predictions, hopes and aspirations for u.s. healthcare in 2015

Predictions, Hopes and Aspirations for U.S. Healthcare in 2015

Dale SandersSenior Vice President, Strategy

© 2014 Health Catalyst

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Poll Questions

2

How are you involved in healthcare?

a. Executive – 26%

b. Clinician – 9%

c. IT – 15%

d. Data Analyst/Data Architect – 15%

e. Other – 32%

What is your primary functional area of expertise?



Today’s Agenda And Format

• Why is so healthcare so predictably unchanging, year-to-year?

• Is there any good news?

• The real predictions for 2015

• The aspirational predictions for 2015

• Poll questions for your predictions

• Open the telephone lines for your comments, questions, and predictions



Mean Time To ImprovementMeasured in years and decades for healthcare… why so long?

4



Only One Part of The Bad News

6



There Is Some Good NewsMaybe our MTTI will start to decrease?

• BCBS of North Carolina posts contract prices with providers

• http://www.bcbsnc.com/content/providersearch/treatments/index.htm#/

• Sec Burwell announcing “Our goal is to have 85% of all Medicare fee-

for-service payments tied to quality or value by 2016, and 90% by 2018.”

• NEJM, January 26, 2015

• Republicans (Hatch, Burr, Upton) offer alternatives to the ACA that seem

to have merit

• But aiming for repeal of ACA and replacing it with Patient Choice, Affordability,

Responsibility, and Empowerment (Patient CARE) Act

• UnitedHealthcare, Humana and Anthem Blue Cross Blue Shield offer

HealthySavings discounts at grocery stores for buying healthy foods

• Kenosha News, Feb 10, 2015

7

http://www.bcbsnc.com/content/providersearch/treatments/index.htm#/



Asymmetric information in

micro and macroeconomics;

Nobel Prize, 2001.



Now, About Those Predictions…

First, the most obvious…

• Mergers & Acquisitions

• Supreme Court

• Accountable Care Organizations

• Physicians

• Drug reform

• Broad insurance, narrow coverage

• HIE Failures

• EHR Disillusionment



Mergers & Acquisitions

CEOs with cufflinks and monogrammed shirts love mergers and acquisitions, fueled by the availability of cheap money and testosterone, until they realize they don’t have the data to manage the new company.

CEOs with a lower wardrobe budget will also look for M&A opportunities, but will be careful, pragmatic, and data driven.

The pragmatic settlers, not the pioneers, are going to create better, more efficient care through M&As in 2015.

By 2020, 70% of US healthcare will be delivered by 9 very large, regional health networks



Supreme Court

The Supreme Court has two choices regarding King v. Burwell and federal subsidies:

1. Interpret the spirit of the law

2. Interpret the law’s precise wording

If overturned, millions of voters would suffer financially from the loss of those subsidies.

The Supreme Court will rule in favor of the subsidies and the Affordable Care Act.

Affordable Care Act

• Congress will threaten to

repeal it, altogether.

• Obama will threaten to

veto the repeal.

• Eventually, the GOP will

propose dramatic but

effective changes that

Obama will support.

• Compassionate

Capitalism



Accountable Care Organizations

Burdened by administrative overhead,

federally ACOs will continue to struggle

and underperform.

In 2015, the federal government will start

acting like the world’s largest customer

of healthcare instead of the world’s

largest bureaucracy of healthcare

governance.

The ACA will be rewritten, trimmed,

improved and Obama will agree to the

changes before he leaves office.



Physicians

In 2015, as the centroid of ACOs

crystallizes around physician

groups.

Physician groups are gaining

ground and will increase their

lead over hospital and insurance

centered ACOs.

The future of accountable care

resides in the hands of

physicians.



Pharmaceutical Cost Reform

High-profile drug costs, such as Solvadi

($84,000 per regimen for hepatitis C),

will spur debate and concern.

But no meaningful progress on reform

in pharmaceutical pricing will take place

in 2015, thanks to pharmaceutical

lobbyists and weak-kneed politicians.

(US drug prices to consumers are 3x-

5x more than in Germany and the UK,

btw)



Broad Insurance, Narrow Coverage

Healthcare will hit 20% of GDP.

Affordability of care will be hotly

debated, once again.

The expansion of “affordable”

insurance policies will highlight the

downside of very narrow networks and

coverage.

Patients will find very limited coverage

and enormous out-of-pocket expenses

that will drive uncomfortable headlines

and subsequent changes to the ACA.



Health Information Exchanges

HIEs will go deeper into the

“Trough of Disillusionment”

The benefits of an HIE are in

direct contradiction to the existing

US economic model which

rewards inefficiencies.

Document-centric HIEs will be the

worst in terms of perceived value

by clinicians.



EHR Disillusionment

The pain of reality is just beginning.

83% of clinicians have a negative view

of EHRs.

The outcry will deepen and broaden as

the limitations of EHRs to support

population health, clinical quality, value

based purchasing, patient safety and

clinician efficiency become more

painfully obvious.

They were designed for Healthcare 1.0,

circa 1964.

Are they to blame or are we?


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Aspirational & Satirical Predictions



Meaningful Use

As Congress debates Meaningful

Use, it will come down to these

two barriers:

1. The EHR data interface is encounter

specific rather than patient centric and

inherently lacks an effective workflow.

2. EHR vendors see interoperability as a

threat to their market share.

Legislation will force EHR vendors

to support interoperability--

technically, contractually, and

economically.



Wal-Mart Disrupts GPOs

Wal-Mart’s entry into primary care

clinics and the insurance market

are the first steps towards the

complete consumerization of

healthcare.

In 2015, Wal-Mart’s next

disruptive step is in the logistics

and supply chain of healthcare,

where they will completely

unsettle group purchasing

organizations (GPOs) in five

years.



Cleveland Clinic Telemedicine

Borrowing from lessons learned in

military operations and command

centers that managed over

400,000 troops in Iraq, the

Cleveland Clinic will open a

telemedicine command center that

can monitor, interact, and manage

100,000 patients in post-acute

home care, hospice care, and

chronic condition management

settings.



Price Transparency

Hospitals and physician groups will

continue to drag their feet on the issue of

price transparency, even though they are

required by the Affordable Care Act to

make their prices publicly available.

Several states will pass laws to address

this problem in 2015.

Hospitals and clinics that do not post

their prices on the web will not be

allowed to pursue their bad debt

collections through collection agencies or

legal action.



DoD EHR Contract

The DoD was once one of the most

inefficient and wasteful operations in the

world.

Today the DoD culture embraces

constant change, adaptability, precision,

and execution.

As a consequence, it will surprise

everyone and delay its award of the $11B

contract until existing vendors offer better

solutions or a new, dark horse vendor

appears with a modern, 5th generation

EHR.



Employer-Sponsored Medicine

In a bold experiment to dramatically cut

costs and improve the quality of care to

their employees, Toyota will acquire two

hospitals and two physician groups near

their San Antonio facility in 2015.

If this experiment succeeds—and it is

expected to—Toyota plans to expand the

model to all of their manufacturing plants in

the U.S.



Medical Tourism In Your Backyard

Dr. Devi Shetty, founder of the 29-hospital

Narayana Health System in India and

Health City Cayman Islands, will open a

1000-bed hospital and affiliated clinics on a

Native American reservation in the central

U.S., most likely Oklahoma, providing a

huge economic boost to the tribe, while

operating under the benefits of sovereign

nation protection.



Affordable, Accountable Insurance

State Governors will follow the lead of

Colorado and require all hospitals and

physician groups licensed in their states to

offer their own health insurance plan, thus

encouraging the same organizational

balance between quality-of-care and cost-

of-care as exemplified for decades by

organizations like Intermountain

Healthcare.



Elimination of Federally Managed Medicare

In a bold, bipartisan move, Congress will

eliminate Medicare at the federal level,

replaced by an expansion of Medicaid

services and funding at the state level.

Several independent analyses will indicate

the move will save billions of dollars without

sacrificing patient care.

Quality of care will improve through tailored,

regional personalization and local

accountability.



Taxation on Violence

An anti-tax, 2nd Amendment Congress, will

ensure all ammunition will be taxed at 50%

and the proceeds will fund:

1. A national insurance program for all

victims of murder and major life

disabilities caused by firearms

2. Development of a behavioral health and

cultural awareness and sensitivity

program that deals specifically with the

reduction of gun violence in the U.S.,

particularly mass shootings.



The NFL and Genetic Medicine

The Denver Broncos will steal DNA

material from the Seattle Seahawks

quarterback, Russell Wilson, and splice that

into Peyton Manning's genome.

The Broncos will go undefeated in 2015

and win five Super Bowls in a row.



Jimmy Hoffa Mystery Resolved

Two of the biggest mysteries of our generation will be simultaneously resolved when Mr. HISTalk reveals his identity in 2015.



Poll Question #1

Will the Supreme Court rule in favor of Burwell and

the Affordable Care Act?

a. Yes – 76%

b. No – 24%

36



Poll Question #2

Will Congress and the President reach a favorable

agreement on improvements to the Affordable Care

Act?

a. Yes – 18%

b. No – 82%

37



Poll Question #3

Will the DoD award an EHR contract to:

a. Epic – 37%

b. Cerner – 10%

c. No one – 16%

d. A surprising dark horse – 36%

38



Poll Question #4

Will we make any significant progress on price

transparency and availability, e.g., publicly available

costs published on the web?

a. Yes – 71%

b. No – 29%

39



Poll Question #5

Will clinician satisfaction with EHRs improve, decline,

or stay the same?

a. Improve – 34%

b. Decline – 32%

c. Stay the same – 34%

40



Poll Question #6

Will Peyton Manning and the Broncos win the Super

Bowl in 2015?

a. Yes – 9%

b. No – 74%

c. What’s the Super Bowl? – 17%

41



Thank YouUpcoming Educational Opportunities

How One ACO is Using Analytics to Drive Clinical & Operational Excellence

Date: February 18, 2015, 1-2pm, EST

Hosts:

Gregory Spencer, MD

Chief Medical Officer and Chief Medical Information Officer

Crystal Run Healthcare

Scott Hines, MD

Co-Chief Clinical Transformation Officer

Crystal Run Healthcare

Register @ www.healthcatalyst.com

http://www.healthcatalyst.com



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predictions, hopes and aspirations for u.s. healthcare in 2015

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