Healthcare Marketplace 1199 Nursing Conference December 1, 2017 - PowerPoint PPT Presentation

Healthcare Marketplace 1199 Nursing Conference December 1, 2017 Jeffrey Kraut Executive Vice President, Strategy Associate Dean, Strategic Planning 1

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Total National Health Expenditures US $ Billions 1970-2015 Repeal & ACA Replace Prospective Payment PPS Wage & Price Controls 3

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How Americans Get Their Insurance - Everyone Has a Different Deal 9 Million (3 %) 29 Million (9 %) ACA The Young U MEDICAID O N CHIP B I PCAP A PRIVATE N M Working-age INSURANCE S A 73 Million people C U A 153 Million (47%) (23%) R R E E D People MEDICARE age 65 56 Million (17%) and over The The The The broad poor near rich middle class 5 poor

NYC Inpatient Resident Discharges by Payor, 2016 Self-Pay/Other 40,257 4% Commercial/ HMO 202,986 Medicare 22% (incl. HMO) 317,779 34% Medicaid (incl. HMO) 364,098 40% N=925,120 Source: SPARCSver2017.10.20adj/ja 6 Excludes newborns (DRG 795)

Medicare and Medicaid Do Not Fully Reimburse Costs of Care Actual Cost $1.00 Medicare Reimbursement $0.91 Prices/Rates Set by Medicaid Government Reimbursement $0.88 7 7

Cost Shift Hydraulics Between Payors Uninsured $ Cost $ Medicaid $ Gap Medicare $ Gap Medicare & Medicaid Commercial Insurance Government Fixed Price Payors Negotiated Price Payors Uninsured Costs 8 8

STRATEGIC HEALTH PERSPECTIVES ℠

Percentage of f All ll Covered Employees Enrolled in in a CDHP in in 2016 10

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Drivers of Health Care Costs 12

Demand is increasing …but funding is limited Projected per capita medical spend Funds available for Care Declining Medical spend per capita • Cost shift to commercial payers unsustainable • Employers dropping coverage • Medicare running out of money • Compressed state budgets on Medicaid • Fewer taxpayers in line with aging population • Deficit and debt spending 2006 2010 2014 2018 2022 rising to fund care 13

Concentration of Health Care Spending in the U.S. Population, 2010 97.3% Determinants of Health 100% 81.7% Percent of Total Health Care Spending 80% 75.0% 65.2% 60% 49.5% 40% 21.0% 20% 2.7% 0% Top 1% 1% Top 5% 5% Top 10 10% Top 15 15% Top 20 20% Top 50 50% Bot ottom 50 50% (≥$53,238) (≥$18,086) (≥$10,044) (≥$6,696) (≥$4,639) (≥$829) (<$ <$829) Percent of Po Pe Popu pula latio ion, Ranke ked by by He Health alth Car are Spe pend ndin ing NOTE: Dollar amounts in parentheses are the annual expenses per person in each percentile. Population is the civilian noninstitutionalized population, including those without any health care spending. Health care spending is total payments from all sources (including direct payments from individuals and families, private insurance, Medicare, Medicaid, and miscellaneous other sources) to hospitals, physicians, other providers (including dental care), and pharmacies; health insurance premiums are not included. SOURCE: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical 14 Expenditure Panel Survey (MEPS), Household Component, 2010.

Triple Aim Better Health Triple Aim Information Incentives Integration Better Health Care Lower Cost 15

Looking For Value Better Health Care Lower Cost Better Health • Improved Processes • Improved Quality Outcomes • Accountable Care • Increased Efficiency • Better Patient Experience • Empowering Patients • Delivery Redesign • Reducing variation • Capturing Big Data • Scope of Practice • Continuum of Care Settings • Data Analytics • Lowest Cost Site of Care • Performance Transparency • Predictive Modeling • Tele-health • Shared Decision-Making • Social Determinants • Digital Substitution • Clinical Guidelines • Self-Care • End of Life Care (Access + Quality + Experience) Value = Cost 16

The Changing Landscape 17

Relentless Pressure on Inpatient Care AMBULATORY • Conversion of one-day stays to observation status CARE • Two Midnight Rule- Reduction in 2-day stays • Declining LOS through operating efficiencies • Reduction in readmissions and PQI’s admissions WORK • Hospital Acquired Conditions Penalties • Reduction in inappropriate SNF transfers to hospitals • Reduction in inappropriate ED utilization • Utilization declines due to other DSRIP initiatives HOME TRY TO GET PAID FOR THE REST: • Inpatient denials, • Pressure on price, trends and spend • Transformation from FFS to VBP • Shift from commercial to government resulting in lower payment rates 18

New York Metropolitan Area Hospital Closures since 2000 Closed Hospital Year of Closure County Beds Massapequa General Hospital 2000 Nassau 122 Brooklyn Hospital Center-Caledonian 2003 Kings 189 Island Medical Center 2003 Nassau 213 Our Lady of Mercy-D'Urso Pavillion 2003 Bronx 120 St. Agnes Hospital 2003 Westchester 142 Beth Israel Medical Center-Singer 2004 New York 200 Staten Island University Hosp-Concord 2004 Richmond 117 St. Joseph's Hospital 2005 Queens 120 St. Mary's Hospital-Brooklyn 2005 Kings 250 NY United Hospital Medical Center 2005 Westchester 133 Brunswick Hospital Center 2007 Suffolk 64 24 Hospitals (5,800 beds) St. Vincent's Hospital-Midtown 2007 New York 149 Cabrini Medical Center 2008 New York 474 Interfaith-Bklyn Jewish Division 2008 Kings 267 Parkway Hospital 2008 Queens 251 Victory Memorial Hospital 2008 Kings 243 Manhattan Eye, Ear & Throat Hospital 2008 New York 150 Mary Immaculate Hospital 2009 Queens 265 St. John's Hospital 2009 Queens 346 St. Vincent's Hospital & Medical Center 2010 New York 727 North General Hospital 2010 New York 170 Peninsula Hospital 2012 Queens 173 Long Island College Hospital 2014 Kings 506 Long Beach Medical Center 2014 Nassau 403

NYC Residents Inpatient Average Daily Census, 2010 - 2016 17,557 17,051 16,738 15,883 15,554 15,162 15,095 X X X X X 2010 2011 2012 2013 2014 2015 2016 20 Source: SPARCSver2017.10.20adj/ja Excludes newborns (DRG 795)

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Market forces are changing healthcare delivery Transformation Access Technology Healthcare Cost of Care Convenience Collaboration Quality Care 22

Data-Driven Approach to Care Management Determine Define Value-Based Contract Patient Risk Stratification and Determination of Contract Population* Identification Program Eligibility Type Traditional Fee-for-Service Contracts TIER 3A Proactive Analytics TIER 3 Hospital & ED Notification Value-Based Contracts TIER 2 1 2 TIER 1 3 TIER 1 Physician Referral *Not to scale 23

Programs Tailored to Individual Patient Needs Risk Stratification and Determination of Full Range of Care Management Programs Program Eligibility Tailored to Individual Patient Needs TIER 3A In-Person Care Management:  Hospice ANALYTICS & INFORMATION TECHNOLOGY  Advanced Illness Mgmt  Complex TIER 3A In-Person & Remote Care Management:  TIER 3 Complex TIER 3  Disease Mgmt  Telephonic  Transitional  Behavioral Health/SW  Resource Coordination TIER 2 TIER 1&2 Remote Care Management:  Prevention & Wellness, Gaps in Care  Utilization Management TIER 1 TIER 1 24

Consumerism Consumerism…new economics of health care Wednesday, February 15 Naval Heritage Center 9:30 AM

Consumer Engagement and Access by Health Status Acuity Guided Asynchronous Synchronous tele- Convenience care self-care e-primary care primary care Educational content Email, text, and/or Telephone or video Visit to retail or for self-care, secure messaging conference with convenience care clinician – potentially informed by with clinicians clinic appropriate medical supported by guidance diagnostic equipment Acuity Specialty care Primary care Emergency (appropriate Urgent care (office or home) department specialties only) Face-to-face Face-to-face Visit to urgent care Visit to emergency interaction directly interaction with center with higher department with primary care with specialist where acuity services than highest acuity provider in office or primary care visit is physician office services and easy not needed in in home access to full 26 advance hospital services

How healthcare consumers will access care in the future 1. Consumer Driven Tools Online information, Internet, appropriate AI-Powered Chatbots If clinically Healthcare Consumers 2. Virtual Care/Telehealth Virtual Visits, Remote Patient Monitoring appropriate If clinically 3. In-Person Care Physical/touch exams, Surgical Procedures 27

Virtual Care: Tele-Health and Tele-Monitoring 28

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NYS Employment Growth, 2000-2014 30

Statewide, jobs grew more rapidly in home health and ambulatory care between 2000 and 2014, compared to other health care settings 31

Growth Opportunities for Nursing Growth by Professionals by Setting 2014 Nursing and Allied Professionals Workforce Survey Report

New Competencies, New Jobs Looking for Nurses 2014 Nursing and Allied Professionals Workforce Survey Report