Deloitte Center for Health Solutions

January 23, 2012

Monday memo

Health reform update

My take

From Paul Keckley, Executive Director, Deloitte Center for Health Solutions

It’s been 34 days since my knee surgery and subsequent clotting complication. I’ve used

two hospitals in two states, three labs to draw blood to monitor my coagulation, and

countless hours online trying to figure out my propensity for further complications that

might lie ahead.

To date, I have received bills totaling $12,712 from the surgeons, anesthesiologists, and

hospital #1 for the initial procedure December 20; none from the series of events that

started December 29, when I collapsed. And in the process, I’ve incurred out-of-pocket

costs to date of $1,502, with more to come I’m sure.

There’s nothing like using “the system” to see its notable achievements and unfortunate

shortcomings. My circumstance is relatively minor compared to others facing vexing

health problems or caring for others. I am lucky to be able to afford my health care and

fortunate to have relatively good health. So each of us starts from a different place, deeply

personal, in assessing the system of care. My current medical journey reminds me that

we are far from operating a system of care. I wonder:

My medical records should have been shared between the hospital #1 and hospital #2

and by the care teams. They weren’t.

My Warfarin directive from hospital #2 should have been informed by a thorough

understanding of my medical history and query about my use of over-the counter

remedies, nutrients, and vitamins. It wasn’t.

My care teams should have been consistent in their directives: the PharmD and

emergency room docs offered strikingly different assessments, and the hand-off by

attending nurses was handled poorly in my eight hour extended stay in the hospital

#2’s emergency room.

And the costs associated with my care in all these settings should be more

understandable. They’re not. The endless flow of statements, bills, and explanation of

benefits (EOB) I am now receiving is confusing, and it appears they will dribble in over the

next month or longer. I ponder:

Why is it virtually impossible to understand an “explanation of benefit”, especially

when the math doesn’t compute?

Why are my out-of-pocket costs for medications more than my out-of-pocket for

hospitals and physicians?

Why was a relatively minor surgical procedure so expensive? It took only minutes.

And why, 34 days after the events unfolded, am I lacking some bills from hospital #1

and am in receipt of none from hospital #2? I know 99% of claims to third parties are

filed electronically within days. Why is the consumer last to know?

This week, a bipartisan joint conference committee in Congress will take up extension of

the payroll tax in tandem with a fix for physician payments (Sustainable Growth Rate

[SGR]) and extension of unemployment benefits. And the bigger discussion in DC for

weeks to come will be about deficit reduction, economic recovery, and government

spending.

It seems clear that health costs contribute to the fiscal problem facing the U.S. For the

past three decades, health costs have increased at 2.1% above the average annual GDP.

In 2010, inflation increased. Combining Medicare, the federal portion spent for Medicaid,

military health, and coverage for federal employees, health spending at the federal level is

almost 25% of all spending. According to the U.S. Bureau of Labor Statistics’ Consumer

Price Index, released last week, hospital prices increased 5.8% in 2011 vs. a 7.6%

increase in 2010; physician increases were 2.7% after increasing 3.4% the prior year. In

the same period, the overall inflation rate increased 3.16% in 2011 vs. 1.64% in 2010, and

the consumer price index increased 3.0% in 2011 vs. 1.5% in 2010.

Most people like me simply meander through stacks of bills, statements, and EOBs and

then give up. I am fortunate to be among the 84% with some form of insurance coverage,

and I have studied the system for 40 years. But my medical excursion these days reminds

me how far we are from a “system” where appropriate evidence-based care is readily

accessible and verifiable, redundant paperwork aggressively reduced, costs and their

relationship to prices is easily obtained and comprehendible, and essential medical

information is shared among providers to optimize care and avoid error.

“Systemness” is achievable but lacking. Amazing we can put humans on the moon, but

we can’t explain medical costs or share medical information effectively in an industry that

represents 18% of our overall GDP employing 16 million and consuming 19.8% of U.S.

household discretionary spending.

We have a long way to go to improve the U.S. system. And cost reduction seems to be an

obvious priority if it is to be accessible to our children and grandchildren.

I am keeping a diary about my experience: one set of notes about the quality of medical

care and the other about costs. Hopefully, weeks from now, I can close the chapter on the

experience, and my data will show a clear relationship between costs and value. Stay

tuned.

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This week’s headlines: My take

Implementation update - States push for details of federal exchanges - House Ways and Means passes CLASS Act repeal bill - Hospital groups urge fix to Medicare formula preferential to Massachusetts

- PCORI research agenda release expected today - HHS gives several religious employers another year to cover FDA-approved

contraceptives

Legislative update - House votes against President’s request to raise federal debt limit - Nursing home cuts proposed for 2014

Campaign 2012 health platforms - GOP Presidential candidate health platforms

- GOP primary process, delegate count

State update - Survey: all but two states expanded or maintained Medicaid eligibility last year

- State round-up

Industry news - OMB is reviewing proposed rule on stage 2 meaningful use - CBO: disease management, value-based purchasing pilots did not reduce costs - NCQA announces organizations that seek ACO accreditation - Study: Medicare Advantage Plans that offer fitness options attract healthier enrollees

Quotable

Fact file

National Health Reform: what now?

Subscribe to the Health Care Reform Memo

Deloitte Center for Health Solutions research and news

Deloitte contacts

Implementation update

States push for details of federal exchanges January 11, officials from seven states—UT, TN, KY, ME, NM, VA, and ND—sent a letter

to the U.S. Department of Health and Human Services (HHS) requesting detailed

information by June on the specifications of a federally-run exchange, including

governance, consumer functions, eligibility, and financial management. Per the Affordable

Care Act (ACA) Section 1311, HHS must determine by January 1, 2013 if a state will have

a “fully operational exchange” by January, 1 2014, which would require operations

beginning Oct. 1, 2013 to support the first open enrollment period. HHS also proposed

allowing states to receive conditional approval if they cannot demonstrate readiness.

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House Ways and Means passes CLASS Act repeal bill Wednesday, the House Ways and Means Committee approved a bill to repeal the

Community Living Assistance Services and Support (CLASS) Act per ACA Section 8002

by a vote (23 to 13) with only one Democrat voting with the Committee’s 22 Republicans.

The bill is expected to be considered on the House floor in February. Last November, the

House Energy and Commerce Committee approved a similar bill to repeal the CLASS

Act.

Note: The CLASS Act establishes a national, government run long term care insurance

program financed by premiums paid by consumers into an insurance pool overseen by a

government trust. Concerns by opponents: the potential it might become an entitlement

program that might increase the federal deficit if underfunded.

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Hospital groups urge fix to Medicare formula preferential to Massachusetts

Thursday, 19 state hospital associations sent a letter to the White House stating “the

PPACA provision (Section 3141) permitted the Commonwealth of Massachusetts to

manipulate the federal Medicare program, reaping an estimated $367 million annually

from the other 49 states and unfairly favoring one state’s hospitals and Medicare

beneficiaries to the detriment of others.” The group contends the measure cost states

$3.5 billion over the next ten years if left unchanged.

Note: Section 3141 is titled “Application of budget neutrality on a national basis in the

calculation of the Medicare hospital wage index floor.” Starting Oct. 1, 2010, “the provision

require[d] application of budget neutrality associated with the effect of the imputed rural

and rural floor to be applied on a national, rather than State-specific basis through a

uniform, national adjustment to the area wage index.”

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PCORI research agenda release expected today

The Patient Centered Outcomes and Research Institute (PCORI) established by the ACA

Section 6301 to support comparative effective research is expected to release its draft

research agenda and national priorities January 23. Additional coverage will be included

in the January 30 Monday Memo.

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HHS gives several religious employers another year to cover FDA-approved

contraceptives

Friday, HHS announced that it will not expand the exemption for several religious

employers from providing health care coverage of contraceptives approved by the U.S.

Food and Drug Administration (FDA) per the interim final rule released August 2011.

However, Secretary of HHS Kathleen Sebelius stated in a press release that “nonprofit

employers who, based on religious beliefs, do not currently provide contraceptive

coverage in their insurance plan, will be provided an additional year, until August 1, 2013,

to comply with the new law.”

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Legislative update

House votes against President’s request to raise federal debt limit Wednesday, the U.S. House of Representatives voted against the President Obama’s

request to raise the federal debt limit $1.2 trillion.

Note: August 2, 2011, Congress passed the Budget Control Act of 2011 that allows the

expansion of the debt ceiling to be accompanied by spending cuts of $1.2 trillion (the

sequester).

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Nursing home cuts proposed for 2014

Friday, January 13, Medicare Payment Advisory Commission (MedPAC) approved

recommendations that eliminate the market basket update for nursing homes—a pay cut

at least by 4% starting in 2014. The industry is somewhat supportive of the advisors' call

to reduce pay for skilled nursing facilities with relatively high risk-adjusted re-

hospitalization rates for Medicare-covered stays.

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Campaign 2012 health platforms The Deloitte Center for Health Solutions is the research arm of the Deloitte health care

and government practice supporting analyses of trends and issues relevant to

policymakers, industry leaders, and interested parties. Our studies are funded by Deloitte;

we accept no outside income, and each study is available on our website. We are non-

partisan, and we do not lobby; rather, we conduct rigorous studies using surveys,

forecasts, expert opinion, and economic modeling to answer questions and gauge cause-

effect relationships, intended/unintended consequences, and related outcomes.

Throughout the election cycle, we will summarize proposals from major candidates in

state and federal campaigns taking a neutral position about the advisability and

effectiveness of each.

GOP Presidential candidate health platforms In an analysis of health care platforms of the four GOP candidates’ websites current to

January 23, 2011, there are many similarities:

All indicate the intent to repeal ACA and do not support the individual mandate in ACA

All favor allowing the purchase of insurance across state lines (permitted via health

care choice compacts in Section 1333)

All believe in liability reform, increased use of information technology to reduce costs,

increased use of private insurance options for Medicare enrollees, and increased

latitude for states to manage their own Medicaid programs.

Some distinctions:

Gingrich: use of health and wellness incentives and investing in R&D to expedite

medical breakthroughs as a national priority

Paul: opposition to taxpayer supported development of a national database of

personal health information

Romney: provisions to allow individuals and small business to form purchasing pools

to lower insurance costs

Santorum: phasing out of Medicare replaced by private market option

Newt Gingrich Ron Paul Mitt Romney Rick Santorum

Approach to Repealing the ACA

Replace ACA with

“Patient Power”

plan to save lives

and money

Repeal ACA, end

individual

mandate that

requires all

Americans to

obtain

government-

approved health

insurance

Issue waivers to

all 50 states, call

on Congress to

repeal ACA and

make health care

“like a market”

Replace ACA with

market-driven,

patient-centered

alternatives to

increase access

and affordability

Medicare Reforms

Create additional

choices in

Medicare by

giving seniors the

option to choose

a more personal

system in the

private sector

with greater

options for better

care

Eliminate

Medicare

eventually; allow

states to provide

health care to

seniors

Give beneficiaries

a generous

defined

contribution or

“premium

support;” allow

for freedom to

choose between

private plans and

traditional

Medicare

Privatize

Medicare, giving

qualified

recipients federal

money to

purchase health

coverage (strong

supporter of

Representative

Paul Ryan’s (R-

WI) plan)

Medicaid Reforms

Allow states to

customize

programs; enact

grants similar to

1996 welfare

reform

Eliminate

Medicaid

eventually; allow

states to provide

health care

Establish block-

grants to expand

health care

access to low-

income

Americans

Establish block-

grants to ensure

states can

implement

solutions to

address unique

needs

Other Insurance Industry Reforms

Allow for

insurance

purchase across

state lines to

increase price

competition in the

industry; extend

HSAs throughout

health care

system

Allow for

insurance

purchase across

state lines; make

all Americans

eligible for HSAs

Allow for

insurance

purchase across

state lines, free

from state benefit

requirements;

strengthen HSAs,

permit funds to

be used for

health insurance

premiums

Allow for

insurance

purchase across

state lines;

strengthen HSAs

coupled with high

deductible

insurance plans

Tax Deduction or

Credit for Buying

Insurance

Allow the choice of

a generous tax

credit or ability to

deduct the value

of insurance to a

certain amount

Allow tax credits

and deductions

for all medical

expenses

Expand tax

deductions to

include not only

employers but

also individuals

Allow for purchase

of health

insurance with

pre-tax dollars,

including a

refundable tax-

credit for the

purchase of

health coverage

Malpractice Reform

Strive to end

“junk” lawsuits

Provide tax credit

for “negative

outcomes”

insurance

purchased before

treatment

Cap non-

economic

damages,

provide

innovation grants

for medical

liability reforms

Enact meaningful

medical liability

reform,

incentivize state

reforms

FDA Speed up medical

breakthroughs by

reforming FDA

Reform FDA,

eliminate

interference with

American’s

knowledge of and

access to

supplements,

alternative

treatments

Not mentioned in

proposal Not mentioned on

website

Personal Health

Information (PHI) and Health IT

Move from paper-

based to

electronic system

(helping reduce

health care fraud)

Prohibit use of

taxpayer funds

for national

database of PHI

Not mentioned in

proposal

Increase use of

electronic health

records and

health care

literacy

Public Health,

Wellness, and

Prevention

Reward health

and wellness by

giving health

plans, employers,

Medicare, and

Medicaid more

latitude to design

benefits to

encourage,

reward healthy

behavior

Exempt those with

terminal illness

from employee

portion of payroll

taxes while ill;

gradually end

government

involvement in

promoting

wellness

programs

Provide states

with resources to

improve access

to care for

chronically ill

Not mentioned on

website

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GOP primary process, delegate count In Tampa, FL in August, 2,286 delegates are expected to attend the Republican National

Convention (RNC): 1,783 delegates will be pledged to certain candidates through states’

primary and caucus rules, and 503 unpledged delegates who are not bound to a state’s

rules. To win the GOP presidential nomination, a candidate must have a simple majority

of votes (1,144 delegates). Through South Carolina’s vote Saturday, 80 delegates have

been designated.

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State update

Survey: all but two states expanded or maintained Medicaid eligibility last

year Wednesday, the Kaiser Family Foundation released a survey conducted with researchers

from Georgetown University Center for Children and Families concluding that all but two

states maintained or expanded their Medicaid income eligibility levels last year. Among

findings in 2011:

Two states reduced Medicaid eligibility for low-income adults through limited

exceptions to the ACA maintenance of eligibility requirement. ACA Section 2001

maintenance of effort (MOE) provision requires states to maintain the same Medicaid

income eligibility levels for adults until January 1, 2014 and for children in Medicaid

and the Children’s Health Insurance Program (CHIP) until October 1, 2019.

11 adopted targeted eligibility expansions, mostly for children. Three states increased

coverage for low-income adults.

25 states increased the efficiency of their enrollment and renewal practices, often by

advancing technology. Twenty-nine states launched major system improvement

projects to use new federal funding to improve and eligibility and systems and

modernize enrollment processes.

Source: Kaiser Family Foundation, “Performing under pressure: annual findings of a 50-

state survey of eligibility, enrollment, renewal, and cost-sharing policies in Medicaid and

CHIP, 2011-2012,” January 2012.

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State round-up Wisconsin Governor Scott Walker (R) announced that the state will stop development of

its health insurance exchange stating, “I have directed the Department of Health Services

to notify the federal government that we will discontinue any development on a health

exchange and that Wisconsin will turn down funding from the Early Innovator Grant

program.”

Ohio is seeking comment about a proposal to create a single dual-eligible care program,

the Integrated Care Delivery System, for 190,000 Ohioans who are eligible for both

Medicare and Medicaid. The program would assign each beneficiary to a care manager,

make periodic home visits with enrollees, review hospital admissions and nursing home

placements, and maintain a centralized record for each beneficiary.

Note: there are seven million dual eligibles in the U.S. On average, costs are 60% higher

per capita for these compared to others covered in the programs. In ACA (Section 2602)

the Medicare-Medicaid Coordination Office was established to facilitate better

coordination of care for dual-eligibles.

A federal judge blocked California from reducing in-home supportive care services to

low-income disabled and elderly residents by $100 million. In 2012, California is predicted

to spend $1.5 billion on this program for 434,000 residents. California currently holds a

$9.2 billion deficit.

New York Governor Andrew Cuomo (D) announced his fiscal year (FY) 2012 budget

Tuesday including a health insurance exchange proposal, measures to curtail Medicaid

spending by phasing in managed care, and cuts to the state’s Early Intervention program

($99 million over five years). The Governor also proposed that executive compensation

for non-profit agencies and for-profit agencies doing business with the state be capped at

$199,000 and “at least 85% of every public dollar will be spent on direct services, not

administration.”

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Industry news

OMB is reviewing proposed rule on stage 2 meaningful use

Thursday, the proposed rule on stage 2 meaningful use of electronic health records (EHR)

under Center for Medicare & Medicaid Services (CMS) Medicare and Medicaid EHR

Incentive Program was sent to the Office of Management and Budget (OMB) for review,

the last step before a rule is publicly released. The rule’s abstract states:

“The final rule that established the initial set of standards, implementation specifications,

and certification criteria was published in the Federal Register on July 28, 2010. The initial

set represented the first round of an incremental approach to adopting future sets of

standards, implementation specifications, and certification criteria to enhance EHR

interoperability, functionality, and utility. Under the authority provided by section 3004 of

the Public Health Service Act (PHSA), this notice of proposed rulemaking would propose

that the Secretary adopt revisions to the initial set as well as new standards,

implementation specifications and certification criteria. The proposed new and revised

standards, implementation specifications, and certification criteria would establish the

technical capabilities that certified EHR technology would need to include to support

meaningful use under the CMS Medicare and Medicaid EHR Incentive Programs.”

Note: As of October, $952 million in the Health Information Technology for Economic and

Clinical Health (HITECH) Act stimulus funding had been distributed to 857 hospitals, and

$287 million dispersed to 14,500 office-based physicians. According to the American

Medical Association (AMA), in 2011, 34% of office-based physicians had adopted a

“basic” EHR, up from 25% in 2010. According to the American Hospital Association

(AHA), 15% of non-federal hospitals had adopted a basic EHR in 2010 vs. 11% in 2009.

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CBO: disease management, value-based purchasing pilots did not reduce

costs Wednesday, the CBO released an issue brief that reviewed the outcomes of six disease

management and four value-based purchasing pilots concluding that they did not reduce

federal spending on Medicare.

Disease management and care coordination programs: “Spending was either

unchanged or increased relative to the spending that would have occurred in the

absence of the program, when the fees paid to the participating organizations were

considered.” Demonstrations where care managers had substantial direct interaction

with physicians and significant in-person interaction with patients were more likely to

reduce Medicare spending than other programs, but on average these programs did

not achieve sufficient savings to offset their fees.

Value-based payment demonstrations: results were mixed. One of the four

demonstrations reduced Medicare spending by 10% through bundled payments that

covered all hospital and physician services for heart bypass surgeries. Other value-

based payment demonstrations appeared to have little or no Medicare savings.

Source: CBO, “Lessons from Medicare’s Demonstration Projects on Disease

Management, Care Coordination, and Value-Based Payment,” January 2012.

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NCQA announces organizations that seek ACO accreditation The National Committee for Quality Assurance (NCQA) announced the first six provider-

based organizations to seek accreditation from NCQA’s accountable care organization

(ACO) accreditation program launched in November 2011. These organizations were

given the early-adopter designation allowing NCQA to survey them on their ACO

capabilities between March 1 and December 31, 2012. The organizations include: Billings

Clinic in Billings, MT; Children’s Hospital of Philadelphia in Philadelphia, PA; an

organization in Middletown, NY; Essentia Health in Duluth, MN; HealthPartners in

Minneapolis, MN; and Kelsey-Seybold Clinic in Houston, TX.

Note: NCQA ACO accreditation is not required to participate in the Medicare Shared

Savings Program or other ACO programs under the ACA. However its accreditation is

used by organizations that seek to apply to the Medicare Shared Savings program per

ACA Section 3022.

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Study: Medicare Advantage Plans that offer fitness options attract healthier

enrollees A study focused on enrollment and disenrollment data for Part C plans concluded that

plans offering fitness memberships “may attract and retain a healthier subgroup of the

Medicare population.” Prescription drug and vision benefits were associated with

attractiveness for less healthy seniors to a Part C plan, while hearing and dental features

attracted a wider range of enrollees.

Source: Cooper et al, “Fitness Memberships and Favorable Selection in Medicare

Advantage Plans,” New England Journal of Medicine 366:2, January 12, 2012.

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Quotable “The new year begins precariously. The global economy vacillates between signs of

recovery and omens of collapse. Businesses seem paralyzed…The world needs invention

and daring now more than ever. Now is the time for audacity, not austerity.”— “List of

Audacious Ideas for Solving the World’s Problems,” Harvard Business Review, January-

February 2012, p. 49-64.

“Demonstrations aimed at reducing spending and increasing quality of care face

significant challenges in overcoming the incentives inherent in Medicare’s fee-for-service

payment system, which rewards providers for delivering more care but does not pay them

for coordinating with other providers, and in the nation’s decentralized health care delivery

system, which does not facilitate communication or coordination among providers. The

results of those Medicare demonstrations suggest that substantial changes to payment

and delivery systems will probably be necessary for programs involving disease

management and care coordination or value-based payment to significantly reduce

spending and either maintain or improve the quality of care provided to patients.”— CBO,

“Lessons from Medicare’s Demonstration Projects on Disease Management, Care

Coordination, and Value-Based Payment,” January 2012.

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Fact file Obesity in the U.S.: 35% in 2010; overweight 65%. Cost in U.S.: $200 billion. (Source:

CDC)

Medicaid enrollment increased 6 million since the economic downturn to 55 million

and cost $400.7 billion in 2010 (the largest health insurance plan in the U.S.). Funding

is $270 billion from the federal government, and $129.8 by states and local

governments. Spending will increase 20.3% as a result of ACA expansion (2014 –

2016). Eighteen states have reduced or restricted Medicaid benefits. (Source: Keehan

et al “National Health Spending Projections through 2020” Health Affairs 2011:30)

Variation across 17 countries for 30 day re-admission rates after myocardial infarction

(severity adjusted) ranged from 7.7% to 14.5% with a median of 9.9%. The U.S. rate

had the highest readmission rate (14.5%) and lowest length of stay (3 days) in the

study. (Source: Kociol et al “International Variation in and Factors Associated with

Hospital Readmission after Myocardial Infarction” Journal of the American Medical

Association 307, No 1 January 4, 2012)

Forecast: ten year savings of $3 billion through the use of "comparative effectiveness"

research. (Source: Kaiser Family Foundation, “New Group to Set Priorities for Medical

Effectiveness Research,” January 16, 2012)

73% of the 255.3 million people with health coverage in 2010 were in private

insurance arrangements. (Source: Larry Levitt and Gary Claxton, “Betting on Private

Insurers,” Kaiser Family Foundation, January 19, 2012)

81% of health care providers use mobile devices to collect, keep, and distribute

personal health information; 49% say they do not secure their mobile devices.

(Ponemon Institute, “Study on Patient Privacy and Data Security,” December 2011)

194,000 jobs will be lost due to 2% Medicare cuts per the Budget Control Act of 2011

sequestration 2013. (Source: American Hospital Association [AHA], January 19,

2012)

In 2011, three of the six most significant data breaches occurred in health care

organizations. (Source: Privacy Rights Clearinghouse, December 2011)

277 physician owned hospitals in the U.S. (Source: Physician Hospitals of America)

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National health reform: what now? National health reform is here. The health reform bills (HR3590 and

HR4872) are law and triggering sweeping changes and disruptions – some

rather quickly and some over many years. The industry is asking, “What

now?” At Deloitte, we continue to explore and debate the key questions

facing the industry, and we look forward to helping our clients find and

implement the right answers for their organizations. To learn more, visit

www.deloitte.com/us/healthreform/whatnow today.

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Subscribe to the Health Care Reform Memo

Health Care Reform Memo —The weekly Health Care Reform Memo is available for

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Deloitte Center for Health Solutions research

Coming soon: Issue Brief: Supervisory care

Physician attitudes about Health Information Technology

Engaging Consumers through Health Information Technology

Currently available: “Physician Perspectives about Health Care Reform and the Future of the Medical

Profession” —December 2011. Available online at

www.deloitte.com/us/physiciansurvey.

“2011 Global Survey of Health Care Consumers” – U.S. and country specific reports

and fact sheet library —2011. Available online at

www.deloitte.com/us/2011consumerism.

“Issue Brief: The fiscal impact to states of the Affordable Care Act (ACA):

Comprehensive analysis” — October 2011. Available online at

www.deloitte.com/us/acafiscalimpactstates.

“Issue Brief: The impact of health reform on the individual insurance market: A

strategic assessment” — October 2011. Available online at

www.deloitte.com/us/acaindividualinsurancemarket.

Readers are encouraged to vote for Modern Healthcare’s 50 Most Influential Physician

Executives. Nominees include many of our clients and friends including our own Senior

Advisor on Health Care Transformation and Technology, Dr. Harry Greenspun. Click here

to vote: www.modernphysician.com/section/50mostinfluential.

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Deloitte contacts Paul H. Keckley, Ph.D., Executive Director, Deloitte Center for Health Solutions

(pkeckley@deloitte.com)

Harry Greenspun, M.D., Senior Advisor, Health Care Transformation and Technology,

Deloitte Center for Health Solutions (hgreenspun@deloitte.com)

John Bigalke, U.S. Industry Leader, Health Sciences & Government and National Co-

Leader, Health Reform, Deloitte LLP (jbigalke@deloitte.com)

Bill Copeland, National Co-Leader, Health Reform, Deloitte Consulting LLP

(bcopeland@deloitte.com)

Andrew Vaz, National Managing Director, Life Sciences & Health Care, Deloitte

Consulting LLP (anvaz@deloitte.com)

Steve Kraus, Principal, Human Capital, Deloitte Consulting LLP (stkraus@deloitte.com)

Mitch Morris, M.D., National Leader, Health Information Technology, Deloitte Consulting

LLP (mitchmorris@deloitte.com)

Clint Stretch, Managing Principal, Tax Policy, Deloitte Tax LLP (cstretch@deloitte.com)

To receive email alerts when new research is published by the Deloitte Center for Health

Solutions, please register at www.deloitte.com/centerforhealthsolutions/subscribe.

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To arrange a briefing for your team, contact Jennifer Bohn (jebohn@deloitte.com).

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