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The US Healthcare System by Madhav Sitaraman

Talk by Madhav Sitaraman, Co-Founder, Enlightiks at The Hive Big Data Think Tank Meetup - Healthcare 2.0 hosted at the EMC India.

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The US Healthcare System by Madhav Sitaraman

  1. 1. The US Healthcare System Madhav Sitaraman – Co‐Founder, Enlightiks
  2. 2. US Healthcare 7% 17.2 % 1970 2012 Share of wallet Value Good Health Gross Domestic Product (GDP)
  3. 3. US Healthcare spending Americans Payer Providers Patients Fee for Service Hospital Care $ 882.3 Billion Physician & Clinical $ 565.0 Billion Professional Service $  76.4 Billion Dental $ 110.9 Billion Personal Care $ 138.2 Billion Home Health Care $   77.8 Billion Nursing Facilities $ 151.5 Billion Prescription Drugs $ 263.3 Billion Medical Equipment $   95.0 Billion
  4. 4. The problem Some facts:  Healthcare spend will crowd out all spending other than defence  If city’s and towns were to report their financials for healthcare commitments, most would be BANKRUPT!!! Millions of uninsured (~48 million Americans) Increasing premium amounts Sick people are being excluded / health care cost was capped Patients with pre-existing conditions were denied insurance or had to pay heft premiums Payments revolved around ‘Fee for Service’ and performance is not tracked Healthcare is  TERMINALLY ILL!!!!
  5. 5. Patient Protection and Affordable Care Act (Obamacare) Health coverage for larger population Continues long term care with no cap Patients with pre-existing conditions get insurance at the same premium Medicaid Expansion with in states to accommodate lower income groups Healthcare Exchange for buying insurance Individual Mandates requiring everyone to get insurance Medicare Shared Saving Program to improve care coordination and performance Obamacare bill is  20,000 pages long Would be over 7 feet  tall if we stacked them
  6. 6. Accountable Care Organization (ACO) Population Health Management Patients ACO must define processes to promote evidence‐based medicine and patient  engagement, monitor and evaluate quality and cost measures, meet patient‐ centeredness criteria and coordinate care.
  7. 7. Querent Overview Readmission Management Risk Prediction Cost & Resource Compliance Patient Similarity Profiling Outcomes Optimization Clinical Pathway Future state Of Health Disease Progression Preventive Healthcare
  8. 8. Solution ‐ Querent Models Hospital Systems Pattern Recognition Big Data Domain Expertise Machine Learning External Sources Claims & Insurance Data
  9. 9. Areas for innovation Care Coordination Care Delivery Security Innovations Education Social Media
  10. 10. Healthcare Security & Privacy HIPAA HITECH MU 94% Data Breach 48% Billing & Insurance records 20% Prescription Details 24% Payment details 13% Monthly statements 48% Medical Files 2769 Avg no. of  records stolen
  11. 11. Q & A