Download Health Challenges and Opportunities: How Technology Can Help

Horizon Council
Health Challenges and Opportunities
How Technology Can Help
Mike Smith
Chief Information Officer
Lee Memorial Health System
October 22, 2015
Discussion Topics
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Macro-level Healthcare Challenges
Macro-level Opportunities
Technology Innovations – How they can help
Possible Opportunities for Employers to Help
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Actuarial Publications
www.socialsecurity.gov
Social Security Online
Status of the Social Security and Medicare Programs
A SUMMARY OF THE 2011 ANNUAL REPORTS
Social Security and Medicare Boards of Trustees
Medicare
Relative to the combined Social Security Trust Funds, the Medicare HI Trust Fund faces a more immediate funding shortfall,
though its longer term financial outlook is better under the assumptions employed in this report.
Medicare costs (including both HI and SMI expenditures) are projected to grow substantially from approximately 3.6 percent of
GDP in 2010 to 5.5 percent of GDP by 2035, and to increase gradually thereafter to about 6.2 percent of GDP by 2085.
The projected 75-year actuarial deficit in the HI Trust Fund is 0.79 percent of taxable payroll, up from 0.66 percent projected in
last year’s report. The HI fund fails the test of short-range financial adequacy, as projected assets drop below one year’s
projected expenditures early in 2011. The fund also continues to fail the long-range test of close actuarial balance. Medicare’s
HI Trust Fund is expected to pay out more in hospital benefits and other expenditures than it receives in income in all
future years. The projected date of HI Trust Fund exhaustion is 2024, five years earlier than estimated in last year’s
report, at which time dedicated revenues would be sufficient to pay 90 percent of HI costs. The share of HI expenditures that
can be financed with HI dedicated revenues is projected to decline slowly to 75 percent in 2045, and then to rise slowly,
reaching 88 percent in 2085. Over 75 years, HI’s actuarial imbalance is estimated to be equivalent to 21 percent of tax receipts
or 17 percent of program outlays.
The drawdown of Social Security and HI trust fund reserves and the general revenue transfers into SMI will result in mounting
pressure on the Federal budget. In fact, pressure is already evident. For the sixth consecutive year, a "Medicare funding
warning" is being triggered, signaling that projected non-dedicated sources of revenues -- primarily general revenues -- will
soon account for more than 45 percent of Medicare’s outlays. That threshold was in fact breached for the first time in fiscal
2010. A Presidential proposal is required by law in response to the latest warning..
Conclusion
Projected long-run program costs for both Medicare and Social Security are not sustainable under currently scheduled
financing, and will require legislative corrections if disruptive consequences for beneficiaries and taxpayers are to be avoided.
The financial challenges facing Social Security and Medicare should be addressed soon. If action is taken sooner rather than
later, more options and more time will be available to phase in changes so that those affected can adequately prepare.
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International Comparison of Spending on Health, 1980-2008
Source: OECD Health Data 2010 (Oct. 2010)
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Costs by Age Categories
Healthcare Costs by Age
U.S. is spending much
more for older ages
Source: Fischbeck, Paul. “US-Europe Comparisons of Health Risk for
Specific Gender-Age Groups.” Carnegie Mellon University; September, 2009.
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Healthcare Challenges for All of Us
Cost – Not sustainable
Quality/Outcomes – Need to continually improve
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The Challenges
A Little More Detail:
– Payment Structure – Generally Fee For Service
(repair shop healthcare)
– Fragmentation of Healthcare
(lack of care coordination, fend for self, chronic disease
management gaps, lifestyle issues)
–
–
–
–
–
Advanced Clinical/Medical Technology (we can do more)
Increased Complexity of Healthcare
As consumers we are not engaged (someone else is paying)
Aging of Workforce/Society
Payor Mix
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PAYMENT SCHEMES THAT
REWARD EXCESS
If automakers were paid by the bolt, cars would be brimming with unnecessary
bolts. The U.S. fee-for-service system in effect pays for “bolts” – unit of
service – rather than for results, rewarding volume over value and encouraging
extra visits, procedures, and tests.
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A FEW PEOPLE COST A LOT
A relatively small number of
patients – often older or chronically
ill people – account for a large
portion of all medical costs.
These include frequent hospital
readmissions and managing the
consequences of obesity and
uncontrolled diabetes.
One in five Medicare
patients discharged from
the hospital will return
within a month; half won’t
have seen a doctor before
their return. More than
50% of all discharged
Medicare patients will be
back within a year.
SOURCE HENRY J. KAISER FAMILY FOUNDATION
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“New Healthcare delivery system”
 Improved coordination of care between Hospitals,
Physicians, and other Providers
 Jointly accountable for quality and resource use
(Which means a different payment model)
 A FUNDAMENTALLY NEW DELIVERY MODEL
 “What could be worse than healthcare overhaul?
No healthcare overhaul”
Assoc Press, Feb 14, 2010
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Lee County
Payor Mix
21.7%
Commercial
44%
Medicare
13%
Medicaid
10%
Uninsured/Self Pay
Cost vs Reimbursement
Cost
Commercial
Medicare
Medicaid
Uninsured
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Medicare Value Based Purchasing Slide
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“Information systems are critical. Medicine is
inherently an information science. In general,
the better information I have, the better
diagnosis I can make, the better treatments I
can offer, the better treatments I can deliver
and the better outcomes I can achieve.”
Brent James, MD
Vice President of Research and Medical Affairs at Intermountain Healthcare,
Executive Director for Healthcare Delivery Research
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The Healthcare Reform Pyramid
Consumerism
Focus: CDHPs, transparency,
PHRs, incentives, value
Coordination of Care
Focus: Primary Care 2.0 Model
(the new “Medical Home”)
Comparative Effectiveness/Evidence-Based Medicine
Focus: personalized medicine, comparative
effectiveness, episode-based payments
to acute organizations
Healthcare IT
Focus: e-prescribing, care coordination,
administrative cost reduction
CDHP=Consumer Driven Health Plan
Source: Deloitte Center for Health Solutions
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How technology is poised to help:
 Electronic Health Records (EHRs)
– Epic, other EHRs
 Intelligent Clinical Decision Support –
– based on clinical data about what actually works
 Patient and Family Engagement Tools
– Patient Portal (i.e. Epic MyChart)
 E-visit/Video Visit Technology
 Mobile/in-home patient monitoring and diagnostics
– Enabling the Right Care at the Right Place at the Right Time
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Lee County Electronic Health Record Vision
Lee Outpatient
Centers
Lee Convenient
Care
Lee Home
Health
Lee Physician
Group
Regional
Network
Partners
Lee
Specialists
EMS
Electronic Health Record/
Personal Health Record
Schools
Nursing Support
Physician Support
Med. Staff Support
Health Park
Care Center
Outcomes Mgmt
Medication Management
Ancillary Systems
Medical Home
Diagnostic Imaging
Children’s/
HealthPark
Accountable Care
Organization
Revenue Cycle
Public/Community
Health Services
Operational Systems
LMHS
Technology Infrastructure
Gulf Coast
Cape
Coral
In Home Services
Employers,
Government,
Insurance
Community
Physicians
Lee Memorial
(Cleveland)
Rehab.
Mental
Health
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MyChart
Mobile
App
IoT - (Internet
of Things)
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Wireless Digital (Mobile) Diagnostics
 http://video.msnbc.msn.com/rock-center/50582822#50582822
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Analytics Applied to Healthcare
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Realtime Analytics/Clinical Decision Support
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The Barriers (and Opportunities)
A Little More Detail:
– Technology Maturity – Payment Structure – Generally Fee For Service
– Fragmentation of Healthcare –
(lack of care coordination, fend for self, chronic disease
management gaps, lifestyle issues) –
–
–
–
–
–
Advanced Clinical Technology
Increased Complexity of Healthcare
Patients not engaged (someone else is paying)
Aging of Workforce/Society
Payor Mix
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Questions / Discussion
 What else can healthcare providers
do to employers/employees?
 What can you as employers do
to help?
 What can we do together to
accelerate the change?
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