shifting from volume to value russell vinik md associate professor of medicine cmo, university of...
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Shifting from Volume to Value
Russell Vinik MD Associate Professor of MedicineCMO, University of Utah Health Plans
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Spending by Age Group
The Need to Rapidly Bend the Cost CurveU.S. Healthcare Performance
US Administration of Aging, “Why We Need to Bend the Health Care Cost Curve”
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PUBLIC PRIVATE
• Affordable Care Act • Accountability for value• Payment reform
• Movement to defined contribution
• High deductible health plans• Consumerism
Employers facing escalating costs in a globally competitive
market & and employees bearing higher cost burden
Government Facing Major Fiscal Challenges
Two related imperatives are Driving Change
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Affordable Care Act
Primary intent to improve health insurance markets Access & affordability
Also- promote wellness, support system and quality performance, & curb overall costs.
Declining uninsured % in U.S.
Variable by state (state level decisions on Medicaid expansion)
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CMS
Other
Inpatient prospective
payment (IPPS)
Outpatient prospective
payment (OPPS)
Provider Payment
Payer & other Organization Driven
IQR VBP HAC HRRP
OQR
MIPS MU-EP VBM
MU-EH
Rankings MISC.HEDIS
(Measurement &) Accountability for Value
Hos
pita
lCo
mpa
re
Phys
icia
nCo
mpa
re
PQRS
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CMS Payment Reform Timelines
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BundlesACO’sPCMHs
Limited v. comprehensive population-based payments
‘D’ =incentives & penalties
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Forces Driving Increased HDHP Adoption Going Forward
Public exchanges
Private exchanges
Cadillac tax
Large employers shifting to full replacement plans
Continued affordability challenges among small employers
High-Deductible Health Plans Continue to Gain Steam
2008 2013 2014 (Jan-Jun)
5%12% 13%
14%
22%24%
Commercially Insured in HDHPs
w/o HSA with HSA
Sources: CDC/NCHS: National Health Interview Study, 12/14 Early Release; Employee Benefit Research Institute: EBRI Databook on Employee Benefits (Chapter 10). Updated May 2011.
19%
37%34%
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Popularity of Bronze and Silver Plans on the Public Exchange Will Further Drive High-Deductible Adoption
Notes: (1) Catastrophic plan. Source: ASPE: Health Insurance Marketplace Enrollment Report. March 1, 2015; HealthPocket, 2015 Obamacare Deductibles Remain High but Don’t Grow Beyond 2014 Levels, 20 Nov, 2014.
Bronze Silver
$5,181
$2,927
$10,545
$6,010
Individual Family
Average Deductible by Metal Level2015 Enrollment Period
National Plan Selection by Metal Level 2015 Enrollment Period
22%
67%7%
3%1%
Bronze
Gold
Platinum
Cat. (1%)1
Silver
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BPCIIPPS
OQR
HCAHPS
MU H-IT
PROs
PSIsVBPPPACA
PSN HAC
CGCAHPs
MIPS
P4P
ACOs
MOC PQRS
Change in Healthcare feels like an OOWAA… (Ocean of Words, Abbreviations & Acronyms)
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COMPLICATED COMPLEX
McChrystal et al. Team of Teams 2015.
BIG IDEA: From Complicated to COMPLEX
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Healthcare Revolutions…BIG IDEA: A VISION FOR REAL CHANGE
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From volume to value…BIG IDEA: Patient level MEASUREMENT
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Manage What You Measure…
V =Q + S
$VALUE
QUALITY SERVICE
COST
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From episode to population…BIG IDEA: Longitudinal Care TEAMS
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Med-ical Care Genes
Health Behav-
iors
Social/Soci-etal
Population Health Influences…
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TEAM | 19
Will require new ways to organize TEAMS…
Team of Teams: new rules of engagement for a complex worldStanley A. McChrystal, Tantum Collins, David Silverman, Chris Fussell.New York, New York: Portfolio/Penguin 2015
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TRAVEL BANKING HEALTHCARE
From Patient to Person…BIG IDEA: Power shift to the CONSUMER
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86%OF PATIENTS CONDUCT
HEALTH-RELATED SEARCH BEFORE SCHEDULING
AN APPOINTMENT.1
33%OF AMERICANS USESOCIAL MEDIA TO RESEARCH HEALTH CONDITIONS.1
MORE THAN
41%SAY SOCIAL MEDIA IMPACTS THEIR CHOICE OFHEALTHCARE PROVIDERS.1
Patients are increasingly…EDUCATED & INFORMED BEFORESEEING A DOCTOR
1. Medcitynews/com/2014/03/healthcare-are-dr-google-2014-digital-patient-journeySource: http://www.cdwcommunit.com/perspectives/expert-perspectives/todays-digital-patient/
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Patients are increasingly…EMBRACING MOBILE HEALTH
1. Mdlive.com/new/press_05142014b.html2. Alegohealth.com/mhealthh-stats-mobile-apps-devices-solutions/3. Blog.ecgmc.com/2014/04/02/promoting –engagement-through-patient-ortal-
adoption/Source: http://www.cdwcommunit.com/perspectives/expert-perspectives/todays-digital-patient/
82%AMERICANS AGES 18-34 WHO HAVE A DOCTOR PREFER CONSULTATION VIA MOBILE DEVICE.1
52%COMFORTABLE
WITH VIDEOCONSULTS.2
84%OF PATIENTS BELIEVETHEY SHOULD HAVE
FULL ACCESS TO THEIR MEDICAL RECORDS
ONLINE.3
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What we need to
execute this?Physician
Patient Focus
Patient
CompetenceCaring
ConvenientQualityValue?
Value Metrics: HEDIS, PQRS, Medicare Stars, Total Cost of Care
ComplianceEfficiency
Payment
Pla
n Fo
cus
Physi
cian
Focu
sThe Cube of Population Health
Plan
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Patient Focus
Disease Focus
Plan F
ocus
Total Cost of Care
UU
HP
U BabyBundle
HEDIS
Direct to patient tele-health
Top 50 Conditions
PSS- Pediatric Specialty Services Home
Empower U- Palliative Care
PQRS
“Super Utilizer” High Risk Home
All Heal
th Plans
Building Blocks to Population Health Management
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VISION MEASURE
PATIENT TEAM