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Predictions, Hopes and
Aspirations for U.S.
Healthcare in 2015
Dale Sanders
Senior Vice President, Strategy
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
5
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
Affordable Care Act
• Congress will threaten to
repeal it, altogether.
• Obama will threaten to
veto the repeal.
• Eventua...
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
© 2014 Health Catalyst
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© 2014 Health Catalyst
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Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst ci...
© 2014 Health Catalyst
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© 2013 Health Catalyst
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© 2013 Health Catalyst
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Aspirational & Satirical
Predi...
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© 2014 Health Catalyst
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© 2014 Health Catalyst
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© 2014 Health Catalyst
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© 2014 Health Catalyst
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© 2014 Health Catalyst
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© 2014 Health Catalyst
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© 2014 Health Catalyst
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© 2014 Health Catalyst
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© 2014 Health Catalyst
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© 2014 Health Catalyst
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© 2014 Health Catalyst
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© 2014 Health Catalyst
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© 2014 Health Catalyst
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© 2014 Health Catalyst
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© 2014 Health Catalyst
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© 2014 Health Catalyst
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Predictions, Hopes and Aspirations for U.S. Healthcare in 2015

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Predicting events in healthcare, especially year to year, is incredibly easy because healthcare advances at a glacial rate. Any significant changes that do happen in a year are rare. The IRS and public education may be the only other institutions that move at such a creeping, crawling, reluctant pace. But that's not to say predictions aren't worth trying. And lately, there have been some interesting developments for the healthcare industry that could mean some intriguing change is finally coming our way.

Please join Dale Sanders as he makes his predictions for 2015, some serious, some irreverent, and some simply hopeful aspirations, but all thought provoking and worthy of discussion. Unlike his past webinars where he does all the talking, this time Dale wants to hear from you. So, we'll be opening up the audio lines to give you the opportunity to share your thoughts and votes on Dale's predictions, and share your own predictions for 2015 and beyond, too.

The discussion will cover the following, and more:

The barriers that stand in the way of significant year-to-year changes in US healthcare
The pending Supreme Court decision on state-level insurance subsidies
Mergers & Acquisitions
The looming reality of hidden patient costs from narrow insurance plans
Why the future of healthcare lies in the hands of physicians and patients, not hospitals and insurance companies
And in a less obvious twist, discover how the Denver Broncos will win the next five Super Bowls using spliced genetics.

It's always fun to look ahead and try to predict what might or might not happen. Come prepared to share your opinions,vote on Dale's predictions, and join in for a candid and lively conversation.

Published in: Healthcare

Predictions, Hopes and Aspirations for U.S. Healthcare in 2015

  1. 1. Predictions, Hopes and Aspirations for U.S. Healthcare in 2015 Dale Sanders Senior Vice President, Strategy
  2. 2. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Poll Questions 2 How are you involved in healthcare? a. Executive – 26% b. Clinician – 9% c. IT – 15% d. Data Analyst/Data Architect – 15% e. Other – 32% What is your primary functional area of expertise?
  3. 3. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Today’s Agenda And Format • Why is so healthcare so predictably unchanging, year-to- year? • Is there any good news? • The real predictions for 2015 • The aspirational predictions for 2015 • Poll questions for your predictions • Open the telephone lines for your comments, questions, and predictions
  4. 4. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Mean Time To Improvement Measured in years and decades for healthcare… why so long? 4
  5. 5. 5
  6. 6. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Only One Part of The Bad News 6
  7. 7. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. There Is Some Good News Maybe our MTTI will start to decrease? • BCBS of North Carolina posts contract prices with providers • http://www.bcbsnc.com/content/providersearch/treatments/index.htm#/ • Sec Burwell announcing “Our goal is to have 85% of all Medicare fee- for-service payments tied to quality or value by 2016, and 90% by 2018.” • NEJM, January 26, 2015 • Republicans (Hatch, Burr, Upton) offer alternatives to the ACA that seem to have merit • But aiming for repeal of ACA and replacing it with Patient Choice, Affordability, Responsibility, and Empowerment (Patient CARE) Act • UnitedHealthcare, Humana and Anthem Blue Cross Blue Shield offer HealthySavings discounts at grocery stores for buying healthy foods • Kenosha News, Feb 10, 2015 7
  8. 8. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  9. 9. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Asymmetric information in micro and macroeconomics; Nobel Prize, 2001.
  10. 10. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  11. 11. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Now, About Those Predictions… First, the most obvious… • Mergers & Acquisitions • Supreme Court • Accountable Care Organizations • Physicians • Drug reform • Broad insurance, narrow coverage • HIE Failures • EHR Disillusionment
  12. 12. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Mergers & Acquisitions CEOs with cufflinks and monogrammed shirts love mergers and acquisitions, fueled by the availability of cheap money and testosterone, until they realize they don’t have the data to manage the new company. CEOs with a lower wardrobe budget will also look for M&A opportunities, but will be careful, pragmatic, and data driven. The pragmatic settlers, not the pioneers, are going to create better, more efficient care through M&As in 2015. By 2020, 70% of US healthcare will be delivered by 9 very large, regional health networks
  13. 13. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Supreme Court The Supreme Court has two choices regarding King v. Burwell and federal subsidies: 1. Interpret the spirit of the law 2. Interpret the law’s precise wording If overturned, millions of voters would suffer financially from the loss of those subsidies. The Supreme Court will rule in favor of the subsidies and the Affordable Care Act.
  14. 14. Affordable Care Act • Congress will threaten to repeal it, altogether. • Obama will threaten to veto the repeal. • Eventually, the GOP will propose dramatic but effective changes that Obama will support. • Compassionate Capitalism
  15. 15. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Accountable Care Organizations Burdened by administrative overhead, federally ACOs will continue to struggle and underperform. In 2015, the federal government will start acting like the world’s largest customer of healthcare instead of the world’s largest bureaucracy of healthcare governance. The ACA will be rewritten, trimmed, improved and Obama will agree to the changes before he leaves office.
  16. 16. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Physicians In 2015, as the centroid of ACOs crystallizes around physician groups. Physician groups are gaining ground and will increase their lead over hospital and insurance centered ACOs. The future of accountable care resides in the hands of physicians.
  17. 17. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Pharmaceutical Cost Reform High-profile drug costs, such as Solvadi ($84,000 per regimen for hepatitis C), will spur debate and concern. But no meaningful progress on reform in pharmaceutical pricing will take place in 2015, thanks to pharmaceutical lobbyists and weak-kneed politicians. (US drug prices to consumers are 3x- 5x more than in Germany and the UK, btw)
  18. 18. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  19. 19. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Broad Insurance, Narrow Coverage Healthcare will hit 20% of GDP. Affordability of care will be hotly debated, once again. The expansion of “affordable” insurance policies will highlight the downside of very narrow networks and coverage. Patients will find very limited coverage and enormous out-of-pocket expenses that will drive uncomfortable headlines and subsequent changes to the ACA.
  20. 20. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Health Information Exchanges HIEs will go deeper into the “Trough of Disillusionment” The benefits of an HIE are in direct contradiction to the existing US economic model which rewards inefficiencies. Document-centric HIEs will be the worst in terms of perceived value by clinicians.
  21. 21. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. EHR Disillusionment The pain of reality is just beginning. 83% of clinicians have a negative view of EHRs. The outcry will deepen and broaden as the limitations of EHRs to support population health, clinical quality, value based purchasing, patient safety and clinician efficiency become more painfully obvious. They were designed for Healthcare 1.0, circa 1964. Are they to blame or are we?
  22. 22. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 22
  23. 23. © 2013 Health Catalyst www.healthcatalyst.com © 2013 Health Catalyst www.healthcatalyst.com Aspirational & Satirical Predictions
  24. 24. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Meaningful Use As Congress debates Meaningful Use, it will come down to these two barriers: 1. The EHR data interface is encounter specific rather than patient centric and inherently lacks an effective workflow. 2. EHR vendors see interoperability as a threat to their market share. Legislation will force EHR vendors to support interoperability-- technically, contractually, and economically.
  25. 25. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Wal-Mart Disrupts GPOs Wal-Mart’s entry into primary care clinics and the insurance market are the first steps towards the complete consumerization of healthcare. In 2015, Wal-Mart’s next disruptive step is in the logistics and supply chain of healthcare, where they will completely unsettle group purchasing organizations (GPOs) in five years.
  26. 26. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Cleveland Clinic Telemedicine Borrowing from lessons learned in military operations and command centers that managed over 400,000 troops in Iraq, the Cleveland Clinic will open a telemedicine command center that can monitor, interact, and manage 100,000 patients in post-acute home care, hospice care, and chronic condition management settings.
  27. 27. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Price Transparency Hospitals and physician groups will continue to drag their feet on the issue of price transparency, even though they are required by the Affordable Care Act to make their prices publicly available. Several states will pass laws to address this problem in 2015. Hospitals and clinics that do not post their prices on the web will not be allowed to pursue their bad debt collections through collection agencies or legal action.
  28. 28. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. DoD EHR Contract The DoD was once one of the most inefficient and wasteful operations in the world. Today the DoD culture embraces constant change, adaptability, precision, and execution. As a consequence, it will surprise everyone and delay its award of the $11B contract until existing vendors offer better solutions or a new, dark horse vendor appears with a modern, 5th generation EHR.
  29. 29. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Employer-Sponsored Medicine In a bold experiment to dramatically cut costs and improve the quality of care to their employees, Toyota will acquire two hospitals and two physician groups near their San Antonio facility in 2015. If this experiment succeeds—and it is expected to—Toyota plans to expand the model to all of their manufacturing plants in the U.S.
  30. 30. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Medical Tourism In Your Backyard Dr. Devi Shetty, founder of the 29-hospital Narayana Health System in India and Health City Cayman Islands, will open a 1000-bed hospital and affiliated clinics on a Native American reservation in the central U.S., most likely Oklahoma, providing a huge economic boost to the tribe, while operating under the benefits of sovereign nation protection.
  31. 31. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Affordable, Accountable Insurance State Governors will follow the lead of Colorado and require all hospitals and physician groups licensed in their states to offer their own health insurance plan, thus encouraging the same organizational balance between quality-of-care and cost- of-care as exemplified for decades by organizations like Intermountain Healthcare.
  32. 32. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Elimination of Federally Managed Medicare In a bold, bipartisan move, Congress will eliminate Medicare at the federal level, replaced by an expansion of Medicaid services and funding at the state level. Several independent analyses will indicate the move will save billions of dollars without sacrificing patient care. Quality of care will improve through tailored, regional personalization and local accountability.
  33. 33. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Taxation on Violence An anti-tax, 2nd Amendment Congress, will ensure all ammunition will be taxed at 50% and the proceeds will fund: 1. A national insurance program for all victims of murder and major life disabilities caused by firearms 2. Development of a behavioral health and cultural awareness and sensitivity program that deals specifically with the reduction of gun violence in the U.S., particularly mass shootings.
  34. 34. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The NFL and Genetic Medicine The Denver Broncos will steal DNA material from the Seattle Seahawks quarterback, Russell Wilson, and splice that into Peyton Manning's genome. The Broncos will go undefeated in 2015 and win five Super Bowls in a row.
  35. 35. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Jimmy Hoffa Mystery Resolved Two of the biggest mysteries of our generation will be simultaneously resolved when Mr. HISTalk reveals his identity in 2015.
  36. 36. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Poll Question #1 Will the Supreme Court rule in favor of Burwell and the Affordable Care Act? a. Yes – 76% b. No – 24% 36
  37. 37. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Poll Question #2 Will Congress and the President reach a favorable agreement on improvements to the Affordable Care Act? a. Yes – 18% b. No – 82% 37
  38. 38. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Poll Question #3 Will the DoD award an EHR contract to: a. Epic – 37% b. Cerner – 10% c. No one – 16% d. A surprising dark horse – 36% 38
  39. 39. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Poll Question #4 Will we make any significant progress on price transparency and availability, e.g., publicly available costs published on the web? a. Yes – 71% b. No – 29% 39
  40. 40. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Poll Question #5 Will clinician satisfaction with EHRs improve, decline, or stay the same? a. Improve – 34% b. Decline – 32% c. Stay the same – 34% 40
  41. 41. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Poll Question #6 Will Peyton Manning and the Broncos win the Super Bowl in 2015? a. Yes – 9% b. No – 74% c. What’s the Super Bowl? – 17% 41
  42. 42. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Thank You Upcoming Educational Opportunities How One ACO is Using Analytics to Drive Clinical & Operational Excellence Date: February 18, 2015, 1-2pm, EST Hosts: Gregory Spencer, MD Chief Medical Officer and Chief Medical Information Officer Crystal Run Healthcare Scott Hines, MD Co-Chief Clinical Transformation Officer Crystal Run Healthcare Register @ www.healthcatalyst.com
  43. 43. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 1. Go to your audio control panel. 2. Click on the icon to raise or lower your hand. 3. Dale will tell you you by name when your line is open. 4. Dale will mute your line and lower your hand when done. Time To Open The Telephone Lines! Click to raise Click to lower A Green Arrow Means Your Hand is Down A Red Arrow Means Your Hand is Up

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