Once the Webinar begins, if you can’t hear the sound, please hang up and dial in again All attendees are on mute, so if you would like to ask a question, please type it into the Q&A box in the control panel on your screen If you would like to minimize the control panel so that you can see more of the screen, click on the white arrow in the small orange box and the control panel will be minimized. You can click on the arrow to open the panel if you would like to type in a question.
Rich Parker, M.D. Parker Healthcare Innovations raparkermd@gmail.com
US population – 320 million Medicare – 40 million elderly and 8 million disabled Medicaid – 58 million Commercial Insurance – +/- 200 million 32 million uninsured $9,000/person X 320 million = $2.9 TRILLION
$2.9 Trillion dollars spent on healthcare in 2013 17.9% of US GDP Median family income in Mass is $61,000 Family healthcare costs -- $24,000 Is something wrong??
Britai Britain Canada ada Fra ranc nce Germany many USA USA MRI Scan $187 $304 $398 $632 $1,009 Normal $2,792 $2,667 $3,768 2,147 $8,435 Childbirth Appendectomy $3,456 $3,810 $2,795 $3,285 $13,123 Average Not $7,707 $4,715 $4,718 $14,427 Hospital Stay Available Cataract Not $1,299 $927 $3,352 $14,764 Surgery Available Hip $9,637 $10,753 $12,629 $15,329 $34,454 Replacement Bypass Surgery $13,998 $22,212 $16,325 $27,237 $59,770 Source: International Federation of Health Plans
V = Q/C Value will win out in the end What is the risk of standing still in a changing world? What is the risk of moving ahead in a changing world? How will you assess these two choices?
In the FFS world, “the more I do, the more I make”. In the Global Payment world, “the more I do, the less I make”. Global Payment – long range view -- incentive is higher quality higher quality care resulting in decreased decreased expense Examples – colon cancer screening, cholesterol and BP control
Leadership Governance – roles of PCPs and specialists differ Quality of providers and services Information Technology Contracts Quality measures Reduction of Total Medical Expense (TME)
Accurate coding Pharmacy management – costs now higher than in-patient! RN Care Management NP Home Visits
NP Housecalls program Nurse care managers Referral to community home care services Disease management programs Clinical pharmacists 10
Data and analytics to measure and monitor quality and utilization Care coordination among specialists, providers, hospitals Predictive modeling to identify and target high-risk patients Registry to plan and track care, ensure follow up Resources to support patient education and self-management 11
Palliative Care/Hospice Care 1. Diabetes 2. Congestive Heart Failure 3. COPD 4. Chronic Kidney Disease 5. Behavioral Health 6.
Information technology Clinical infrastructure Culture and leadership Physician, advanced care practitioner, RN and hospital collaboration 13
PCPs and Advanced Practice Providers serve as the backbone Primary Care structure based on shared culture and geography Primary Care Leader training Specialists engagement 14
Management of Quality measures Interoperability for EMRs and data center Risk stratification Efficiency and utilization reporting 15
Complete understanding of all expenditures Admits, OBS Pharmacy Radiology Specialty visits and procedures Lab
Transparent sharing of data between groups “Best practices” benchmarks of utilization Mechanism for sharing of data and demonstrating progress over time Practice pattern variation analysis for common diagnoses, e.g. GERD, sinusitis and joint pain
Emergency department (ED) engagement Inpatient case management Skilled Nursing Facility (SNF) strategy Post-acute care 18
Moving more care into patients’ homes and other non- acute settings Increased patient care self management Ongoing initiatives to reduce excess utilization Constant emphasis on improving quality, and patients and families experience of care Finding innovative ways to increase specialist engagement 19
Thank You! Thank You! We hope you enjoyed this presentation. To make sure that you receive invitations to future Webinars, follow us: @ZurickDavis Rich Parker MD Parker Healthcare Innovations raparkermd@gmail.com
Recommend
More recommend
