The document discusses the challenges and opportunities facing the US healthcare system in light of the Patient Protection and Affordable Care Act (PPACA). It notes the fragmented and episodic nature of care prior to reforms, and the goals of PPACA to introduce new models like accountable care organizations (ACOs) and health insurance marketplaces. However, it also acknowledges the uncertainties created by reform and ongoing tests of new programs. The document advocates for a coordinated, team-based approach leveraging emerging technologies like telehealth to improve outcomes across domains and overcome common challenges in a sustainable way.

1. Carl W. Taylor JD
Fraser Institute for Health and Risk Analytics

2. Telehealth Before Sequestration?

3. Where Did We Begin?
• Fragmented silos of episodic FFS
care with some risk in some markets
• Push for EHR and connectivity with
only a vague notion of why
• Explosion in the aging and chronic
population
• No accountability for costs
• Disconnect between wellness as a
preference and illness as a business

4. PPACA Is An Attempt To Try
Something New

5. The First Barrier: Them vs. Us

6. The Second Barrier: Us vs. Us

7. The Third Barrier: Us vs. Them

8. The Health Reform Uncertainty
• There is a difference between Risk and
Uncertainty
• We have always had risk in healthcare but
now we have uncertainty

9. And The Current Future
• PPACA’s Contribution
– Supreme Court ruling and election gives certainty for
today but leaves a Medicaid hole for some states
– Medicare Advantage cuts may impact benefits/MLR
– CMS driven ACOs with likely un-eveness in
performance and higher market costs
– CMS Duals Office- Un-eveness on its journey
– Health Insurance Marketplaces (f/k/a exchanges) will
emerge in some form but with what populations
– CMS –CMMI will test a wide variety of programs to
save money will any of them work

10. Reform Has Forced Consolidation
Across All Players

11. And Created A Dilemma for Physicians

12. And The Doctor Question
• It is 3 a.m. in the morning I just finished
delivering Mrs. Jones baby- what am I paid?

13. The Fears
 Will any of this work
 Can we balance the 3 R’s (risk, reward
and regulation)
 Who wins and more importantly how do I
win

14. When Choosing A Path Becomes
Confusing

15. Some Options
1. Wait and do nothing-Keep The As Is State
2. Build an expanded enterprise to create more
leverage and market dominance- Some ACOs fall
into this category.
3. Build a risk bearing broader bio/psycho/social
clinical enterprise where all professions are
focused on coordinated quality and outcomes to
overcome our common challenges……

16. Our 9 Common Challenges
• 1. We Must Re-invent the Physician Practice
• 2. We Must Improve Our
Access/Understanding of Data
• 3. We Must Accelerate The Adoption of
Successful Programs to Improve Patient
Adherence and Physician Skills
• 4. We Must Improve Quality and Consistency
of Outcomes Across All Domains

17. Common Challenges Together
• 5.We must reduce readmissions
• 6. We must keep mom at home
• 7. We must deliver more healthy babies and
raise healthier children
• 8. We must create interdisciplinary
approaches to dealing with complexity
• 9. We must reach the unreachable

18. Telehealth Under Health Reform

19. Our Future Is Now World

20. The Rise of Connected Knowledge

21. And Then How Do We
• Embrace, absorb, deploy or reject the 40,000
or so apps for healthcare?

22. What I Think I Think
• We will navigate from episodic encounters to
continuous interactions.
• Narrow networks will prevail not only by offering
quality and cost advantages but by achieving
them through the appropriate use of emerging
technology

23. A Confidential Secret: We Can
Make This Work

24. If We Can Re-Language The Solution

25. Questions
Contact: Carl Taylor
FIHRA
cwtaylor1@gmail.com
cwtaylor1 Skype