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The Changing
Healthcare Landscape
What it means for healthcare
providers across the country

© WellVentures - TT Haws, 2013

1
Backdrop
“We do not have a health care crisis in this country - we have
a health crisis with a health care system incapable of dealing
with it.” ~ Mike Huckabee, Former Governor of Arkansas
“We have to move from illness to wellness. Businesses will have to

invest in wellness. There is no choice. It’s not philanthropy. It’s
enlightened self-interest.”
~ Shrinivas M. Shanbhag, Medical Adviser, Reliance Industries, India

“Our vision should be to have the healthiest people, not just the best
health care, in the world. With prevention and wellness as the
cornerstone of our health policy, we can be number one in both.”
~ Newt Gingrich

“In a time of drastic change it is the learners who inherit the future.
The learned usually find themselves equipped to live in a world that
no longer exists.”
~ Eric Hoffer
© WellVentures - TT Haws, 2013

2
PPACA National Market Predictions
(Jan 1 2013)
•

The majority of employers <1000 will decide to “pay” rather than “play” sending
millions into the exchanges.

•

Employers will move to a defined contribution model by 2020 giving employees
lump sums to purchase benefits of their choosing.

•

From 2014-16 the market will be non-commoditized as every product offering will
have its day in the sun resulting in confusion, plan swapping, and consumer
frustration.

•

Health plans will try desperately to maintain channel control by spinning up
marketing and adding various frills and add-ons – competition based on price will
reign until consumers realize they get what they pay for. Future of traditional
health plans??

•

Consumer enlightenment is slow, relying on support from information brokers for
decisions - the age of amazon.health is still years away.

•

ACOs will fail to prove significant savings in the next 5 years with a few exceptions
from provider organizations successfully remaking themselves into integrated
health management systems able to align provider and payor incentives and win
buy-in from patients/consumers through creative shared savings/incentives with
patients and physicians.

© WellVentures - TT Haws, 2013

3
Market Makers Will Lead And Win
(Jan 1 2013)
High
Market Makers
Offering a comprehensive
suite of wellness, medical &
lifestyle education services
+
1 Care Prevention &
Lifestyle Improvement
Member Model
o

Revenue and
Value

Hybrids/F-Followers
Willing to make a few
new investments but
maintain structures

Resisters
Resources focused on
protecting current
assets/networks

Low

High
Health Improvement

© WellVentures - TT Haws, 2013

4
The Great Shift
(Jan 1 2013)

Strength through size
Differentiation through specialty volume
Infrastructure
for billing &
collections

CMS pmts
are ring in
nose

Continual hunt for
best reimbursements
to cover poor ones

Strength & differentiation through
monetizing value and benefits

Current
Provider System
• Episodic care
• illness focused
• Procedures/admissions
based revenues
• It’s all about the network
• Health plan is patient
channel – contracts rule
• Physicians = agents for
volume
• Patients = transient
relationships

New
Provider System

New
Product
&
Social
Contract

$ incentives &
rewards for all
(providers & patients)

The more stuff you do,
the more $ you make

© WellVentures - TT Haws, 2013

• Care continuum
• Focused on well being
• A “membership” model
w/ revenues f/ pre-paymts
• Still about the network
but as packaged products
• Health plan now one of
many channels
• Physicians = critical
agents for quality and
outcomes
• Patients = partners &
members

5

Provider is now
“front of the bus”
competing on best
value directly to
consumer
Boutique and
retail medicine
models in play
Redesigned
Primary care w/
H&W focus
Less is more
Corporate Wellness Evolution
Game Changer
Wellness 3.0
Credibility
Level

ROI
High

0%
1%

Level 5

Avg
Low

4%
15% Level 3
35% Level 2
30% Level 1

15% Level 0

Level 4

Level 6

“Community Wellness” +
integrated pop health mgt

“Selling Wellness” + program sales

“Outcomes Wellness” + ROI measures, cost

“Culture of Wellness” + leadership, policy, environment

“Strategic Wellness” + interventions, coaching, incentives, data

“Survey Wellness” + HRA and employee interest/satisfaction surveys

“Cafeteria Wellness” Potpourri of discounts and services (gym, walkathon, fair)

% of ERs at this level
© WellVentures - TT Haws, 2013

6
Contact
Travis Haws, MPH
P: 970-371-8610
E: thaws@wellventures.com

© WellVentures - TT Haws, 2013

7

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The changing healthcare landscape - What it means for providers

  • 1. The Changing Healthcare Landscape What it means for healthcare providers across the country © WellVentures - TT Haws, 2013 1
  • 2. Backdrop “We do not have a health care crisis in this country - we have a health crisis with a health care system incapable of dealing with it.” ~ Mike Huckabee, Former Governor of Arkansas “We have to move from illness to wellness. Businesses will have to invest in wellness. There is no choice. It’s not philanthropy. It’s enlightened self-interest.” ~ Shrinivas M. Shanbhag, Medical Adviser, Reliance Industries, India “Our vision should be to have the healthiest people, not just the best health care, in the world. With prevention and wellness as the cornerstone of our health policy, we can be number one in both.” ~ Newt Gingrich “In a time of drastic change it is the learners who inherit the future. The learned usually find themselves equipped to live in a world that no longer exists.” ~ Eric Hoffer © WellVentures - TT Haws, 2013 2
  • 3. PPACA National Market Predictions (Jan 1 2013) • The majority of employers <1000 will decide to “pay” rather than “play” sending millions into the exchanges. • Employers will move to a defined contribution model by 2020 giving employees lump sums to purchase benefits of their choosing. • From 2014-16 the market will be non-commoditized as every product offering will have its day in the sun resulting in confusion, plan swapping, and consumer frustration. • Health plans will try desperately to maintain channel control by spinning up marketing and adding various frills and add-ons – competition based on price will reign until consumers realize they get what they pay for. Future of traditional health plans?? • Consumer enlightenment is slow, relying on support from information brokers for decisions - the age of amazon.health is still years away. • ACOs will fail to prove significant savings in the next 5 years with a few exceptions from provider organizations successfully remaking themselves into integrated health management systems able to align provider and payor incentives and win buy-in from patients/consumers through creative shared savings/incentives with patients and physicians. © WellVentures - TT Haws, 2013 3
  • 4. Market Makers Will Lead And Win (Jan 1 2013) High Market Makers Offering a comprehensive suite of wellness, medical & lifestyle education services + 1 Care Prevention & Lifestyle Improvement Member Model o Revenue and Value Hybrids/F-Followers Willing to make a few new investments but maintain structures Resisters Resources focused on protecting current assets/networks Low High Health Improvement © WellVentures - TT Haws, 2013 4
  • 5. The Great Shift (Jan 1 2013) Strength through size Differentiation through specialty volume Infrastructure for billing & collections CMS pmts are ring in nose Continual hunt for best reimbursements to cover poor ones Strength & differentiation through monetizing value and benefits Current Provider System • Episodic care • illness focused • Procedures/admissions based revenues • It’s all about the network • Health plan is patient channel – contracts rule • Physicians = agents for volume • Patients = transient relationships New Provider System New Product & Social Contract $ incentives & rewards for all (providers & patients) The more stuff you do, the more $ you make © WellVentures - TT Haws, 2013 • Care continuum • Focused on well being • A “membership” model w/ revenues f/ pre-paymts • Still about the network but as packaged products • Health plan now one of many channels • Physicians = critical agents for quality and outcomes • Patients = partners & members 5 Provider is now “front of the bus” competing on best value directly to consumer Boutique and retail medicine models in play Redesigned Primary care w/ H&W focus Less is more
  • 6. Corporate Wellness Evolution Game Changer Wellness 3.0 Credibility Level ROI High 0% 1% Level 5 Avg Low 4% 15% Level 3 35% Level 2 30% Level 1 15% Level 0 Level 4 Level 6 “Community Wellness” + integrated pop health mgt “Selling Wellness” + program sales “Outcomes Wellness” + ROI measures, cost “Culture of Wellness” + leadership, policy, environment “Strategic Wellness” + interventions, coaching, incentives, data “Survey Wellness” + HRA and employee interest/satisfaction surveys “Cafeteria Wellness” Potpourri of discounts and services (gym, walkathon, fair) % of ERs at this level © WellVentures - TT Haws, 2013 6
  • 7. Contact Travis Haws, MPH P: 970-371-8610 E: thaws@wellventures.com © WellVentures - TT Haws, 2013 7

Editor's Notes

  1. PPACA is the big elephant in the room. Clearly IHC is taking the initiative and being proactive but you will also have to live in a world of reactionaries around you locally and nationally including how this will change the care seeking behavior of the patient population as they jocky around with health plan channels.
  2. Already seeing this differentiation among healht systems they are beefing up their strategy departments, health and wellness programs, physician acquisition strategies, primary care accountability and so forth. Some are going to get it right, others are going to go through the motions, and others will simply find themselves in a world that no longer exists.
  3. Won’t spend much time on this as it’s busy but point is to illustrate the massive change process underway that will lead to new products and services and ultimately a new social contract that underwrites a shared investment, savings and accountability for all players, particularly for consumers who will have a higher price to pay for opting out of wellness or savings/earnings for opting in.
  4. Safeway, J&amp;J, Mayo, CC, large carriers like United’s Optum,