REDEFINING HEALTH CARE How do we define “Value” in health care?

REDEFINING HEALTH CARE Value equals Outcomes?

REDEFINING HEALTH CARE Value equals Outcomes and Cost?

REDEFINING HEALTH CARE “Health outcomes achieved per dollar of cost compared to peers.” Three aspects: 1. Outcomes 2. Cost 3. Competition

REDEFINING HEALTH CARE Competition in the health care industry today. Competition is for a “piece of the pie” Little or no benefit to the patient

REDEFINING HEALTH CARE Zero-sum Competition 1. Cost Shifting to other participants 2. Costs actually increase 3. Overall no benefit

REDEFINING HEALTH CARE Zero-sum Competition 1. Cost Shifting to other participants 2. Costs actually increase 3. Overall no benefit

REDEFINING HEALTH CARE Example - Start

REDEFINING HEALTH CARE Example – Provider Mandate

REDEFINING HEALTH CARE Example – Cost Shift to Payer

REDEFINING HEALTH CARE Example – Cost Shift to Employer

REDEFINING HEALTH CARE Example – Cost Shift to Employee

REDEFINING HEALTH CARE Example – Cost Shift to Employee

REDEFINING HEALTH CARE Value Based Competition – 8 Aspects 1.The focus should be on value for patients, not just lowering costs. 2.Competition must be based on results. 3.Competition should center on medical conditions over the full cycle of care. 4.High-quality care should be less costly.

REDEFINING HEALTH CARE 5.Value must be driven by provider experience, scale, and learning at the medical condition level. 6.Competition should be regional and national, not just local. Value Based Competition – 8 Aspects

REDEFINING HEALTH CARE 7.Results information to support value- based competition must be widely available. 8.Innovations that increase value must be strongly rewarded. Value Based Competition – 8 Aspects

REDEFINING HEALTH CARE 1. Value from patient’s perspective 2. Outcomes information must be made available to consumers 3. Health care must move away from “Discrete Interventions” to “Cycle Of Care”. Value Based Competition

REDEFINING HEALTH CARE 1. Providers not only must be willing to be under scrutiny, they must initiate it. 2. Fear of litigation lessened if patient is making truly informed decisions. 3. Provider re-alignment from Service model to medical condition via the IPU. 4. I.T. cannot be seen as an enemy Changing Roles - Providers

REDEFINING HEALTH CARE 1. Health care structured along medical condition, not service. 2. All treatments, test, etc. aligned by medical condition. 3. Do not limit by facility nor even geography The IPU – Integrated Practice Unit

REDEFINING HEALTH CARE 1. No fear of I.T. and have gathered much data 2. May have more information about patient’s health habits 3. May be best suited as keeper of Medical Record Changing Roles – Health Plans

REDEFINING HEALTH CARE 1. Need to be main driver 2. Demand health plans contract with quality providers 3. Providers will have to report to have contracts Changing Roles – Employers

REDEFINING HEALTH CARE 1. Some government intervention required 2. Do not want nationalized healthcare 3. Must have universal health care 4. Re-examine medical laws such as Stark 5. Free up competition – do not restrict specialty hospitals Policy

REDEFINING HEALTH CARE 1. How feasible? Is it “Pie-in-the-sky”? 2. Providers may be hardest to convince 3. But there are many examples of advancement in this area. Conclusions