Adapted from Kaiser Family Foundation, Timeline: History of Health Reform in the US, May 2013
10. Current
Source: Adapted from: Are Healthcare Consumers at the Forefront of Digital
Health? By Barbara Ficarra, RN, BSN, MPA and Ben Heubl
Source: Adapted from: Experts say rural healthcare in crisis: OIG report,
Medicaid opt-outs cause concern; August 29, 2013 by Zack Budryk
Source: Adapted from: 8 Issues Affecting Population Health Management Right
Now; Dec. 16th, 2012, by Matthew Smith
11. US Census Data (2012)
United States Census Bureau
Ortman.May.2016.pdf
Source: Adapted from: U.S. Population Projections 2012 – 2060; Presentation for the FFC/GW Brown Bag Seminar Series on Forecasting; Washington, D.C.,
February 7, 2013 by Jennifer M. Ortman, Population Division, United States Census Bureau
13. Terms - Defined
• Charity Care and Uncompensated Care
– Charity Care – Patient cannot afford
– Uncompensated Care – Payment is expected but
hospital is unable to collect
Source: Adapted from: https://www.dhs.wisconsin.gov/guide/freehosp.htm
14. Charity Care
Source: Adapted from: Milwaukee-Area Hospital Systems; Milwaukee Business Journal,
Charity Care, bad debt increased in 2011; Corrinne Hess, December 23, 2011
Source: Milwaukee Business Journal, More Charity at Hospitals, June 29th, 2006, by Ben Fishcer
Source: Hospitals seeing drop in bad debt, charity care, October 22, 2010, by Corrinne Hess
(8.6 million Euro)
(100 million Euro)
16. Terms – Defined (Con’t)
• Medicaid
– Medicaid is a joint federal and state program that
helps with medical costs for some people with
limited income and resources. Medicaid also
offers benefits not normally covered by Medicare,
like nursing home care and personal care services.
Source: Adapted from: https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicaid/medicaid.html
17. Terms - Defined
• Medicare
– Medicare is the federal health insurance program
for people who are 65 or older, certain younger
people with disabilities, and people with End-
Stage Renal Disease (permanent kidney failure
requiring dialysis or a transplant, sometimes
called ESRD).
• Part A (Hospital)
• Part B (Medical)
• Part C (Medicare Advantage Plan)
• Part D (Prescription Drug Coverage)
Source: Adapted from: https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-
medicare.html
18. Current
Source: Adapted from: The Joint Commission, Quality logo, 2015
Source: Adapted from: Commission on Cancer, Logo, 2015
Source: Adapted from: NCI, Community Oncology Research Program, 2015
Source: Adapted from: ASCO, QOPI, 2015
Source: Adapted from: Univ. of Nebraska, FACT, 2015
20. Growth in Total Health Expenditure Per Capita, U.S. and
Selected Countries, 1970-2008
Source: adapted from:
Organization for Economic Co-operation and Development (2010), “OECD Health Data”, OECD Health Statistics (database). doi:
10.1787/data-00350-en (Accessed on 14 February 2011).
Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD
estimates. Numbers are PPP adjusted. Break in series: CAN(1995); SWE(1993, 2001); SWI(1995); UK (1997). Numbers are PPP adjusted.
Estimates for Canada and Switzerland in 2008.
21.
22. Quality and Benchmarks
• Quality and Reports
– Hospital Comparison Benchmark Reports (HCBR)
– Rapid Quality Reporting System (RQRS) Flyer
– Quality Care Measures
Source: Adapted from American College of Surgeons, Commission on Cancer, Quality Cancer
Tools, 2015
25. Current / Future
•Reform
Source: Adapted from: Does the Private Option sink or save providers by Katie Bo Williams, March
14, 2014
Source: Adapted from: Dances with Fat: Fat Chance for Healthcare Access, January 20, 2011
Source: Adapted from: The Case for Single Payer, Universal Health Care for The United States:
Outline of Talk given to the assocaition of State Green Parties, Moodus, Connecticut on June 4, 1999;
by John R. Battista, M.D. and Justine McCabe, PhD.
26. PPACA
• Patient Protection and Affordable Care Act =
Obamacare
– The Affordable Care Act was passed by Congress
and then signed into law by the President on
March 23, 2010. On June 28, 2012 the Supreme
Court rendered a final decision to uphold the
health care law.
– PPACA
Source: Adapted from: http://www.hhs.gov/healthcare/about-the-law/read-the-law/index.html
27. Future of Healthcare Delivery
• Fee for Service (FFS) vs. Episodes
• ER Utilization
• Length of Stay (LOS)
• Insurance Coverage (40 million - PPACA)
• Tiered System
• Best Health System in the World (Videos)
28. Fee for Service (FFS) vs. Bundle
• Providers
– (Doctors) paid for each service they provide (i.e.
Office visit, tests, etc.)
• Bundle
– Single payment covering all the care for a patient’s
medical conditions or treatment over a specified
timeframe
Source: Adapted from: https://hbr.org/2015/10/getting-bundled-payments-right-in-health-care
29. Joint Replacements Annually
• 400,000 procedures
(Source: CMS)
• $7 billion for the
hospitalizations alone
(Source: CMS)
• Cost ranges from
$16,500 to $33,000 per
case (Source: CMS)
• Average charges in
Milwaukee: $59,000 per
case (source: Wisconsin PricePoint)
30.
31. Comprehensive Care for Joint
Replacement Model
• Inception: 4/1/2016
• Value Based Care
• Mandatory Enrollment
– 67 metropolitan
communities
PY1 PY2 PY3 PY4 PY5
Hospital specific
episode data
66.6% 66.6% 33.3% 0% 0%
Regional specific
episode data
33.3% 33.3% 66.6% 100% 100%
32. The Strategy That Will Fix Health Care
Michael E. Porter Thomas H. Lee, MD
41. References
• Harvard Business Review; Getting Bundled Payments Right in Health
Care; Derek A. Haas, Robert S. Kaplan, Dereesa Reid, Jonathan Warsh,
Michael E. West; OCTOBER 19, 2015
