Trends and Forces - IHIapp.ihi.org/Events/Attachments/Event-2342/Document...5. Digital, social and...

Institute for Healthcare Improvement 1

Forces and Trends And How They Are Shaping Our Future

Pete Knox Executive Vice President

Chief Learning & Innovation Officer Bellin Health, Green Bay WI

Salt Lake City, Utah - March 2013

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• Pressure from many different directions

for change

• Driven as much by the commercial

market as the government

• Speed of change accelerating

Trends and Forces


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Physicians: 10 Healthcare Reform Market Changes

1. Expect to be measured – no more invisible man or woman

2. The emergence of ACO’s and population management

3. Traditional payment will decline

4. EMR and connectivity are “table stakes”

5. A chance to lead the market through pilots

6. Access – when and how matters

7. Patient expectations will continue to rise

8. Reframing the clinical workforce

9. No relief in operating costs

10.Hospital relationships matter

SOURCE: Media Health Leaders

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Consumer: Top Ten Trends for Healthcare & Wellness

1. Technology will lead the way

2. Awareness and preventive will have a renewed focus

3. The empowered consumer continues to rise

4. Retail plays are an increase role

5. Digital, social and mobile a priority

6. Open data access continues

7. The line between healthcare insurers and provider continues to blur

8. Increased government involvement and focus

9. Cost transparency

10. From patient to consumer SOURCE: Solohealth


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Technology: Trends for 2013

1. Mobile Health

2. Personal Health Records

3. Tele-medicine

4. EHR vendor shakeout

5. Clinical Analytics Source: Information Week - Healthcare

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Health Systems:

Five Key Trends Reshaping the Future of Healthcare

1. New accountability concepts are reshaping healthcare delivery models with risk shifting from payers to providers and from groups to individuals.

2. Changing channels: Payers will market directly to consumers, expanding the retail insurance market, and readying themselves for participating in health benefit exchanges.

3. With an “app for that” available, all healthcare is not local. Experiments with “virtual care” models and telehealth will accelerate disrupting traditional care model.

4. Vertical integration, diversification, and the leverage of conglomerates. With lines of demarcation among industry sectors blurring. New business models to share in risks and rewards of new ways of delivery care.

5. Healthcare will begin unlocking the value in big data, artificial intelligence, and next generation health analytics and business intelligence. Structural barriers are removed to access and sharing and puts incentives in place to encourage the same.

Source: Cognizant 20-20 insights


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Payment: Market Forces and the Impact on

Physicians/ System Compensation

1. Medicare reimbursement cuts could hit physicians hard

2. Value based purchasing – pay for outcomes

3. Moving from episodes to continuum – global or bundled payments

4. Payment managing populations – shared savings or fully

5. Shifting payment for Primary Care

6. Fee for service on its way out

7. Models combine quality, production, utilization, and satisfaction

Sources: Cancer Services MGMA The New England Journal of Medicine Merritt Hawkins & Associates

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Strategies: For Changes in Reimbursement

1. Physician hospital collaboration

2. Develop integrated and comprehensive continuums of specialty care

3. Clinical and functional outcomes to substantiate effectiveness

4. Define quality

Sources: Vega Healthcare


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Navigating the Corridor

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Navigating the Corridor

• All signs point to a transition from fee for

service to managing a population

• The differences between the two worlds is

striking

• Building a different type of organization


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Low

Risk

High

Risk

High

Coordination

TODAY

-$

-$

$$

Low

Coordination

Business Case

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8 Core Strategies to Mind the Gap

1. Drive out waste

2. Implement new payment models

3. Collaborate with other healthcare providers

4. Invest in primary care

5. Develop health data analytics

6. Establish employee health programs

7. Begin a cultural revolution

8. Evaluate and re-evaluate strategy

Source: Bechers Hospital Review

Special Section 2012 CEO Strategy

Roundtable (November/December 2012)


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Understanding the Payer Segments and

Relationship Options

• Multiple payers but all with the same need

– manage a population at lower cost and

higher quality

• Navigating through the corridor will not be

a straight shot

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The Local Market

• A play for the commercial market

• Back to the future

• Can anyone deliver what customers really

want


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Taking Utilization Cost Out of the System

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Accountable Care and the

Lesson of Energy Management

“Managing Health” Driver Diagram

Navigating the

corridor from fee

for service to

managing health

and Triple Aim

for a population

•Financial

Management

•Partnerships/

Network

•Alignment

•Defining New

Care Delivery

Models

•Managing a

Population

•Building

Infrastructure

•Reimbursement models

•Financial risk management

•Capacity planning

•Contractual/payer relationship

Proactive measures to initiative new payment models

•Full scope/continuum of services

•Partners vs. contractors

•Whole network alignment & engagement

•Community partnerships

Create size and scale

•Models for Primary Care

•Integrating Primary Care & Specialty Care

•Partnering with patients

•Coordination across the continuum

Acute care redesign

•Manage all determinates of health

Act as integrator

Establish governance

Act for the Individual

Learn for the population

•Manage population & segments

•IT capabilities

•Data analytics

•Care coordination

•Operational management

•Facilities/services

Quality Improvement

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Strategies to Position Bellin

in the Market

• Differentiate by delivering what the customers

really want

• Leverage existing capabilities to manage a

population

• Create relationships that are difficult to duplicate

• Build a platform that can apply across

populations

• Move to population management relationships

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Payer Segments by % of Net Revenue

Commercial

Self Funded

Fully Funded

Individual

Medicare

Medicare Advantage

Fee-for-Service

Medicaid

Other

44% of Theda/Bellin Business

12 % of Theda/Bellin Business





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Medicare Accountable

Care

Pioneer Update

A Shared Savings Model


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Pioneer Example:

A Framework for intentionally

managing a population that is

the foundation for managing

any population.

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BTHP Pioneer 2012 ACO Projection Range Using 5 approaches to estimate 2012 from Qtr2, 2012 (Annual Cost Per Beneficiary)

National Trend

BTHP Trend

Target

$296

Savings

Base

Base

($4.3M to $7.6M take home @ 70%)

Qtr 2

Data cutoff line

Projection

Projection

Projection Actual

estimate

estimate

estimate

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On this document we also keep our

Pioneer metrics/measures of success front

and center .

Pioneer – Tying Pioneer Projects to our Metrics

& Definitions of Success for Pioneer (closer look)

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We set our financial targets for overall

revenue and the amount of shared savings

that will be distributed to our members.

This example is for 2012. We did this for

each year in Pioneer.

Once our targets were set, we then defined

the amounts of savings (to Medicare) we

needed to generate and the composite

percentage quality score we need to

achieve




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Once our targets for savings and quality

were set, we defined how projects will help

us achieve those targets. We aligned

projects under the appropriate category:

Projects that help generate the saving to

Medicare and projects that are focused on

our quality scores. We tied those projects

back to the responsible organization and

put a dollar amount to how their work

contributes to the target.

Projects are numbered and correspond to

areas that need to be addressed in the

driver diagram.



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Pioneer – Defining Which Projects to Target by

Creating a Driver Diagram


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Pioneer – Defining Which Projects to Target by

Creating a Driver Diagram (closer look)

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Foundational Pillars

1. Build a common platform that is capable of

managing any population.

2. Leverage existing capabilities and

competences to manage populations.

3. Listen and respond to the customer in order to

differentiate ourselves in the market.

4. Stay close to the payer market and respond to

opportunities and focus our energy.

5. Drive efficiency into the core system.

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Thank you!

All rights are reserved. Copyrights for the materials used in this booklet owned by Bellin

Health and its affiliates. The use and/or reproduction by any means of any information

contained in this booklet without the written permission of Bellin Health is strictly prohibited.

Trends and Forces - IHIapp.ihi.org/Events/Attachments/Event-2342/Document...5. Digital, social and...

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