Cardiovascular Market Update 2018 - UK HealthCare CECentral · Congress passes MACRA. 1. to...

Cardiovascular Market Update 2018 Market Realities Impacting CV Service Line Strategy Prepared for UK HealthCare Gill Heart and Vascular Institute Network

Cardiovascular Roundtable

Megan Tooley Practice Manager Advisory Board Tooleymadvisorycom

copy2018 Advisory Board bull All Rights Reserved bull advisorycom bull 35425A

2

Objectives

- Review market dynamics and regulatory changes impacting CV providers and the delivery of cardiovascular care

- Discuss opportunities for performance improvement that should be evaluated as part of CV service line strategy

Educational NeedPractice Gap

- The complexity of an ever-changing health care market makes it challenging for CV programs to prioritize efforts often leading to a more narrow focus on individuals metrics versus a holistic focus on value across the continuum

Megan Tooley has nothing to disclose


3

What a Year and a Half itrsquos Been

Source Cardiovascular Roundtable research and analysis

1) American Health Care Act of 2017 Better Care Reconciliation Act Obamacare Repeal and Reconciliation Act 2) Episode Payment Models 3) Department of Health and Human Services

January 20 2017 President Trump sworn in makes health care top priority on Day 1

bull July 25-28 Senate votes down AHCA BCRA ORRA1

bull September 26 Senate cancels vote on Cassidy-Graham

Key Milestones in Recent Health Care Agenda

New President of the United States

Attempts to Repeal Replace the ACA

Mandatory Cardiac Bundles Cancelled

November 30 CMS cancels mandatory CABG AMI EPMs2

New HHS3 Secretary

January 24 Alex Azar confirmed as HHS Secretary following resignation of Tom Price

MedPAC Weighs in on MACRA

January 11 2018 MedPAC asks Congress to replace MIPS with voluntary value program faces pushback

BPCI Advanced Applications Due

March 12 CMS opens new voluntary bundled payment model


4

Raising Questions About the Future of Riskhellip hellipBut Despite Uncertainty Payment Reform Will Remain in Some Form

Source Verma S ldquoMedicare and Medicaid Need Innovationrdquo The Wall Street Journal September 19 2017 wwwwsjcom Cardiovascular Roundtable interviews and analysis

1) Centers for Medicare and Medicaid Innovation 2) Medicare Access and CHIP Re-Authorization Act

Key Questions from CV Leaders

How will the new administration impact MACRA2 implementation

Will the new administration migrate away from payment transformation

How will CMS prioritize value-based initiatives moving forward

What is the future of CMMI1 and care transformation programs (eg ACOs)

Many Reasons to Bet on the Future of Payment and Care Delivery Reform

Strong bipartisan support for the concept of payment reform

Near-unanimous bipartisan support for MACRA legislation

CMS Administrator Seema Verma has confirmed continued support for value-based care

Current administration committed to testing new models to deliver and pay for health care through CMMI


5

5 Market Realities Impacting CV Providers


1

2

3

4

5

Margin pressure will only intensify for CV

CV is not just increasingly an outpatient business but an ambulatory business

MACRA is rewriting the rules on physician payment as well as alignment

As referring providers become more accountable for population health CV will be expected to play a bigger role

The shift to risk is not abatingmdashmore CV payment will be tied to cross-continuum cost and quality in the future


6

Guess Whatrsquos Not Getting Repealed Even If ACA Repealed Majority of Obama-Era Cuts Would Have Remained

1 Margin pressure will only intensify for CV

Source CBO ldquoBudgetary and Economic Effects of Repealing the Affordable Care Actrdquo June 2015 CBO ldquoLetter to the Honorable John Boehner Providing an Estimate for HR 6079 The Repeal of Obamacare Actrdquo July 24 2012 CBO ldquoCost Estimate and Supplemental Analyses for HR 2 the Medicare Access and CHIP Reauthorization Act of 2015 Budget of the United States Government (Proposed) FY 2016 Cardiovascular Roundtable research and analysis

1) Calculation includes ACA Inpatient Prospective Payment System Update Adjustments ACA Disproportionate Share Hospital payment cuts MACRA Inpatient Prospective Payment System update adjustments

ldquoProductivityrdquo Adjustments and Other Cuts to Reimbursement1 2017 2018 2019 2020 2021 2022 2023 2024 2025

($32B) ($48B)

($60B) ($71B)

($82B) ($94B)

($103B) ($116B)

($143B)

60 Significantly Impacting Margins

Percent of hospitals projected to have negative margins by 2025


7

CV Costs Increasingly Under the Microscope Key Market Trends Shaping the Economics of CV Care


1) Bundled Payments for Care Improvement Initiative 2) Hospital Value-Based Purchasing Hospital Inpatient Quality Reporting Merit-Based Incentive Payment System

Reimbursement Pressures bull Payment updates not keeping

pace with increasing costs

bull MACRA holding physician payments steady

bull Readmission reduction program

bull BPCI1 voluntary risk-based payment models

bull New VBP IQR MIPS2 episodic cost measures

Pay-for-Performance Programs Scrutinizing Episodic Cost

Shifting Demand to Less Profitable Services

bull Softening acute procedural volumes (eg CABG PCI)

bull Shift to outpatient medical care with lower margins

Cost-Sensitive Patients and Referring Providers bull Patients facing greater

out-of-pocket costs

bull Increasing price transparency

bull Referring providers increasingly accountable for costs under MACRA ACOs


8

No Relief in Sight CV Demographics Increasing Cost of Care Moving Forward

Source American Heart Association ldquoCardiovascular Disease A Costly Burden for AmericamdashProjections Through 2035rdquo (2017) Cardiovascular Roundtable research and analysis

Cost of CV Disease in United States

Drivers Impacting the Rising Cost of CV Care Delivery

Increase in staffing costs

Investment in more complex expensive technologies

Increasingly chronic comorbid patient population

2016 $555 billion

2035

$11 trillion


9

Carving Out a Role in Institution Efforts Clear Opportunity for CV to Support Targeted Cost Reduction Initiatives


Savings Potential

Difficulty

High Low Low

High

bull Reallocate acute care services across system

bull Rightsize excess inpatient capacity

Minimize Unwarranted Care Variation

Restructure Fixed Cost amp Assets

Reduce Labor and Supply Costs

bull Develop a foundation for implementing care standards

bull Eliminate quality shortfalls that increase cost per case

bull Update labor staffing models

bull Ensure value of supply contracting arrangements

Focus of C-Suite health system executives

More within CVrsquos realm of control


10

Ensuring Appropriate Use a Top CV Priority Regulatory Scrutiny Shift to Value put Appropriateness Back in the Spotlight


1) With a physician or qualified non-physician provider 2) With an independent non-interventional physician using

an evidence-based decision tool on oral anticoagulation

High-profile Legal Rulings on Misuse of CV Procedures

bull Hospitals fined millions of dollars for inappropriate PCI

bull Cardiologists found guilty of Medicare fraud for PCI and PVI

bull DOJ investigations of ICDs PVI

Value-Based Payment Initiatives

New Imaging Clinical Decision Support Requirement

bull MACRA includes use of appropriate use criteria for stress imaging as quality metrics

bull Success under bundled payments requires elimination of unnecessary care across the continuum

bull Medicare Appropriate Use Criteria Program requires ordering and performing physicians to consult AUC via electronic CDS for advance imaging exams including some for CAD

bull Reimbursement denials set to begin January 1 2021

Requirements for Shared Decision Making

bull New 2018 NCD for ICDs requires every patient receiving an ICD for primary prevention to have an encounter for shared decision-making using an evidence-based decision tool1

bull NCD for Watchman requires a formal shared decision making interaction2


11

19 19 18

12 11

-2 -3 -4 -5 -5

-12

-23

Outmigration of CV Services Marches On Inpatient Volumes Declining as Outpatient Takes a Greater Share

2 CV is not just increasingly an outpatient business but an ambulatory business


Get Custom Forecasts for Your Market

Access the CV Market Estimator for five year forecasts for CV services in your market

CV Five-Year Growth Projections by Sub-Service Line National All-Payer 2017-2022

Inpatient Cardiac Surgery

Outpatient Cardiac

Cath

Inpatient Arterial Disease

Inpatient Cardiac

Cath

Inpatient Medical

Cardiology

Inpatient Other

Vascular

Inpatient Cardiac

EP

Outpatient Vascular

Cath

Outpatient Cardiac

EP

Outpatient Medical

Cardiology

Outpatient Vascular Surgery

Outpatient Medical Vascular


12

Many Factors Driving CV ldquoOutrdquo Outpatient Shift Unlikely to Abate Given Changing Dynamics


1) Recovery audit contractor

Greater Risk for Total Cost

Shifting services contributes to lower total cost helps reduce readmissions by enhancing cross-continuum care

Market Forces Favoring Outpatient Shift of CV Services

Regulatory Scrutiny

RAC1 audits Two-Midnight Rule penalize for unnecessary inpatient admissions

Need for Hospital Efficiency

Triaging low-risk patients to lower acuity settings alleviates capacity constraints

Payer Steerage

Lower-cost settings help retain patients steered by insurers to alternate providers

Consumer Demands

Offering accessible care settings shorter wait times attracts patient and physician consumers


13

Site-Neutral Payments Shaking Up Outpatient Strategy Already Seeing Significant Cuts to Payment Rate for Off-Campus Sites

Source Centers for Medicare and Medicaid Services CMSgov Cardiovascular Roundtable interviews and analysis

1) Medicare Physician Fee Schedule 2) Hospital Outpatient Prospective Payment System

Access our cheat sheet on site neutral payments on the online resource page

Hospital Sites Meeting Three Criteriahellip

hellipReceive Less than Half of Previous Payment in 2018 2019

Reimbursed for all services on site-specific MPFS1 rate set at 40 of HOPPS2 payment down from 50 in 2017

Hospital-owned designated as ldquooff-campus provider-based sitesrdquo

Located more than 250 yards from hospitalrsquos campus

Acquired opened or built after November 1 2015


14

Tomorrowrsquos Ambulatory Strategy Looks Beyond HOPD Long-Term Priorities Require Service Placement Outside of Hospital

Source ldquoImaging Program Expands to Include Level of Care Reviews FAQrdquo Anthem Blue Cross Blue Shield May 2017 Cardiovascular Roundtable research and analysis

Lower copays for patients

Payment rate differential less significant than in the past

Community practice more accessible to patients providers

More attractive to payers who are steering patients to lower-cost providers

Benefits of Shifting Select Services to Physician Practice Setting

Case in Point Anthem to Deny Some On-Campus Imaging Services bull Select Anthem insurance plans

conducting level-of-care reviews for imaging exams

bull Will deny authorizations for HOPD CT MRI exams not requiring in-hospital testing

bull Ordering provider will be given list of alternative freestanding imaging facilities

Is Echo Next For more information on Anthemrsquos payment denials read our blog


15

Payment Reform Accelerates with MACRA With MACRA1 Underway 2017 a Pivotal Year for Value-Based Care

3 MACRA is rewriting the rules on physician payment as well as alignment

Source CMS Cardiovascular Roundtable research and analysis

1) Medicare Access and CHIP Reauthorization Act of 2015 2) Medicare Incentive Payment System 3) Advanced Alternative Payment Model 4) Episode payment models

A Brief History of MACRA

92ndash8 2015 Senate vote in favor of MACRA

2015 Congress passes MACRA1 to overhaul flawed sustainable growth rate (SGR)

2017 First performance year tying physician payment to risk will impact 2019 payment

Access our cheat sheet on MACRA on the online resource page

What CV Providers Need to Know

Key strategies to maximize performance under MIPS

Implications of each physician payment trackmdashMIPS2 versus APM3

The future of APMs for CV following cancellation of cardiac EPMs4

How MACRA will impact physician hospital alignment


16

Doubling Down on Cost in Addition to Quality Tying Physician Payment to Episodic Cost Metrics

1) 2019 MACRA QPP Proposed Rule

Category Weighting Under MIPS

60 50 45

25 25 25

15 15 15 10 15

2017 2018 2019

Source CMS ldquoMedicare Program CY 2018 Updates to the Quality Payment Programrdquo November 2 2017 Cardiovascular Roundtable research and analysis

Quality Promoting Interoperability

Improvement Activities Cost

By Performance Measurement Year1 Cost Metrics 1

2

3

Total per capita cost

Medicare spend per beneficiary

Proposed eight episodic cost measures for 2019 including the following for CV

bull Elective outpatient PCI

bull Revascularization for Lower Extremity Chronic Critical Limb Ischemia

bull STEMI with PCI Ensure Patients are Attributed to a PCP bull Attribution for total per capita cost is based on

patientrsquos utilization of primary care

bull Specialists can reduce the likelihood of attribution by encouraging patients to visit their PCP


17

An Environment Ripe for Partnership MACRA Will Drivemdashand RequiremdashHospital-Physician Alignment

Source Medical Group Management Association 2017 Cost and Revenue Survey Cardiovascular Roundtable research and analysis

$15128 IT operating expenses per FTE physician at a physician-owned CV practice

Improve performance under MIPS

Offload reporting burden

Stabilize practice economics

Case in Point IT Expense

Think Strategically About Alignment

Hospitals employing physicians will be accountable for physician performance under MIPS

Programs may restructure physician incentive models to incorporate metrics impacting performance under MACRA

Physicians Will Increasingly Look to Employment Tohellip Health Systems Shouldhellip

Consider opportunities to scale physician network to support new or existing risk contracts


18

Primary Care at Center of Population Health Efforts Seeing Continued Interest in ACOs but CV Often Left On the Sidelines

4 As referring providers become more accountable for population health CV will be expected to play a bigger role

Source CMS available at datacmsgov Advisory Board ldquoWhere the ACOs arerdquo available at advisorycom Cardiovascular Roundtable interviews and analysis

220 353 404 474 525

2013 2014 2015 2016 2017

Yet CV Leaders Rarely Involved in ACO Decisions

ACO Participation Continues to Grow Total ACO Participants by Performance Year

VP Heart amp Vascular Services Large Hospital in the Midwest

Our physicians are assigned to an ACO on the contract but as far as our involvement Irsquod say minimal at bestrdquo

Director of CV Services AMC in the Northeast

Wersquove received a global view and know the goals of the ACO but we havenrsquot quite formulated our strategies to function as one in CVrdquo


19

Risks of Non-Action Too Great to Ignore Accountable PCPs1 Changing Referral Patterns to CV Specialists


1) Primary care providers 2) Pseudonym 3) Aortic stenosis

Potential Consequences for CV Due to Care Redesign Initiatives

ACO PCPs hesitant to refer patients for high-cost specialty services

Patients referred later in disease progression with more acute needs

CV program locked out of referral network if not demonstrating high-value care

An Extreme Example Curie Hospital2

bull Large CV program with robust structural heart program

bull Hospital-employed PCPs joined ACO started referring fewer valve patients due to fear patients would receive expensive treatments (eg TAVR)

bull Structural heart program sees volume decline threatens stability

bull Patients with AS3 referred too late in disease progression

PCPs Acting as Gatekeeper for High-End CV Care


20

Positioning CV to Succeed Under Care Redesign Programs Must Demonstrate Value to Secure Continued Referrals


Secure Referrer Trust Strengthen referring physician alignment by demonstrating positive outcomes and appropriate utilization

Improve Patient Access Ensure timely convenient referrals and appointments in accessible care settings

Provide Quality Care at Low Cost Deliver high-quality low-cost care to demonstrate high-value CV care delivery

Imperatives for Success Under Care Redesign Initiatives

Market to Providers Based on Value Emphasize quality of care appropriate utilization and cost reduction efforts to attract referring PCPs


21

The Risemdashand Fallmdashof Mandatory Cardiac Bundles Future of Mandatory Programs Unclear but Voluntary Bundles Advanced

5 The shift to risk is not abatingmdashmore CV payment will be tied to cross-continuum cost and quality in the future

Source CMS The Daily Briefing ldquoHHS Sec nominee signals potential shift on mandatory payment modelsrdquo January 9 2018 Cardiovascular Roundtable research and analysis

1) Episode Payment Models 2) Bundled Payments for Care Improvement

bull Mandatory bundling for CABG and AMI originally slated to go into effect July 2017

bull Final rule released on November 30th cancels both programs

Cardiac EPMs1 Cancelled

bull Mandatory bundling for hip and knee replacements originally in 67 markets

bull Final rule makes participation in 33 markets voluntary cancels planned expansion to SHFFT

CJR Scaled Back BPCI2 Advanced Introduced

bull Optional bundling program providers may opt into any of 29 inpatient and 3 outpatient conditions

bull Program scheduled to begin on October 1st 2018 and run through December 31st 2023

New HHS Secretary Signals Potential Shift on Mandatory Payment Models

ldquoIf to test a hypothesis around changing our health care system it needs to be mandatory as opposed to voluntary to get adequate data then so be itrdquo

Alex Azar Secretary of HHS January 9 2018


22

Bundles are Back


1) Convener participant brings together multiple downstream episode initiators coordinates participation and bears and apportions risk non-conveners only bear financial risk on their own behalf

2) Provider must have 50 of Medicare fee-for-service payments or 35 of patients through Advanced APMs to qualify in performance year 2019

Retrospective 90-day bundles including 9 inpatient and 2 outpatient CV clinical episodes

Acute care hospitals and physician group practices are eligible episode initiators either as convener or non-convener participants1

Qualifies as an Advanced Alternative Payment Model for MACRA participants may be eligible for the APM bonus if they meet paymentpatient thresholds2

Downside risk begins day 1 unlike BPCI 10 there will not be a phase-in period for risk

Applicants do not have to select episodes until August 2018 and can see target prices before joining

January 11 2018 Application portal opens

March 12 2018 Applications due must name all episode initiators

June 2018 CMS provides target prices to applicants

July 2018 CMS releases Participation Agreements

August 8 2018 Participation Agreements due to CMS must select clinical episodes

Providers Must Act Quickly

YEAR 1 BEGINS 10118 SECOND COHORT 1120

1

2

3

4

5

Five Things to Know About BPCI Advanced


23

Episodic Scrutiny Goes Beyond BPCI Advanced CMS Tying More Payment to Risk for Episodic Cost Outcomes

Source Verma S ldquoMedicare and Medicaid Need Innovationrdquo The Wall Street Journal September 19 2017 wwwwsjcom Burwell SM ldquoProgress Towards Achieving Better Care Smarter Spending Healthier Peoplerdquo HHS January 26 2015 wwwhhsgov Cardiovascular Roundtable research and analysis

1) Inpatient Quality Reporting 2) Value-Based Purchasing Program

bull Cost category 30 of MIPS score by 2022

bull Comprises Medicare Spend per Beneficiary Total Per Capita Cost

bull 2019 proposed rule introduces eight episodic cost measures including

bullElective outpatient PCI

bullRevascularization for lower extremity chronic CLI

bullSTEMI with PCI

bull AMI HF excess days in acute care (IQR1 2018)

bull Hospital Readmissions Reduction Program (CABG AMI HF)

MACRA emphasizing episodic-cost measures

Episodic value measures added to pay-for-performance quality reporting programs eg

bull Over 500 Medicare ACOs in 2017

bull Physicians hospitals have greater interest in ACOs with significant risk in order to qualify as an Advanced Alternative Payment Model

bull Look to partner with high-value specialists

MACRA Pay-for-Performance ACOs


24

Private Sector Spurring More Innovation Risk-Based Payment Models Not Losing Steam for Private Payers

Source Health Care Transformation Task Force ldquoHealth Care Transformation Task Force Urges Incoming Administration and Congress to Continue Drive for Value-Based Paymentsrdquo December 6 2016 available on wwwhcttforg Cardiovascular Roundtable research and analysis

Percent of payments task force members (eg private payers) will tie to risk-based payment models by 2020

Commitment from Health Care Transformation Task Force

75

Medicare Advantage Continues to Grow

CMS testing Medicare Advantage Value-Based Insurance Design Model for enrollees in select states

Medicare Advantage will count as a MACRA APM starting in performance year 2019

Percentage of Medicare population enrolled in MA plans in 2025 40

Private payers piloting Centers of Excellence models designations to steer patients to high-value specialty providers


25

The Perils of Teaching to the Test Reactive Strategies Not Pathways to Success in an Uncertain Market


2010 2016

30-day HF Readmission Penalties Announced

Response

Mandatory cardiac bundles cancelled

No-Regrets Priorities

Build an infrastructure to eliminate unwarranted care variation implement evidence-based care standards

Partner across the continuum to improve outcomes and costs

Prioritize investments based on the demands of your market

Lower the cost of care delivery with appropriate staffing utilization

Old Response to Risk New Plan for Risk

bull Focus on HF

bull Hire HF nurse navigators

bull Focus on 30-days post-discharge

Mandatory Cardiac Bundles Announced

Response

bull Redesign physician incentives to support CABG AMI outcomes

bull Support PAC providers in delivering high-quality care through 90 days

First mandatory cardiac bundles track CABG AMI outcomes for 90-days

Planning for an Uncertain Future

Market Shift Market Shift

2018+


26



1

2

3

4

5






Cardiovascular Market Update 2018

Slide Number 2


Raising Questions About the Future of Riskhellip


Guess Whatrsquos Not Getting Repealed

CV Costs Increasingly Under the Microscope

No Relief in Sight

Carving Out a Role in Institution Efforts

Ensuring Appropriate Use a Top CV Priority

Outmigration of CV Services Marches On

Many Factors Driving CV ldquoOutrdquo

Site-Neutral Payments Shaking Up Outpatient Strategy

Tomorrowrsquos Ambulatory Strategy Looks Beyond HOPD

Payment Reform Accelerates with MACRA

Doubling Down on Cost in Addition to Quality

An Environment Ripe for Partnership

Primary Care at Center of Population Health Efforts

Risks of Non-Action Too Great to Ignore

Positioning CV to Succeed Under Care Redesign

The Risemdashand Fallmdashof Mandatory Cardiac Bundles

Bundles are Back

Episodic Scrutiny Goes Beyond BPCI Advanced

Private Sector Spurring More Innovation

The Perils of Teaching to the Test



2

Objectives

- Review market dynamics and regulatory changes impacting CV providers and the delivery of cardiovascular care

- Discuss opportunities for performance improvement that should be evaluated as part of CV service line strategy

Educational NeedPractice Gap

- The complexity of an ever-changing health care market makes it challenging for CV programs to prioritize efforts often leading to a more narrow focus on individuals metrics versus a holistic focus on value across the continuum

Megan Tooley has nothing to disclose


3












New HHS3 Secretary







4















5



1

2

3

4

5







6






($32B) ($48B)

($60B) ($71B)

($82B) ($94B)

($103B) ($116B)

($143B)




7















out-of-pocket costs




8








2016 $555 billion

2035

$11 trillion


9



Savings Potential

Difficulty

High Low Low

High













10



















11

19 19 18

12 11

-2 -3 -4 -5 -5

-12

-23








Outpatient Cardiac

Cath


Inpatient Cardiac

Cath

Inpatient Medical

Cardiology

Inpatient Other

Vascular

Inpatient Cardiac

EP

Outpatient Vascular

Cath

Outpatient Cardiac

EP

Outpatient Medical

Cardiology




12







Regulatory Scrutiny




Payer Steerage


Consumer Demands



13












14














15
















16




60 50 45

25 25 25

15 15 15 10 15

2017 2018 2019





2

3










17














18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






3












New HHS3 Secretary







4















5



1

2

3

4

5







6






($32B) ($48B)

($60B) ($71B)

($82B) ($94B)

($103B) ($116B)

($143B)




7















out-of-pocket costs




8








2016 $555 billion

2035

$11 trillion


9



Savings Potential

Difficulty

High Low Low

High













10



















11

19 19 18

12 11

-2 -3 -4 -5 -5

-12

-23








Outpatient Cardiac

Cath


Inpatient Cardiac

Cath

Inpatient Medical

Cardiology

Inpatient Other

Vascular

Inpatient Cardiac

EP

Outpatient Vascular

Cath

Outpatient Cardiac

EP

Outpatient Medical

Cardiology




12







Regulatory Scrutiny




Payer Steerage


Consumer Demands



13












14














15
















16




60 50 45

25 25 25

15 15 15 10 15

2017 2018 2019





2

3










17














18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






4















5



1

2

3

4

5







6






($32B) ($48B)

($60B) ($71B)

($82B) ($94B)

($103B) ($116B)

($143B)




7















out-of-pocket costs




8








2016 $555 billion

2035

$11 trillion


9



Savings Potential

Difficulty

High Low Low

High













10



















11

19 19 18

12 11

-2 -3 -4 -5 -5

-12

-23








Outpatient Cardiac

Cath


Inpatient Cardiac

Cath

Inpatient Medical

Cardiology

Inpatient Other

Vascular

Inpatient Cardiac

EP

Outpatient Vascular

Cath

Outpatient Cardiac

EP

Outpatient Medical

Cardiology




12







Regulatory Scrutiny




Payer Steerage


Consumer Demands



13












14














15
















16




60 50 45

25 25 25

15 15 15 10 15

2017 2018 2019





2

3










17














18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






5



1

2

3

4

5







6






($32B) ($48B)

($60B) ($71B)

($82B) ($94B)

($103B) ($116B)

($143B)




7















out-of-pocket costs




8








2016 $555 billion

2035

$11 trillion


9



Savings Potential

Difficulty

High Low Low

High













10



















11

19 19 18

12 11

-2 -3 -4 -5 -5

-12

-23








Outpatient Cardiac

Cath


Inpatient Cardiac

Cath

Inpatient Medical

Cardiology

Inpatient Other

Vascular

Inpatient Cardiac

EP

Outpatient Vascular

Cath

Outpatient Cardiac

EP

Outpatient Medical

Cardiology




12







Regulatory Scrutiny




Payer Steerage


Consumer Demands



13












14














15
















16




60 50 45

25 25 25

15 15 15 10 15

2017 2018 2019





2

3










17














18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






6






($32B) ($48B)

($60B) ($71B)

($82B) ($94B)

($103B) ($116B)

($143B)




7















out-of-pocket costs




8








2016 $555 billion

2035

$11 trillion


9



Savings Potential

Difficulty

High Low Low

High













10



















11

19 19 18

12 11

-2 -3 -4 -5 -5

-12

-23








Outpatient Cardiac

Cath


Inpatient Cardiac

Cath

Inpatient Medical

Cardiology

Inpatient Other

Vascular

Inpatient Cardiac

EP

Outpatient Vascular

Cath

Outpatient Cardiac

EP

Outpatient Medical

Cardiology




12







Regulatory Scrutiny




Payer Steerage


Consumer Demands



13












14














15
















16




60 50 45

25 25 25

15 15 15 10 15

2017 2018 2019





2

3










17














18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






7















out-of-pocket costs




8








2016 $555 billion

2035

$11 trillion


9



Savings Potential

Difficulty

High Low Low

High













10



















11

19 19 18

12 11

-2 -3 -4 -5 -5

-12

-23








Outpatient Cardiac

Cath


Inpatient Cardiac

Cath

Inpatient Medical

Cardiology

Inpatient Other

Vascular

Inpatient Cardiac

EP

Outpatient Vascular

Cath

Outpatient Cardiac

EP

Outpatient Medical

Cardiology




12







Regulatory Scrutiny




Payer Steerage


Consumer Demands



13












14














15
















16




60 50 45

25 25 25

15 15 15 10 15

2017 2018 2019





2

3










17














18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






8








2016 $555 billion

2035

$11 trillion


9



Savings Potential

Difficulty

High Low Low

High













10



















11

19 19 18

12 11

-2 -3 -4 -5 -5

-12

-23








Outpatient Cardiac

Cath


Inpatient Cardiac

Cath

Inpatient Medical

Cardiology

Inpatient Other

Vascular

Inpatient Cardiac

EP

Outpatient Vascular

Cath

Outpatient Cardiac

EP

Outpatient Medical

Cardiology




12







Regulatory Scrutiny




Payer Steerage


Consumer Demands



13












14














15
















16




60 50 45

25 25 25

15 15 15 10 15

2017 2018 2019





2

3










17














18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






9



Savings Potential

Difficulty

High Low Low

High













10



















11

19 19 18

12 11

-2 -3 -4 -5 -5

-12

-23








Outpatient Cardiac

Cath


Inpatient Cardiac

Cath

Inpatient Medical

Cardiology

Inpatient Other

Vascular

Inpatient Cardiac

EP

Outpatient Vascular

Cath

Outpatient Cardiac

EP

Outpatient Medical

Cardiology




12







Regulatory Scrutiny




Payer Steerage


Consumer Demands



13












14














15
















16




60 50 45

25 25 25

15 15 15 10 15

2017 2018 2019





2

3










17














18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






10



















11

19 19 18

12 11

-2 -3 -4 -5 -5

-12

-23








Outpatient Cardiac

Cath


Inpatient Cardiac

Cath

Inpatient Medical

Cardiology

Inpatient Other

Vascular

Inpatient Cardiac

EP

Outpatient Vascular

Cath

Outpatient Cardiac

EP

Outpatient Medical

Cardiology




12







Regulatory Scrutiny




Payer Steerage


Consumer Demands



13












14














15
















16




60 50 45

25 25 25

15 15 15 10 15

2017 2018 2019





2

3










17














18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






11

19 19 18

12 11

-2 -3 -4 -5 -5

-12

-23








Outpatient Cardiac

Cath


Inpatient Cardiac

Cath

Inpatient Medical

Cardiology

Inpatient Other

Vascular

Inpatient Cardiac

EP

Outpatient Vascular

Cath

Outpatient Cardiac

EP

Outpatient Medical

Cardiology




12







Regulatory Scrutiny




Payer Steerage


Consumer Demands



13












14














15
















16




60 50 45

25 25 25

15 15 15 10 15

2017 2018 2019





2

3










17














18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






12







Regulatory Scrutiny




Payer Steerage


Consumer Demands



13












14














15
















16




60 50 45

25 25 25

15 15 15 10 15

2017 2018 2019





2

3










17














18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






13












14














15
















16




60 50 45

25 25 25

15 15 15 10 15

2017 2018 2019





2

3










17














18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






14














15
















16




60 50 45

25 25 25

15 15 15 10 15

2017 2018 2019





2

3










17














18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






15
















16




60 50 45

25 25 25

15 15 15 10 15

2017 2018 2019





2

3










17














18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






16




60 50 45

25 25 25

15 15 15 10 15

2017 2018 2019





2

3










17














18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






17














18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






18




220 353 404 474 525

2013 2014 2015 2016 2017








19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






19















20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






20









21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






21

















22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






22

Bundles are Back
















1

2

3

4

5



23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






23









bullSTEMI with PCI










24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






24





75







25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






25



2010 2016


Response








bull Focus on HF




Response






2018+


26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back






26



1

2

3

4

5







Slide Number 2






No Relief in Sight














Bundles are Back





Cardiovascular Market Update 2018 - UK HealthCare CECentral · Congress passes MACRA. 1. to...

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Transcript of Cardiovascular Market Update 2018 - UK HealthCare CECentral · Congress passes MACRA. 1. to...