Byron C. Scott, MD, MBA

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Global Healthcare Trends

• Byron C. Scott, MD, MBA
• Associate Chief Medical OfficerTruven Health
  Analytics

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Agenda

• Puerto Rico Healthcare Trends
• Performance Improvement
• Population Health Management
• Consumerism
• Payers Employers Health Plans

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Healthcare Reform!
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• Puerto Rico Healthcare Trends

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Puerto Rico Healthcare Trends

• Puerto Rico Bond Debt Crisis
• Healthcare is 20 of Puerto Ricos Economy
• 60 of the Population rely on Medicare, Medicare
  Advantage, or Medicaid
• Disparate reimbursements rates compared to
  mainland states
• Medicaid70 lower than states
• Medicare Advantage--60 of states
• Lack of individual mandate
• Risk of future cuts to programs

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• Performance Improvement

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Performance Improvement

• Institute of Healthcare Improvement Triple Aim
• Improve the experience of care
• Improve the health of populations
• Reduce the per capita costs of healthcare

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Aging Population Worldwide
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U.S. Healthcare Spend Today

• US Total Cost in 2013
• 2.9 Trillion
• Federal Spend in 2013
• Medicare 586 Billion
• Medicaid 450 Billion

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Center for Medicare Medicaid Services Projects
Spend by 2023

• U.S. Total Cost 5.2 Trillion
• Continued Government Spend
• CMS will be 33 of this!
• GDP on healthcare over 20

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Global Medical Cost

• Americans spend over twice as much per capita
  as any other developed countryapproaching 18
  of GDP

Peter G. Peterson Foundation Study
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Performance Improvement Targets

• Readmissions
• Medicare 30 Day Readmissions
• 20 Medicare Patients
• 2 million patients per year
• 26 Billion per year
• Quality and Patient Safety
• Mortality
• Hospital Acquired Conditions
• Sepsis

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Performance Improvement Targets

• Efficiency
• Length of Stay
• Throughput
• Operating Room
• Emergency Department
• Cost/Spend
• Supply ChainPharmaceuticals, Medical Device,
  Joint Implants
• Medicare Spend Per Beneficiary (MSPB)
• Patient Engagement
• Patient Satisfaction
• Compliance

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Performance Improvement Tools

• Team Based Care
• Process Improvement tools like LEAN
• Electronic Health Records with Population Health
  Focus
• Outpatient areas connected to Inpatient
• Analytics
• Data

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• Population Health Management

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Population Health Management

• Ability to view and manage patients/groups of
  patients across a continuum of time and location
• Retrospective, Real Time, and Predictive
• Population Health Management More than
  collecting clinical information/data and
  performing analytics

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Population Health Management
Home Health
Hospital
Skilled Nursing
Rehab Hospital
Physician Office
Nursing Home
Hospice
Other Outpatient
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Population Health Management

• Strategy
• Socioeconomic determinates impact on health in
  the community
• Care Coordination between Inpatient and
  Outpatient
• Skilled Nursing, Home Health, Nursing Home,
  Rehab, etc.
• Care Management
• Physician Engagement and Alignment

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Population Health Management

• Strategy
• Patient Engagement
• Behavioral Changes
• Wellness
• Prevention
• Information Technology
• Electronic Medical Records
• Health Analytics Capabilities
• Interoperability

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Population Health Management

• The Nirvana of Population Health
• Achieve both Cost Quality Improvement by
  leveraging
• Predictive Analytics
• Target Patients at risk for admissions,
  readmissions, and chronic disease

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Population Health ManagementGlobal Issues

• Globalization
• Increased International Travel
• Need for Improved Real Time Surveillance Tools
• MalariaPuerto Rico
• Ebola---Mainland U.S.
• MERSoutbreak in Korea outside the Middle East
• Influenzawhen is the next pandemic?

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• Consumerism

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Consumerism

• Patient Engagement
• Patient Satisfactionimproved satisfaction
  fosters better compliance
• Transparency
• Cost/Price
• Access to Health Information
• Make informed decisions on providers and quality

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• Payers Employers Health Plans

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Payer Trends

• Align higher reimbursement percentages tied to
• Performance
• Value Based
• Readmissions
• Hospital Acquired Conditions
• Alternative Payment Models
• Accountable Care Organizations (ACOs)
• Medicare Shared Savings Program (MSSP)
• Bundled Payments

• Key Issues

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Payers Efforts to Control Cost

• Benefit Redesign
• Increase Employee Cost Share
• Higher Co-Pays and Deductibles
• Narrow Networks and Centers of Excellence
• Very Interested in Hospital and Physician Quality
  Metrics

• Employers

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Payers Efforts to Control Cost

• Plans to expand provider value based
  reimbursement
• Narrow Networks and Centers of Excellence

• Health Plans

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Data Releases Driving New Reimbursement Models

• Release of hospital charge and reimbursement data
  on 2013 Hospital Medicare patients on June 1,
  2015 by CMS
• Joint Replacement Surgery was most common
  Medicare Inpatient Surgery in 2013 with cost of
  6.6 Billion
• Commercial Payers reviewing closely and could
  influence decisions about narrow networks
  bundled payments
• Blue Cross Blue Shield Association released cost
  variation of hip/knee surgery in January 2015
• CMS announces on July 9, 2015 that 800 hospitals
  in 75 geographic areas will have to participate
  in test of bundled payments for hip/knee
  replacement starting January 1, 2016

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Bundled Payments

• A single payment for bundles of related
  services during an episode of care, rather than
  separate payments for each service
• CMS, Health Plans, and Employers interested in
  model
• Improve quality and reduce costmore efficient
• Center for Medicare Medicaid Innovation (CMMI)
  launched Bundled Payments for Care Improvement
  program (BPCI)
• Pays hospitals a bundled rate for certain
  hospital-based and outpatient services associated
  with select DRGs
• 4 Different Payment Models

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Bundled Payments

• Focus Areas for Success
• Post Acute Care Facilities and Physicians
• Reduce Physician Practice Variation
• Reduce Readmissions

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Bundled Payments

• Timeframe Length of bundle varies
• Default is 30/60/90 days post-discharge
• 90 days is the typical market expected maximum
  length