Beckers Hospital Conference · The Health System of the Future: A Model April 10, 2018 Beckers...
Transcript of Beckers Hospital Conference · The Health System of the Future: A Model April 10, 2018 Beckers...
The Health System of the Future: A Model
April 10, 2018
Beckers Hospital Conference
Objectives
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» Understand the drivers of competition in the health system of the future.
» Define potential strategies for addressing these drivers.
What Is the Health System of the Future?
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Assumptions/Preconditions
» Exists in a competitive environment
» Is significantly at risk for total cost of care for a defined population
» Handles entire continuum of care, whether through ownership, management, or partnership
Key Implications
» Hospitals become cost centers, not revenue centers.
» The optimal PCP network is critical to capture “covered lives” for prospective payment; specialists are valuable only if cost-effective.
» Appropriately optimizing technology to drive cost-effectiveness and patient engagement is essential.
Competitive Drivers
» Patient centricity
» Value transparency
Care Will Shift to the Most Cost-Effective
Environments across a Broader Continuum
Form Follows Finance
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Home25%
Digital50%
Ambulatory20%
Acute5%
Care EnvironmentHome
2%
Digital3%
Ambulatory80%
Acute15%
Care Environment
34%of respondentsself-referred
42%of respondents followed a physician referral
Access and Convenience
Rank 1-4
Provider Continuity
Rank 5
Provider Credentials
Rank 8
Patient Centricity and “Consumerism”
Cost and Convenience Will Drive Competitive Success
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Source: The Advisory Board, 2015. https://www.advisory.com/media/Advisorycom/Research/MPLC/Resources/2015/30502_MPLC_Consumer_Survery_IG_web.pdf.
0
500
1,000
1,500
2,000
2007 2014
Consumers prioritize convenience over continuity and credentials.
Respondents preferred email visits over a visit to a clinic near errands or work.
Respondents demonstrated a likelihood of using newer sites of care for an illness like the flu.
“Short distance” is the most frequently cited reason for choosing a specialist.
Consumers self-refer to specialty care, and the trend is growing.
Between 2007 and 2014, the number of retail clinics increased from approximately 300 to 1,800.
Rank of Clinic Attributes Preference for Service Location
NearWork
NearErrands
Visits
NearHome
Least Preferred Most Preferred
56%of consumers would consider using retail clinics
42%of consumers would consider using email visits
Percentage of Consumers
Citing Distance as Factor
42%of consumers said distance was in their top three reasons for choosing a specialist
11%of consumers said distance was their number one reason for choosing a specialist
but only…
Source of Specialist Visit
Value Transparency
Value transparency is the need to be able to define and express the cost of services predictably.
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18.6% patients would switch their PCP if it would mean saving $500 to $1,000.1
St. George Surgical Center saw 5% to 10% growth in cash-paying patients after six months of posting prices.2
Of those who have compared prices across multiple providers, 82% will do so again.3
External Pressures
» Reference pricing
» High-deductible health plans
Internal Pressures
» Bundled pricing
Drivers Impacts
1 https://www.healthpocket.com/healthcare-research/surveys/more-than-half-not-wed-to-doctor#.WYH_vIWcF9M.2 https://www.ahcmedia.com/articles/135442-price-transparency-is-growing-but-hear-lessons-from-frontrunners-first.3 “How Much Will it Cost? How Americans Use Prices in Health Care.” Public Agenda. https://www.publicagenda.org/media/how-much-will-it-cost-topline-methodology.
What is Patient Centricity?
It’s NOT “Patient Experience”
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Comprehensiveness
Coordination
Environments
Service
Patient
Technology
» 24/7 convenience» “Valued customer” attitude» Tailored education» Anticipated needs
» Appropriate self-service› Centralized scheduling› Pricing visibility› Messaging
Service
» Fewest steps for patient» Bring services to the patient» Healing household milieu
» In your neighborhood (retail, UCC)
» In your home (extensivism)
Environments
» Meaningful apps» Home monitoring devices» Telehealth support
» E-visits» Risk identification
Technology
» Personal physician (PCP)» Care navigator» Connected specialists
» A team that coordinates care across all services
Coordination
» Wellness to hospice » Connected by IT
Comprehensiveness
Innovation in Care DeliveryToday: Emphasis on Access
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Implication: Customer preferences for low-touch care are evolving, but traditional providers are at risk of losing profitable low-acuity cases.
Call Centers: These centers offer around-the-clock access to nurse advice, triaging of clinical conditions, and appointment scheduling.
Retail Medicine: Urgent care and drugstore-based mini-clinicsare the sites of choice for many patients who appreciateconvenience.
Video Visits and E-Visits: These visits are on therise as preferred service modalities for technology-friendly patients. Reimbursement is becoming less of a barrier.
What’s Next: This area is evolving rapidly.
Patients are demanding more convenient access to healthcare services that mirrors
the 24/7 expectations of other consumer services.
Innovation in Care DeliveryTechnology Investment
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Platforms create actionable patient data to aid in the treatment or prevention of diseases
outside of the traditional care setting, drastically reducing costs in the process.
Potential Cost-Saving Opportunity
Investment advisers are increasingly focused on research related to market size opportunities in technological approaches to wellness and healthcare.
Increasing Venture Capital (VC) Funds Flow
» 2017 is on pace for a record year of funding after a high of $3.8 billion in invested capital for Q2 2017.
» Average deal size has recently almost doubled, rising to $21.3 million in 2017 from $12.2 million in 2014.
Vertical Disease State
Total Savings
Opportunity
RemotePatient Monitoring
Heart disease, COPD/asthma, diabetes
More than$200 billion
Telehealth Routine and psychological care
More than $100 billion
Behavior Modification
Obesity, smoking cessation, overall lifestyle improvement
Indefinitely large
Source: Goldman Sachs Global Investment Research.
Source: StartUp Health Insights, 2017 Mid-Year Funding Report.
Baby Boomers Are Peaking
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70 60 50 40 30 20100 90 80
Today’s Systems Must Transform across Seven
Key Dimensions over the Next 10–15 Years
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Value Transparency
Patient Centricity
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Risk-Based Payment Models
Health System
of the FutureThis is what needs to be enabled to compete and succeed.
This is the environment to which we need to respond.
These are the elements that need to be transformed.
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Defined Populations
Increased Scope Is Needed to Be Successful in
More Value-Based Models
» Management of costs across the continuum is needed.
» Lower-cost environments will need to be included through gainsharing or ownership.
» Fixed costs need to decrease.
» Cost accounting analytics are essential to measuring performance.
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Employed Physicians
Hospitals
PrivatePhysicians
Diagnostics
Home Care Services
Community Services
Post–Acute Rehab
Pharmacy
Retail and Urgent Care
Ambulatory Centers
Population-Level Risk
There is no “opting out” of the
Value game, as payors shift more
volume to providers offering
better value (cost/quality)
Innovation In Care DeliveryIn-Home Hospitalization
» While prevalent in many other developed countries, providing in-home acute healthcare services is still developing in the United States.
› In Victoria, Australia, 6% of all hospital bed days are provided through in-home hospitalization programs.
» Leading healthcare systems are operating in-home
hospitalization programs with equivalent outcomes and fewer
complications when compared to receiving traditional hospital care.
› Johns Hopkins Medicine’s in-home hospitalization program continues to operate (started 1994), and its delivery model serves as a benchmark to other healthcare systems.
› Johns Hopkins developed its in-home hospitalization program to provide care to elderly patients who were at heightened risk of hospital-acquired conditions.
› Results highlights from Johns Hopkins include lower cost of care (32%) and dramatically lower instances of delirium (9% at home versus 24% in the hospital).
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In-home hospitalization programs offer patients the convenience of receiving care
in the comfort of their own home, while concurrently reducing complications and
the cost of care by over 30%. 1
Innovation In Care DeliveryVirtual Urgent Care
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Virtual technology is now capable of providing on-demand healthcare remotely.
Concierge medical services, such as One Medical, are using this technology to
redefine how high-quality care can be delivered anytime, anywhere.
» Through their mobile devices, patients have access
to most of the care they can receive when visiting a
brick-and-mortar urgent care center.
› Book appointments, renew prescriptions, and access health records.
» The most innovative piece of the mobile urgent care platform is capability to communicate live with
healthcare providers via videoconference.
» Physical storefronts supplement the mobile application to provide the care scheduled and/or evaluated through video chat.
› Multiple points of access mean increased convenience for patients and a larger footprint for affiliated healthcare systems.
Innovation In Care DeliveryMobile Urgent Care and Home Diagnostics
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Mobile technology is now capable of bringing specific clinical professionals to the
home for urgent care, x-ray imaging, physical therapy, etc. DispatchHealth is using
this technology to redefine how high-quality care can be delivered anytime,
anywhere.
Nurse Advice Line
Empower staff to offer on-demand medical care in the comfort of an individual’s home.
Senior Communities
Direct contracting with independent living and assisted living communities to reengineer processes for acute care medicine.
Hospice and Palliative Care
Treat acute exacerbations of underlying illnesses in the home and thereby allow patients to live out their remaining days with comfort and dignity.
Home Health
Aid in delivering simple to complex medical care as an adjunct to provider services.
Skilled Nursing Facilities
Aid in preventing readmission penalties by providing improved access to acutely ill patients.
911 System
Interrupt unnecessary transports to the emergency room through direct integration into the triage process and definitive on-scene treatment.
PCPs/Specialty Groups
Extend the reach of care through an integrated approach.
Growth MarketKey Delivery Environments
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Digital Care Home Care Community Care Center
Milieu Home/Work Home Neighborhood
Populations» Episodic concerns and
illnesses
» Chronic illness management
» Uncomplicated, short term, acute
» Long term, high intensity, chronic 65+
» Chronic 65+
» Adult day care
Providers » PCPs and SPCs
» RN/RNP triage
» Peer communities
» Care managers and navigators
» Extensivist MD, RN, RT, PT
» RNPs, Aides, PharmD
» PCP/RNP
» Nutritionist
» PT/OT
» Health coach/navigator
» Activities coordinator
Population 60% (150,000) 4% (10,000) 20% (50,000)
Services » Social media
» Provider messaging
» Scheduling
» Patient education
» Prompted reminders
» Health record
» Infusion
» Imaging
» Biometrics
» Lab
» Specialty tele-consult
» Open access scheduling
» Imaging
» OT
» Day care services
» Lab
» Specialty tele-consult
Design
Considerations
» Mobility and ease of use
» Privacy
» Integration and breadth
» Self-service
Safety » Access/community convenience
» Multiuse spaces
What to Think About Now
Challenging Facts Current Strategy Needed Strategy
» Baby boomer demographics are about to peak.
» Markets will be 50% overbuilt in 10 years.
Keep building 40-year plants. » Build flexible, lower-cost environments.
» Focus in the community.
» Competitors are getting larger.
» VC funding is involved.
» Continue “shrink to profitability” strategy.
» Focus on service lines.
Focus on patient centricity and value.
» Care outside hospital will grow dramatically.
» Playing field will not be level.
Dabble where the current revenue models permit.
» Move care to the home and community.
» Figure out digital.
» Get paid to do it now.
» Approach commercial payors on total-cost basis.
» Get cost structures down.
» Be nimble with regard to change management.
Payors are hesitant to disrupt what is profitable for them.
» Take what you can get for now.
» Wait for market to change.
Risk for costs will shift almost entirely to the providers.
Continue to shift to commercial payors.
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