Ahead of the CurveTop 10 Emerging Healthcare Trends: Implications for Patients, Providers, Payers and Pharmaceuticals

Acknowledgements

• The report was developed under the direction of the Academy of

Managed Care Pharmacy (AMCP) Foundation, in collaboration with

Pfizer, Inc.

• The research initiative was made possible by the generous support

of Pfizer through the US Payer & Channel Access and US Medical

Affairs groups

• On behalf of the AMCP Foundation, research and report

development was conducted by IMS Health

− IMS Health contributors included Isabella Chow, Prina Donga, Stacey

Kowal and Julie Munakata

2

Is there a great deal of change in US healthcare today?

In the past, new trends in healthcare moved this fast….

Recent catalysts for change:

• Patient Protection and Affordable Care Act and

the ―Triple Aim‖

• Ageing population

• Innovation

• Cost pressures

• Technology

• Consumerism

How do we get information on the most important trends in

healthcare?

FLIPBOARD

GOOGLE HEALTH NEWS

CNN HEALTH NEWS

NEW YORK TIMES

ECONOMIST

USA TODAY

JAMA

HEALTH AFFAIRS

MEDICAL DECISION-MAKING

BROOKINGS INSTITUTE

KAISER FAMILY FOUNDATION

NATIONAL INSTITUTE OF HEALTH

IMS HEALTH INSTITUTE

NATIONAL INSTITUTES OF HEALTH

MEDPAC

AMCP FOUNDATION

FEINSTEIN INSTITUTE

PRICE WATERHOUSE COOPER

MCKINSEY

WIKIPEDIA

Top10 emerging trends in US health

care

impacting the health insurance industry

…….in the next five years

Research goal:

• Provide real-world insights on key health

policy priorities

• Develop a comprehensive reference

resource for managed care provider

organizations, health care payers, policy

makers and other stakeholders

Research objectives:

Comprehensive

report available at:

www.amcp.org/amc

p-foundation/

Today’s Presentation

11

• Research Methodology

• Top 10 Emerging Health Care Trends

• Understand where we are now

• Discuss potential implications

• Look ahead

• Concluding Remarks and Discussion

11

• Peer-reviewed literature

• Gray literature (white papers, industry reports, etc.)

• Informal sources (news, blogs, etc.)

• Representative panel of experts

• Validate trends from the public domain

• Identify and prioritize the most important trends

• Provide insight on implications

Research Methodology

SECONDARY RESEARCH

ADVISORY PANEL

12

sources were reviewed in detail and synthesized to

understand the current landscape for trends

More than120

26“big” trends were identified

Value-oriented marketplace

Growth of consumerism

Increasing patient cost sharing

Health literacy

E-prescribingPhysician shortages

Expansion of patient centered medical homes

High cost, complex diseases

Consolidation of HC stakeholders

Focus on the whole patient

Healthcare everywhere

Changing role of employers in US healthcare

Growth and performance of ACOs

Migration from FFS payment

Biosimilars

Personalized medicine

Health insurance exchanges

HC reform and 340B

Defining value in US healthcare

CMS Medicare STAR rating

Technology and patient engagement

Specialty pharmaceuticals

Big data

Value for money

Data in patient care

15

1.Knowledge of literature-based trends

2.Current professional role in at least one core, relevant-field of

research including:

1.Payer: managed care payer organizations or other form of health

payers/insurers

2.Patient: patient care, patient perspective or patient outcomes

3.Government: health care policy or government stakeholders

4.Pharmaceuticals: pharmaceutical research or manufacturing

3.Recognized as a thought leader in their respective field

Selecting the Advisory Panel

The Advisory Panel

16

Joe Biskupiak – Professor, University of Utah College of Pharmacy –

Health EconomistChris Dawe– Former Health Policy Advisor (Clinton administration),

Health StrategistJeff Dunn– Senior VP VRx Pharmacy Service, Pharmacy Benefit

ManagementSandy Robinson– VP Avalere Health, Health Policy Research and

Patient Access ExpertJeremy Nobel– Professor Harvard University, Executive Director

Northeast Business Group, Health Technology Expert and Employer

ExpertBecky Snead– Executive VP and CEO of the National Alliance

of State Pharmacy Associations, Pharmacy RepresentativeMark Snyder, MD– Specialist Leader, Deloitte Consulting,

Healthcare Technology and Health System Design ExpertJoAnn Volk– Professor Georgetown University Health Policy

Institute, Expert in Health Insurance Exchanges and Health

Insurance ReformMitzi Wasik– Director of Medicare Pharmacy Clinical

Programs, Aetna, US Managed Care ExpertJed Weissberg, MD– Senior Fellow at the Institute for

Clinical and Economic Review, Health Economist and Health

Insurance Expert

Employer

benefits expert

Patient access

expert

Health insurance

experts

Pharmacy benefit

expert

Health

economists

Health

policy and

health system

experts

10 Experts

Today’s Presentation

18

• Research Methodology

• Top 10 Emerging Health Care Trends

• Understand where we are now

• Discuss potential implications

• Look ahead

• Concluding Remarks and Discussion

18

#10

Healthcare Everywhere

LocationThe Location of Care is Shifting Beyond Health Care Facilities

PersonnelNon-Physician Care Roles are Expanding

A New Generation of Health Care Roles Will Emerge

New Care Settings

21

A CVS Example:1

• 2000 – First QuickMedx center in

Minneapolis-St. Paul area

• 2002 – Employers push health plans to

include QuickMedx centers

• Convenience leads to expansion

• 2014 – More than 800 minute clinics

across 28 states

1. CVS CareMark 201521

Expanding Care Roles

22

HOME

WORK

HOLIDAY

Patient Mobile Assistance Programs

22

Of health care will shift from hospitals and

clinics to homes and the community over

the next decade1

50%

1. Ernst & Young 2012

Technology Tools

2424

Technology Tools

25

• Google Fit health

• Apple health kit

• Samsung’s SAMI

• Connect with other apps

• Central and personal data

collection point

• More sophisticated health

metrics

• Integration into US

healthcare system

• Pilot programs for

monitoring chronic

conditions1,2

25 1. Ernst & Young 2012; 2. IMS Institute 2014

February 2015

Apple’s healthkit launched by 14 of the top23 hospitals in the US1

Future projectionsBy 2018, about 70% of healthcare organizations around the globe will invest in healthcare technology that includes apps, remote monitoring, virtual care and wearable devices2

1. Reuters 2015; 2. Business Insider 2015

Healthcare Everywhere

27

• New care settings

• Expanding care roles and expanded workforce

• Technology tools

• Linking old and new approaches to care

27

Looking Ahead

28

• Expanded role for retail pharmacies

• Technologies and devices to enable physician extenders

• New roles in the healthcare work force

• Care coordination and continuity of care

• Data portability and technology integration

• Establish billing and tracking protocols

• Near-term investments to link and integrate fragmented data

Opportunities Ahead

Challenges Ahead

HC Insurance Considerations

28

#9

Increasing Patient Cost-Sharing

Of spending results from many chronic diseases

that are manageable/preventable through the

right patient behaviors1

75%

Patient engagement is key to

affecting change in healthcare (in

terms of outcomes and spending)

1. CDC 2009

Patient Cost-Sharing is Increasing

31

• 20% – Of American’s with employer-sponsored coverage

have high-deductible health plans (HDHPs)1

• 40% – Of employers are considering offering only HDHPs in

the future1,2

• Co-insurance for drugs increased by 63% and co-payments

increased by more than 18% between 2011 and 20123

• 12-50% – Reductions in total care costs are seen in the first

year when plans adopt increased patient cost sharing

practices4

31 1. Blumenthal 2013; 2. CVS Caremark 2013, PWC Health Research Institute 2013a; 3. Magellan Pharmacy Solutions 2012; 4. Tzeel 2013

Patient Cost Sharing Challenges

32

$3,800Average American family’s savings account balance1

$4,059Average deductible for a family on HDHP2

VS

• 40% – of patients on HDHPs report postponing care due to costs

(including free preventive services)3

• Adherence to therapy is likely to decrease as member OOP costs

increase – a 10% increase in cost sharing leads to an 8.6% decline

in adherence4

32 1. Statistic Brain 2015; Harvard Business Review 2015; 3. CVS CareMark 2013; 4. Owens 2013

Beyond Patient Cost Sharing

33

BUT…non-financial mechanisms are also needed to drive

patient engagement:

Some form of cost sharing is needed for all stakeholders

33

Looking Ahead

34

• Promoting the use of high value services

• Increasing patient ownership over disease management

• Balanced risk sharing models are needed

• Changes in provider payment and health system delivery expected to increase patient burden

• Improved patient cost sharing schemes can have checks and balances

• Novel consumer-focused programs and technologies should be harnessed

Opportunities Ahead

Challenges Ahead

HC Insurance Considerations

34

#8

Role of Technology in Patient Engagement

Growth and Evolution of Technology

36

Medical

Technologies

Personalized Medical

Technologies

Future Medical

Technologies

Capsule Endoscopy

36

Technology Benefits

37

Benefits for patients

• Empowered patients

• Educated patients

• Patients as informed consumers

• Patients are increasingly willing to pay for social, mobile

and cloud technologies to help manage their health1

• 25% – Of consumers use mobile applications to

schedule health care appointments1

37 1. PWC Health Research Institute 2013

Technology Benefits

38

Benefits in patient care

• New approach to medication management

• Improving patient/provider communication

• 67% – Of specialty pharmacy providers use

smartphone and tablet applications to engage patients

with drug order related items, such as medication/dose

reminders1

38 1. Genentech 2012

Technology Challenges

3939

Technology Challenges

40

• Information overload

• Coordination of technologies

• Digital divide

• Younger patients (25-44) are almost 2 times as likely

to use mobile technology to communicate with

providers1

• Access challenges can also be based on geographic

location

40 1. PWC Health Research Institute 2013

Looking Ahead

41

• Improved patient health care decision-making

• Patient ownership over disease management

• Patient education - including health literacy and e-literacy

• Coordination of technologies

• Bridging the digital divide

• Connecting with covered members in new ways through technology

• Selection and promotion of preferred technologies

Opportunities Ahead

Challenges Ahead

HC Insurance Considerations

41

#7

Growth and Performance of ACOs

Conventional Care Models

43

InpatientCare

OutpatientCare

Ambulatory Care

Pharmaceu-ticals

Conventional care models: Individual accountability for

care quality and patient outcomes with separate payments

$

$

$

$

$

43

Integrated Care Models

44

Integrated care

models:

$

$

$

$

$Shared accountability

for care quality and

patient outcomes

BUT

Individual payments

Broad suite of patient

care services across

sectors and settings

44

Accountable Care Models

45

Accountable care

models (ACO)

Broad suite of patient

care services across

sectors and settings

$

Shared accountability for care

quality and patient outcomes

AND

Shared payments

Payments are tied to quality

outcomes and providers within

the system share the risk and

rewards for meeting or failing to

meet key quality standards

45

Appeal of the ACO

46

• PAYERS – Improved model for containing cost and

achieving quality metrics

• EMPLOYERS – Potential reductions in absenteeism1

• PATIENTS – Coordinated care to improve patient

experience and typically lower premiums (in narrow

networks) 1

• PROVIDERS – Increase administrative efficiency and health

information technology (HIT) infrastructure

46 1. CMS 2013

Growth of the ACO Model

47

• 14% – Of the American population is now

receiving care from an ACO2

• As of January 2014, there were 606 ACOs,

including 366 Medicare ACOs1

47 1. Muhlstein 2013a; Gold 2014

Performance of the ACO Model

48

• Preliminary data suggests mixed results1

• Fiscal success with Medicare’s Pioneer ACOs2,3

• All 32 programs performed better than FFS systems

• Improvements in 28 of 33 quality measures

• Gross savings $88 million (year 1) to $96 million (year 2)

• Nearly one third of Pioneer ACOs announced they were

leaving the model to adopt a model with less financial risk2

48 1. Ignani 2013, Sanofi 2013, Peterson 2013, Muhlstein 2013b; 2. Gold 2014; 3. CMS 2013, CMS 2014

The Future of the ACO Model

49

NOW FUTURE

Gaining insights from early ACO performance

• Willingness of ACOs to use data & analytics

• Moving from short-term, episodic view of patient care to

more medium-term perspective

• Successful components of value-based payments and

coordinated care approaches

49

The Future of the ACO Model

50

NOW FUTURE

• The ACO is likely a transitional step towards a more

consolidated, long-term view of population health

management

• Many will try the model and inevitably leave to revert to old

models or try new models

• Key successes of ACOs (data, care coordination) can be

applied in practice moving forward

• A broader shift in the US healthcare culture may be needed

to truly bend the cost curve

50

Looking Ahead

51

• Dual focus on cost and quality

• Data-driven insights will increasingly shape care

• Reduced provider autonomy

• Sharing revenue

• Fragmented health system

• Leverage 360° view of patient care and drive care efficiency

• Harness improved adherence and persistence outcomes

Opportunities Ahead

Challenges Ahead

HC Insurance Considerations

51

10 MINUTE BREAK

#6

Migration to a Value-Oriented Health Care Marketplace

Value in US Healthcare

54

Drug A Drug BVS

Most

effective

Drug C

Only works in

some people

Very expensive

Extremely

safe

InexpensiveMore effective

Serious side

effects

Cheap

generic

Drug D

Mildly effective

Risky

surgery

Drug EPotentially

curative

Medium

efficacy

Drug F

Mid-priced

Expensive

Drug G

Works in

small sub-

population

54

Example of a Value-Oriented Marketplace

5555

The QALY in the UK

• Single measure/benchmark for

impact of a new treatment

• Quality of life determined by

detailed questionnaires of

patient health status

• Compares ―value‖ across

diseases and populations

• Pre-determined thresholds for

willingness to pay (cost per

QALY gained)

• Special considerations for

vulnerable populations

1.0

0.0

+

-

Perfect Health

Death

Worst possible health state

Movement to a Value-Oriented Marketplace

56

• Value through incentives (employer, insurer)1

• Value through quality metrics (i.e., HEDIS, STAR)

• Rise of comparative effectiveness in some plans

• Adjusted patient risk sharing for high-value services (i.e.,

preventive services)

56 1. Cruickshank 2012; Owen 2014

Challenges in Paying for Value

57

• Lack of a consistent definition of value

• Lack of benchmark criteria for defining value across

stakeholders

• Lack of available data to track meaningful, measurable

patient outcomes and provider performance metrics

• Financial incentives alone will not be sufficient to achieve

value in health care

57

Looking Ahead

58

• The era of the value-based marketplace

• Paying for value instead of services

• Lack of consistent definition of ―value‖

• Lack of available data

• Opportunity to champion a dialogue on standard benchmarks for value

• Establish procedures to iteratively evolve the definition of value

Opportunities Ahead

Challenges Ahead

HC Insurance Considerations

58

#5

Medicaid Expansion Due to Healthcare Reform

Facts on Medicaid Expansion

60

• The ACA changed the Medicaid eligibility threshold to 138%

of the federal poverty level, increasing eligibility nationwide

• Over 18 million new patients will become eligible for

Medicaid by 20211

• Total Medicaid enrollment is projected to reach 93 million by

20242

• The Congressional Budget Office projections estimate that

expansion will increase total Medicaid expenditures by

approximately 7% per year for the next 10 years3

60 1. Sanofi 2013; 2. Rudowitz 2014

Current State of Medicaid Expansion

6161 1. Advisory Board Company 2014

Importance of Medicaid Expansion as a Trend

62

• Expected ―hot bed‖ of innovation as program expands to

cover more vulnerable populations

• Innovative methods for patient engagement given challenges

with patient cost sharing

• Testing new models – ACOs, patient-centered medical homes,

episode-based payments, value-based payment reforms1

• Efficiency is key given very limited Medicaid budgets

• Demand for improved outcomes with lower reimbursements

• Expected focus on care coordination

• New roles likely to emerge -patient navigators, care

coordinators, health informatics specialists

62 1. Kocot 2013

Looking Ahead

63

• A ―hot bed‖ of innovation

• New roles in the health care system will emerge

• Growth in member-base via managed Medicaid for managed care organizations

• Potential trickle-down effect of financial risk

• Difficult processes for treating and paying for the uninsured

• Proactive steps to drive care efficiency

• Customized solutions for benefit designs and payment models

Opportunities Ahead

Challenges Ahead

HC Insurance Considerations

63

#4

Spending and Utilization for Specialty Pharmaceuticals

Not All Drugs are Created Equal

65

Small Molecule Drugs

• Small size, low molecular

weight

• Simple, well defined structure

• Predictable chemical

synthesis process to produce

• Highly stable

• Typically less expensive

Large Molecule Drugs,

Biologics

• Large size, high molecular weight

• Complex, unique structure

• Difficult to produce, typically a

patented production process

• Unstable, sensitive to external

conditions

• Typically very expensive

~90% of drugs on the market

65

Specialty Pharmaceuticals

66

• Specialty drugs: require special handling, administration or

monitoring

• Used to treat complex conditions, such as multiple sclerosis,

rheumatoid arthritis, hepatitis C, and hemophilia

• 70% of drugs approved in 2013 were specialty drugs1

• 50% of the drug budget will be consumed by specialty drug

spending by 20182

• Specialty drugs are expensive given their design (potentially

biologic) and the healthcare resources used for administration and

monitoring

• The average cost of a specialty Rx is $1,776 compared to $54 for a

traditional drug3

66 1. Tharaldson 2014; Artemetrx 2013; National Business Coalition on Health 2015

Specialty Pharmaceuticals

67

30%

34%

38%

42%

45%

48%50%

0%

10%

20%

30%

40%

50%

60%

2012 2013 2014 2015 2016 2017 2018

Forecasted Net Prescription Drug Spending Percentage for Specialty

Medicines in Commercial Plans1

67 1. Artemetrx 2013

Managing Specialty Drug Spending

68

• Leveraging biosimilars to shift the cost curve

• Between 2009 and 2019, $50 billion worth of biologics to go off

patent1

• Based on trends seen in Europe, biosimilars pricing could be

20-30% less than originators1,2

• Challenges in the US regulatory market for biosimilars

• Scientific advances to help get the right treatments to the

right patients

• Advances in personalized medicine through biomarkers and

targeted treatments

• Genomics driven treatment decisions (mapping genome to fall

from $10,000-$25,000 to approximately $1,000)3

68 1. Hernandez 2013; 2. Sorokin 2014; Dillon 2014

69

1. Open formularies (i.e., provider choice) with robust treatment

guidelines

2. Site of care and channel management

3. Increased number of tiers in drug formulary

4. Increased patient cost sharing within and across tiers

5. Closed formularies based on centralized decision-making

Health Plan Responses to Specialty Medicines

Looking Ahead

70

• ―Personalized‖ or ―precision‖ medicine

• Improved patient outcomes

• Final regulatory framework for biosimilars

• Over-specialization of care

• Unified health insurance stance on use of biosimilars

• Harmonizing across pharmacy and medical benefits

• Improved requirements for demonstrating value in pharmaceuticals

Opportunities Ahead

Challenges Ahead

HC Insurance Considerations

70

#3

Widespread Use of Data and Analytics in Patient Care

Patient Data Assets are Growing

72

• New opportunities for the wide spread application of

analytics and predictive modeling

• Integrated systems are primed to lead the way for

harnessing data given HIT infrastructure and wealth of

linked data

• 48% – Of office physicians

• 45% – Of acute care hospitals

• 75% – Of oncologists

• ……adopted a basic or advanced EHR system in recent years1

72 1. Hsiao 2014; Charles 2013; ASCO 2014

Leveraging Data and Analytics in Cancer Care

73

CancerLinQTM pilot program gathered de-identified data from

more than 100,000 breast cancer patients across US to achieve

multiple objectives1

1. Create cancer data to overcome inconsistent data standards

2. Generate individualized guidance for any given patient based

on evidence-based medicine

3. Extend exploration of trends in data on patient characteristics,

treatment patterns and outcomes from real-world data

4. Provide feedback on physician performance

73 1. ASCO 2014

Challenges in Utilizing Patient Data

74

Challenges in collecting the right data

• Legacy HIT systems and patient data assets are often designed to

support billing and reimbursement rather than outcomes research

• Many data assets are discrete and are not linked

• Patient privacy concerns adds complications to linking

• Very few data assets are customized to collect the most relevant,

useful information on disease outcomes

74

Challenges in Utilizing Patient Data

75

• Collecting the right data

• Scope of practice (smaller practices) for many providers

• Reluctance of many clinicians to invest in resources required to gain

competency

• Reluctance of many health care systems to implement process

changes based on data-driven insights

• The complexity in payment systems

• A lack of tangible incentives for HIT/analytics investment for small

practices

• Concerns on use of data across state lines/patient privacy issues

75

The Potential of Data/Analytics in Patient Care

76

NOWMEDIUM

TERMTHE

FUTURE?

76

Growth of real world evidence (RWE)

Expansion of predictive modeling

Data-driven patient tools (i.e., diabetes apps)

Looking Ahead

77

• Data driven insights

• Transparency in the care provision process

• Fragmented patient data

• Reluctance of many clinicians to invest in and use data/analytics

• Availability of meaningful patient metrics

• Place emphasis on improving data tracking and linking across disparate sources

• Transition to long-term, 360° view of patient management

Opportunities Ahead

Challenges Ahead

HC Insurance Considerations

77

#2

Consolidation of Health Care Stakeholders

What Do We Mean by Consolidation?

79

One example of a common form of consolidation is the clinically integrated organization (CIO):

Typically legal agreements that allow stakeholders to remain

independent while collaborating on:

• Patient care

• Performance improvement

• IT infrastructure (clinical registries, performance management systems)

• An example of a CIO would be integrated delivery networks (IDNs)

partnering with hospitals

Consolidation is occurring across the healthcare system, with trends in increasing partnerships, mergers and acquisitions in the form of vertical and horizontal consolidations

79

Consolidation is on the Rise

80

• 20% Of hospitals will seek to merge in the next five to

seven years1

• 62% Of not-for-profit and for-profit hospitals have either

purchased or own physician practices2

• Pharmacy benefit management (PBM) organizations are

rising, with independent and specialty pharmacies being

purchased by larger entities3

• Oncology practices are increasingly consolidating and joining

hospitals to obtain more favorable reimbursements under

Medicare 340B drug discounts4

80 1. Enders 2014; Brooks 2012; Genentech 2012; Hernandez 2013

Benefits of Consolidation

81

• Increase in team-based coordinated care approach

• Standardization of decision-making

• Improved care efficiency

• Reduced use of unnecessary services

• Shift in relative market power/negotiating power

• Sufficient infrastructure to harness HIT and evidence-

based medicine in patient care

• Improvements in linked, longitudinal patient tracking

81

Challenges of Consolidation

82

• Challenges in providers sharing revenue

• Potential loss of innovative or important ―custom‖ care

approaches with standardized decision-making

• Gaps on patient tracking and linking that limit the ability

to track and improve performance

• Potential increase in prices if entities are moving to

consolidate to maximize returns

• Recent evidence on hospital consolidations cites

increases in the cost of services between 10-40%

82

Looking Ahead

83

• Increased use of data and technology

• Increased care efficiency

• More negotiating power

• Gaps in data on longitudinal patient outcomes and the health care supply chain

• Shifts in the conventional provider role

• Ensure payment models prepare for the shift in market power

• Leverage increased patient tracking & data from integrated systems

Opportunities Ahead

Challenges Ahead

HC Insurance Considerations

83

#1

Migration from Fee-for-Service to New Providers Payment Models

Migration from FFS Payments

85

Historic Payment Practices

Future Payment Practices

FFS Models Bundled Payments

Capitation

Episode-Based

Payments

Global Payments

SERVICES VALUE

85

Importance of Migration from FFS Models

86

Changes in

payment models

directly impact

profits, salaries

and budgets

Providers now

must consider

costs in their

clinical decision-

making

86

The Bundled Payment Example

87

• Payers covering 53% of total lives in the US have initiated

pilot bundled payment programs for services with oncology

groups1

• 86% of hospital pharmacists believe that most hospitals

will be involved in at least one type of bundled payment by

20182

• More than 500 hospitals are currently participating in the

Medicare bundled payment initiative3

• Early evidence for bundled payments is suggesting savings

from improved care efficiency and stakeholder alignment4

87 1. Magellan Pharmacy Solutions 2012; 2. Zellmer 2013; 3. Blumenthal 2013 ; 4. RWJF 2013

Where the Migration Stands

88

• A variety of models are being explored

• No dominant payment model as emerged as the optimal

option for balancing cost and quality

• Abandonment or reduction of care for high-cost and chronic

diseases is a concern with many models that increase

patient cost-sharing or heavily reduce provider payments

• More attention is being placed on reducing administrative

inefficiencies to streamline operating costs

88

Innovation from Payment Reform

89

• Shift in payment models is the fueling rapid emergence of

new approaches for care delivery as providers seek to ―do

more with less‖

• Disease management by pharmacists

• Expansion of near-site and on-site clinics for employers

• Expanded population health management activities

• ACOs and consolidation are further redefining what’s

possible in terms of coordinated care and care efficiency

89

Looking Ahead

90

• High-quality patient experiences and outcomes

• Reduced costs for government and commercial payers

• New approaches for care delivery

• Lack of long-term data on performance

• Potential abandonment/reduction of care for certain high-cost chronic diseases

• Ability of providers to identify and reduce waste in care delivery

• Payment reform will need to be an evolving process

• Use of data-driven insights can improve models

Opportunities Ahead

Challenges Ahead

HC Insurance Considerations

90

Top 10 Emerging Health Care Trends

Top 10 Emerging Health Care Trends

92

1 Migration from fee-for-service to new provider payment models

2 Consolidation of health care stakeholders

3 Widespread use of data and analytics in patient care

4 Spending and utilization for specialty pharmaceuticals

5 Medicaid expansion due to health care reform

6 Migration to value-oriented health care marketplace

7 Growth and performance of accountable care organizations

8 Role of technology in patient engagement

9 Increasing patient cost sharing

10 Health care everywhere

92

Today’s Presentation

93

• Research Methodology

• Top 10 Emerging Health Care Trends

• Understand where we are now

• Discuss potential implications

• Look ahead

• Concluding Remarks and Discussion

93

94

• Many of these emerging trends are heavily interconnected and their impact across stakeholders should be viewed in an aggregate manner

• The next five years are expected to signal significant advances in the movement towards a system where:

−Holistic care for the patient sits center stage

−Accountability is shared across stakeholders

−Value becomes the core currency of the health care marketplace

Concluding Remarks

95

• To prepare for these trends, various stakeholders will need to:

−Proactively work to link and improve fragmented patient data metrics to increase patient tracking capabilities across the care continuum

−Leverage new technology tools and care extenders to enhance patient engagement in new ways and in new settings

−Utilize tracking and iterative refinements to care and payment approaches to drive care efficiency while maintaining patient access

Concluding Remarks

AppendixBibliography of Cited References and Included Images

References (1)

• The Advisory Board Company. Where the states stand on Medicaid expansion. The Daily Briefing. 2014. Accessed September 2014. Available at: http://www.advisory.com/daily-briefing/resources/primers/medicaidmap#lightbox/0/

• American Society of Clinical Oncology. The State of Cancer Care in America, 2014: A Report by the American Society of Clinical Oncology. J Oncol Pract. 2014;10(2):119-42.

• Artemetrx. Specialty Drug Trend Across the Pharmacy and Medical Benefit. 2013. Accessed May 2014. Available at: http://www.artemetrx.com/docs/ARTEMETRX_Specialty_Trend_Rpt.pdf.

• Blumenthal D. Stremikis K, Cutler D. Health Care Spending — A Giant Slain or Sleeping? NEJM. 2013;369(26): 2551-2557.

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• Minute clinic image taken from: http://www.dispatch.com/content/stories/business/2013/06/08/pharmacy-clinics-fill-need-draw-concerns.html

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• Slides 24, 39: Microsoft fitness wearable image taken from: http://thenextweb.com/microsoft/2014/10/30/microsofts-fitness-wearable-leaked-apple-google-app-stores/

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