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HOW TO SURVIVE THE
HEALTHCARE TSUNAMI
May 2016
Industry Dynamics:
• Payment and Delivery becoming more
interdependent
• Health care becoming more retail
• New clinical care models transforming
care delivery
Industry Dynamics:
• Technology changes creating business
models to change
• Government is playing a larger role
• Local competitive dynamics shifting
Why is Change so Difficult:
• Fee for service engrained in existing
architecture/reimbursement
leadership is required to change
• Uncertainty of what future state looks like
• Value based models and measures are still developing in some specialties and settings
Why is Change so Difficult:
• Transformation requires funds for support
and infrastructure
• Health IT infrastructure needed to share
health information to new models to be
successful
• Difficult to communicate with patients,
doctors, employers, payers and others
How Do Companies Reduce Health
Care Cost:
• Through benefit design
• Pass through costs
• Incentive fees
• Company subsidy of copayments
How Do Providers Reduce Cost:
• Cost reduction does not work!
• Need to keep up with new costly technology
• Expert Labor costs are unsustainable
• New generation drugs always in demand
• Providers need to change the way care is delivered!
Things that you do not want to see!
• You do not want to see how Democracy works
• You do not want to see how sausage is made
• You do not want to see how healthcare is developed
What is the Problem in Healthcare
• Money’s worth vs. Cost
• Care vs. Value
• Reimbursement vs. Outcome
• Compassionate care vs. Technology
• As you can see, it is very difficult to define the overall objective of Healthcare
Current Trends
• OutPatient Services
• Pharmacy
• Inpatient Services
Current Trends
• Ambulatory & retail site
• Post Acute care
• Alternative care
• Government set the stage for providers to deliver care!
Opportunities
• Maximize HACHPS value based scores
COURTESY OF PERSON CLEANING ROOM RESULTS
0
25
50
75
100
1st Qtr 2nd Qtr
3rd Qtr Goal 4th Qtr
34
84 81
90 92
COURTESY OF PERSON SERVING FOOD RESULTS
NURSING RESULTS
0
22.5
45
67.5
90
2N 3N 4N ED
22
48
27
9
48 54
40
20
81
54 54
28
Nurses Treat w/ Courtesy and Respect HCAHPS - Overall MMC
HACHPS April 2015
HCAHPS May 2015
HCAHPS June 2015
HCAHPS July 2015
HCAHPS August 2015
Opportunities
• Maximize HACHPS value based scores
• Maximize quality incentives and Gain Share programs
• Develop Community Care Networks
• Expand services in growth areas
• Look for opportunities to allocate overhead in other service lines
• Develop Rural Health Centers in appropriate areas