Challenges Facing Healthcare Delivery Systems

Carl W. Taylor JDFraser Institute for Health and Risk Analytics

Telehealth Before Sequestration?

Where Did We Begin?• Fragmented silos of episodic

FFS care with some risk in some markets

• Push for EHR and connectivity with only a vague notion of why

• Explosion in the aging and chronic population

• No accountability for costs• Disconnect between wellness

as a preference and illness as a business

PPACA Is An Attempt To Try Something New

The First Barrier: Them vs. Us

The Second Barrier: Us vs. Us

The Third Barrier: Us vs. Them

The Health Reform Uncertainty

• There is a difference between Risk and Uncertainty

• We have always had risk in healthcare but now we have uncertainty

And The Current Future

• PPACA’s Contribution– Supreme Court ruling and election gives certainty

for today but leaves a Medicaid hole for some states

– Medicare Advantage cuts may impact benefits/MLR– CMS driven ACOs with likely un-eveness in

performance and higher market costs– CMS Duals Office- Un-eveness on its journey– Health Insurance Marketplaces (f/k/a exchanges)

will emerge in some form but with what populations

– CMS –CMMI will test a wide variety of programs to save money will any of them work

Reform Has Forced Consolidation Across All Players

And Created A Dilemma for Physicians

And The Doctor Question

• It is 3 a.m. in the morning I just finished delivering Mrs. Jones baby- what am I paid?

The FearsWill any of this workCan we balance the 3 R’s (risk, reward

and regulation)Who wins and more importantly how do I

win

When Choosing A Path Becomes Confusing

Some Options

1. Wait and do nothing-Keep The As Is State2. Build an expanded enterprise to create more leverage and market dominance- Some ACOs fall into this category.3. Build a risk bearing broader bio/psycho/social clinical enterprise where all professions are focused on coordinated quality and outcomes to overcome our common challenges……

Our 9 Common Challenges

• 1. We Must Re-invent the Physician Practice• 2. We Must Improve Our

Access/Understanding of Data• 3. We Must Accelerate The Adoption of

Successful Programs to Improve Patient Adherence and Physician Skills

• 4. We Must Improve Quality and Consistency of Outcomes Across All Domains

Common Challenges Together

• 5.We must reduce readmissions• 6. We must keep mom at home• 7. We must deliver more healthy babies and

raise healthier children• 8. We must create interdisciplinary

approaches to dealing with complexity• 9. We must reach the unreachable

Telehealth Under Health Reform

Our Future Is Now World

The Rise of Connected Knowledge

And Then How Do We

• Embrace, absorb, deploy or reject the 40,000 or so apps for healthcare?

What I Think I Think• We will navigate from episodic

encounters to continuous interactions.• Narrow networks will prevail not only by

offering quality and cost advantages but by achieving them through the appropriate use of emerging technology

A Confidential Secret: We Can Make This Work

If We Can Re-Language The Solution

Questions

Contact: Carl Taylor FIHRA cwtaylor1@gmail.com cwtaylor1 Skype