Population Health

8 Reasons We Must Evolve

8 Reasons We Must Evolve 1. The way providers get paid is shifting. Fee-for-service reimbursement for physicians and hospitals are expected to become less frequent. Performance-based or value-driven contract arrangements, in which both hospitals and providers are expected to better manage patient health and contain costs, are increasing. 50 percent of payments will be tied to alternative payment ACO or bundled payment arrangements by the end of 2018. 90 percent of all traditional Medicare payments will be tied to quality or value by 2018 through programs such as Hospital Value Based Purchasing and Hospital Readmissions Reduction.

8 Reasons We Must Evolve 2. Our nation’s aging population is growing rapidly. By 2030, 20 percent of the US population will be age 65 or older. Life expectancy among the global population of people 85 or older is expected to increase 351 percent by 2050.

8 Reasons We Must Evolve 3. Our communities’ health is worsening. By 2020, 74 percent of the US population’s BMI scores will be categorized as overweight and obese. According to the CDC, 70 million Americans have high blood pressure. 29.1 million Americans have diabetes. 86 million have pre-diabetes. 40 million Americans smoke cigarettes.

8 Reasons We Must Evolve 4. Healthcare spending is ever-increasing. As of 2010, 72 percent of Medicare spending came from 34 percent of its population. These patients individually suffered from four to six chronic medical conditions. The US healthcare system is the costliest in the world, yet our population is considered unhealthy (IHI). Our healthcare dollars account for 17 percent of the gross domestic product and are expected to rise to 20 percent by 2020.

8 Reasons We Must Evolve 5. Healthcare providers are challenged to reduce inefficiencies and unnecessary work, often the result of disconnected or episodic care. In 2013, an estimated $750 billion was spent on inefficiencies and unnecessary work. (Institute of Medicine, 2013) Sadly, one in three patients experiences some form of harm or medical error. (Institute of Medicine, 2013) As of 2016, approximately two out of every 10 US doctors have not yet adopted electronic medical record (EMR) systems. (Office of the National Coordinator for Health IT) One approach embraced by CMS for cost containment is bundling payments, where providers share in an established bundled rate for episodes of care.

8 Reasons We Must Evolve 6. The cost of practicing medicine is rising, and physicians are burning out. Primary care practices spend an average of $50,000 annually on tracking and reporting quality measures and lose 48 minutes per day due to the EMR. (Advisory Board, 2016, Physician WorkForce Infographic) 81 percent of physicians report spending more time dealing with external quality measures than three years ago. (Advisory Board, 2016, Physician WorkForce Infographic)

8 Reasons We Must Evolve 7. Patient consumers are becoming more price sensitive and savvy. In the past decade, consumer healthcare costs have increased seven times faster than wages. (Beckers) In 2015, 24 percent of employees enrolled in employer-sponsored high-deductible plans, up from only 4 percent in 2006. (Beckers) Given a choice, about 41 percent of employees choose a high-deductible plan. (Benefitfocus) 80 percent of patient consumers think their doctors should discuss the cost of recommended treatments or therapies. With online transparency becoming an increasingly relevant factor influencing patient choice, 37 percent of consumers report avoiding a physician based on a negative review. (Advisory Board, 2016)

8 Reasons We Must Evolve 8. None of us can go it alone; we are smarter together. Nearly 700 Commercial and Medicare ACOs have been formed with physicians who have been able to maintain their independence and benefit from a collaborative partnership. The ACO model was formalized by CMS in 2011. As of mid-2016, there were nine Pioneer ACOs, 20 Next Generation ACOs and 433 Shared Savings Programs.

8 Reasons We Must Evolve The way providers get paid is shifting. Our nation’s aging population is growing rapidly. Our communities’ health is worsening. Healthcare spending is ever-increasing. Healthcare providers are challenged to reduce inefficiencies and unnecessary work, often the result of disconnected or episodic care. The cost of practicing medicine is rising, and physicians are burning out. Patient consumers are becoming more price sensitive and savvy. None of us can go it alone; we are smarter together.