Horizon CouncilHealth Challenges and Opportunities

How Technology Can Help

Mike SmithChief Information OfficerLee Memorial Health System

October 22, 2015

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Discussion Topics

Macro-level Healthcare Challenges Macro-level Opportunities Technology Innovations – How they can help Possible Opportunities for Employers to Help

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MedicareRelative to the combined Social Security Trust Funds, the Medicare HI Trust Fund faces a more immediate funding shortfall, though its longer term financial outlook is better under the assumptions employed in this report.

Medicare costs (including both HI and SMI expenditures) are projected to grow substantially from approximately 3.6 percent of GDP in 2010 to 5.5 percent of GDP by 2035, and to increase gradually thereafter to about 6.2 percent of GDP by 2085. The projected 75-year actuarial deficit in the HI Trust Fund is 0.79 percent of taxable payroll, up from 0.66 percent projected in last year’s report. The HI fund fails the test of short-range financial adequacy, as projected assets drop below one year’s projected expenditures early in 2011. The fund also continues to fail the long-range test of close actuarial balance. Medicare’s HI Trust Fund is expected to pay out more in hospital benefits and other expenditures than it receives in income in all future years. The projected date of HI Trust Fund exhaustion is 2024, five years earlier than estimated in last year’s report, at which time dedicated revenues would be sufficient to pay 90 percent of HI costs. The share of HI expenditures that can be financed with HI dedicated revenues is projected to decline slowly to 75 percent in 2045, and then to rise slowly, reaching 88 percent in 2085. Over 75 years, HI’s actuarial imbalance is estimated to be equivalent to 21 percent of tax receipts or 17 percent of program outlays.

The drawdown of Social Security and HI trust fund reserves and the general revenue transfers into SMI will result in mounting pressure on the Federal budget. In fact, pressure is already evident. For the sixth consecutive year, a "Medicare funding warning" is being triggered, signaling that projected non-dedicated sources of revenues -- primarily general revenues -- will soon account for more than 45 percent of Medicare’s outlays. That threshold was in fact breached for the first time in fiscal 2010. A Presidential proposal is required by law in response to the latest warning..

Conclusion Projected long-run program costs for both Medicare and Social Security are not sustainable under currently scheduled financing, and will require legislative corrections if disruptive consequences for beneficiaries and taxpayers are to be avoided. The financial challenges facing Social Security and Medicare should be addressed soon. If action is taken sooner rather than later, more options and more time will be available to phase in changes so that those affected can adequately prepare.

Social Security Onlinewww.socialsecurity.gov

Actuarial Publications

Status of the Social Security and Medicare Programs

A SUMMARY OF THE 2011 ANNUAL REPORTSSocial Security and Medicare Boards of Trustees

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Source: OECD Health Data 2010 (Oct. 2010)

International Comparison of Spending on Health, 1980-2008

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U.S. is spending much more for older ages

Healthcare Costs by Age

Source: Fischbeck, Paul. “US-Europe Comparisons of Health Risk for Specific Gender-Age Groups.” Carnegie Mellon University; September, 2009. 

Costs by Age Categories

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Healthcare Challenges for All of Us

Cost – Not sustainable

Quality/Outcomes – Need to continually improve

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The ChallengesA Little More Detail:

– Payment Structure – Generally Fee For Service(repair shop healthcare)

– Fragmentation of Healthcare(lack of care coordination, fend for self, chronic disease

management gaps, lifestyle issues)– Advanced Clinical/Medical Technology (we can do more)– Increased Complexity of Healthcare– As consumers we are not engaged (someone else is paying)

– Aging of Workforce/Society– Payor Mix

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If automakers were paid by the bolt, cars would be brimming with unnecessary bolts. The U.S. fee-for-service system in effect pays for “bolts” – unit of

service – rather than for results, rewarding volume over value and encouraging extra visits, procedures, and tests.

PAYMENT SCHEMES THAT REWARD EXCESS

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A FEW PEOPLE COST A LOTA relatively small number of patients – often older or chronically ill people – account for a large portion of all medical costs.

These include frequent hospital readmissions and managing the consequences of obesity and uncontrolled diabetes.

SOURCE HENRY J. KAISER FAMILY FOUNDATION

One in five Medicare patients discharged from the hospital will return within a month; half won’t have seen a doctor before their return. More than 50% of all discharged Medicare patients will be back within a year.

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“New Healthcare delivery system” Improved coordination of care between Hospitals,

Physicians, and other Providers

Jointly accountable for quality and resource use (Which means a different payment model)

A FUNDAMENTALLY NEW DELIVERY MODEL

“What could be worse than healthcare overhaul? No healthcare overhaul” Assoc Press, Feb 14, 2010

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Lee County Payor Mix

Commercial

Medicare

Medicaid

Uninsured/Self Pay

Cost

Commercial Medicare Medicaid Uninsured

21.7%

44%

13%

10%

Cost vs Reimbursement

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Medicare Value Based Purchasing Slide

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“Information systems are critical. Medicine is inherently an information science. In general, the better information I have, the better diagnosis I can make, the better treatments I can offer, the better treatments I can deliver and the better outcomes I can achieve.”

Brent James, MD Vice President of Research and Medical Affairs at Intermountain Healthcare,

Executive Director for Healthcare Delivery Research

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The Healthcare Reform Pyramid

Healthcare IT

Focus: e-prescribing, care coordination, administrative cost reduction

Comparative Effectiveness/Evidence-Based Medicine

Focus: personalized medicine, comparative effectiveness, episode-based payments

to acute organizations

Coordination of Care

Focus: Primary Care 2.0 Model(the new “Medical Home”)

Consumerism

Focus: CDHPs, transparency, PHRs, incentives, value

Source: Deloitte Center for Health SolutionsCDHP=Consumer Driven Health Plan

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How technology is poised to help:

Electronic Health Records (EHRs)– Epic, other EHRs

Intelligent Clinical Decision Support – – based on clinical data about what actually works

Patient and Family Engagement Tools– Patient Portal (i.e. Epic MyChart)

E-visit/Video Visit Technology

Mobile/in-home patient monitoring and diagnostics– Enabling the Right Care at the Right Place at the Right Time

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Lee County Electronic Health Record Vision

Electronic Health Record/

Personal Health Record

LMHS

CapeCoral

Lee Home Health

Health Park Care Center

Lee PhysicianGroup

Lee Convenient Care

Lee Outpatient Centers

Ancillary Systems Medical Home

Outcomes MgmtMedication Management

Public/Community Health Services

In Home Services

Regional Network Partners

Employers, Government, Insurance

Technology Infrastructure

Community Physicians

Lee Memorial (Cleveland)

Rehab.

HealthPark

Diagnostic Imaging

Gulf Coast

Children’s/

Schools

EMS

Nursing Support

Revenue Cycle

Physician SupportMed. Staff Support

Operational Systems

Accountable Care Organization

Lee Specialists

Mental Health

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MyChart Mobile App

IoT - (Internet of Things)

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Wireless Digital (Mobile) Diagnostics

http://video.msnbc.msn.com/rock-center/50582822#50582822

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Analytics Applied to Healthcare

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Realtime Analytics/Clinical Decision Support

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The Barriers (and Opportunities)A Little More Detail:

– Technology Maturity - – Payment Structure – Generally Fee For Service– Fragmentation of Healthcare –

(lack of care coordination, fend for self, chronic disease

management gaps, lifestyle issues) –– Advanced Clinical Technology– Increased Complexity of Healthcare– Patients not engaged (someone else is paying)– Aging of Workforce/Society– Payor Mix

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Questions / Discussion

What else can healthcare providers do to employers/employees?

What can you as employers do to help?

What can we do together to accelerate the change?