Champion And Healthcare


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

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.
  • Champion And Healthcare

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