Healthcare Megatrends: Pursuit of the Triple Aim

Altegra Health Summit Las Vegas March 20, 2014 Charles Kenney

Introduction

Seven Key Trends in Health Care

1.  Triple Aim

�  Improving the patient experience of care (including access, quality, satisfaction)

�  Improving the health of populations

�  Reducing the per capita cost of care

Mark Fabiano Executive VP Altegra Health

“Whether your politics are red or blue, liberal or conservative, no one can be against the Triple Aim.”

Seven key trends

2.  Overhaul/reinvigoration of primary care

3.  Lean management

4.  Large employers marketplace clout for quality/affordability

5.  Payment reform

6.  Marketplace consolidation

7.  The doctor crisis: preservation/enhancement of physician careers

Triple Aim

�  Reality today?

American Health Care: View from 50,000 feet

�  Orthopedics

�  HIV

�  Human genome

�  Life expectancy

�  Cancer

Ground-level view

�  My friend Steve

Triple Aim / Triple Failure

�  Disastrous patient experience of care

�  Epidemic patients falling through cracks

�  Huge cost of treatment

Transformation of Primary Care

�  Old model: Sorry you are sick. We will try to heal you.

�  New model: We will do everything we can to prevent you from getting sick in the first place.

Virginia Mason promise

We will

�  Prevent you from getting sick whenever possible.

�  “We cannot have any of our patients walking around in an unsafe condition.”

Primary Care a Team Sport

�  Rewrite the primary care lineup card

�  Let doctors be doctors leading a team.

�  Breakthrough: Flow in primary care

Kaiser Permanente: World class primary care

�  Mary Gonzales meets Susan Salas

Virginia Mason: At the heart of three trends

�  Lean

�  Primary Care renewal

�  Employer marketplace

clout

Lean Pathway to Triple Aim

�  Lean management �  Improves patient experience of care �  Improves population care �  Controls costs

�  Power of lean method/tools �  Professional liability cost down 74 percent since 2005 �  20-60 percent more affordable �  Virginia Mason Institute

Power of Major Employers to Drive the Triple Aim

�  When purchasing non-health care goods/services, most companies exacting procurement standards.

�  Why not the same approach in purchasing health care?

Starbucks Marketplace Clout

�  Uncomplicated low back pain

�  Again, the power of lean

�  From a wasteful, provider-centric approach to a lean, patient-centered approach

Starbucks Specs

�  Evidence-based care

�  100 percent patient satisfaction

�  Same-day access

�  Rapid return to function

�  Affordable price for employers and providers

Quality up, costs down

“When employers use purchasing power in procuring health care with the same attention they invest in buying other goods and services, they get better quality at lower cost.”

Dr. Bob Mecklenburg

Understanding costs

�  Identify and focus on most costly medical conditions �  back pain �  headaches �  shoulder, knee and hip pain �  other common conditions

Payment reform

�  Historically costs hard to contain under FFS

�  The more you do, the more you are paid

�  What if the team paid keep Steve healthy?

How will you be paid?

�  Capitated

�  Bundled

�  Reference pricing: 2011 California “reference-based pricing” for state workers/retirees

Alternative Quality Contract

�  Pay for quality not procedures

�  Kate Koplan – highest and lowest performers

Challenging transition to capitated plans

�  AQC patients treated differently than FFS patients?

�  Make sure AQC patients covered on all quality metrics – paid to do so.

Consolidation

�  Reduces competition

�  Increases prices

�  Where is this going?

Martin Gaynor, Carnegie Mellon University

�  We have allowed U.S. health care markets to

become concentrated and uncompetitive.

�  Higher prices, lower quality, less innovation, poor

service.

�  Harms consumers

The Doctor Crisis

�  Burnout/job dissatisfaction

�  "Taking physician satisfaction seriously does not mean giving physicians anything they want, but it should mean creating an environment where physicians are always able to put patients first.“ Jay Crosson MD, AMA

From new book

�  We need to liberate doctors from the work that others can capably handle to allow physicians to focus on providing the best care possible.

�  Preserving the professional dignity and idealism of physicians and enhancing their career experience can play a major role in achieving a patient-centered system.

Physician leadership essential

�  Docs part of the problem/Essential to the solution

�  Remove barriers between doctors-patients

What does leadership look like? What are characteristics/behaviors of leaders?