Post on 26-Dec-2015
Caroline R. Piselli RN, DNP(c), MBA, FACHEPricewaterhouseCoopers Health Industries Advisory Director
Building Your Plan to Get from Here to There: Steps Required to Achieve a Blended Services Model
Source: PwC Health Research Institute
• National Trends / Role of Government• Payment Methodologies• Shifting Demographics• New Customers• Empowered Consumer• Care Anywhere, Anytime
Agenda
Source: PwC Health Research Institute
New Health Economy Transformation
TRANSFORMATION from a fee for service environment to population health aligned with risk is a current to future state process.Key critical success factors expand well beyond payment methodology design, actuarial computation and include some of the following:
1- INNOVATIVE Design2- Population Health- OUTCOMES focused3- Current to future state VISION driven4- RISK linked to OUTCOMES, not process5- Flexible & Adaptable to CONTINUAL IMPROVEMENT6- CONTINUAL COLLABORATION 6- Sense of URGENCY and ACCELERATION
Source: PwC Health Research Institute
How is your organization preparing?
How are your current and new competitors preparing?
What is the overall market impact in your area?
What is the impact of new entrants? Retail? Pharma? Consumers?
What lessons can be leveraged from early adopters?
Is Your Organization Prepared for the New Health Economy ?
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
ACA Implementation
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute 13
Some Published Examples to Follow
Source: PwC Health Research Institute
MD Statewide Experience: PPC Cost SavingsSource: Health Affairs December 2012
Source: Health Affairs, December 2012 31:12; doi: 10.1377/hlthaff.2012.0357
Source: PwC Health Research Institute
Potentially Preventable Events
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
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Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Risk Adjustmen
t
Reinsurance
Risk Corridors
Balancing insurer risks in the reformed insurance market:
Incentivize health plans to participate
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Population Management ReadinessDevelop a network across a geography that delivers evidence-based
care to improve the quality, efficiency and coordination of health care services
Pop
ula
tion
Man
ag
em
en
t R
ead
iness
Build to Scale
Select Providers & Physicians
Contract for Outcomes
NE
W C
ost
& V
alu
e
Posi
tion
ing
Patient Experience
Operational Efficiency
Clinical Outcomes
Adverse Event Mitigation
Cost/ ROI
Leveraging:• Data• Transparency• Critical Mass• Long Term
Commitment• Consumer
Value
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Source: PwC Health Research Institute
Questions?
Caroline R. Piselli, RN, MBA, FACHEHealth Industries Advisory DirectorPricewaterhouseCoopers caroline.r.piselli@us.pwc.com
Source: PwC Health Research Institute