What CIOs Should Know about Health System Strategy in 2018 · Focused Payment Models, April 25,...

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What CIOs Should Know about Health System Strategy in 2018

Session 131, March 7, 2018

Naomi Levinthal, MA, MS, CPHIMS, Practice Manager,

The Advisory Board Company

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Naomi Levinthal, MA, MS, CPHIMS

Salary: The Advisory Board Company

Conflict of Interest

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Agenda• The State of the Healthcare Union

• System Strategy and IT Implications

• Successful Practices

– Clinical Decision Support

– Telemedicine

– Consumer Technologies

• Next Steps

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Learning Objectives• Identify key trends in the healthcare industry

• Recognize the impact of changing legislative and regulatory factors to health care business

• Apply strategic imperatives and their IT implications to your organization

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– Telemedicine


• Next Steps

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2017…. What a Year

1) American Health Care Act.2) Better Care Reconciliation Act.3) Obamacare Repeal Reconciliation Act.4) Health Care Freedom Act.

Key Milestones in Last Year’s Health Care Agenda

Source: Advisory Board interviews and analysis.

January 20th

President Trump

sworn in; signs,

health care

executive order

May 4th

After multiple

false starts, House

passes AHCA1

July 25th-28th

Senate votes

down BCRA2,

ORRA3, HCFA4

December 22nd

President Trump signs tax

bill into law; repeals ACA’s

individual mandate penalty

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A Three-Staged Approach to Repeal and Replace the ACA

Sources: The White House, “Three-Pronged Approach to Repeal and Replace Obamacare,” March 13, 2017; Advisory Board interviews and analysis.

1) Health Savings Accounts.

Administrative

Action

Additional

LegislationBudget

Reconciliation1 2 3

Proposed Target Areas:

• Repeal ACA taxes, employer and

individual mandates

• Replace insurance subsidies with

refundable tax credits

• Transform Medicaid into block grant

system

• Increase contribution limit of HSAs1

• Allocate funds for state innovations

• Require continuous coverage

insurance incentive

Process: Requires simple

majority in House and Senate


• Shorten individual market enrollment

period and limit special enrollment

• Loosen restrictions on actuarial value

of individual market plans

• Enable state flexibility through waiver

process

• Approve state Medicaid eligibility

changes (e.g., work requirements,

premiums)

Process: Federal agencies issue

regulation through rulemaking

Process: Requires simple majority

in House, super-majority in Senate


• Allow insurance to be sold across

state lines

• Expand use of HSAs1

• Allow formation of Association

Health Plans

• Reform malpractice regulation

• Streamline FDA processes

• Expand flexibility of state use of

federal dollars

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Guess What’s Not Getting Repealed

Sources: CBO, Budgetary and Economic Effects of Repealing the Affordable Care Act,” June 2015; CBO, “Letter to the Honorable John Boehner Providing an Estimate for H.R. 6079, The Repeal of Obamacare Act,” July 24, 2012; CBO, “Cost Estimate and Supplemental Analyses for H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015; The Daily Briefing, “How to Understand Last Week’s Big Budget Deal,” November 2, 2015; Budget of the United States Government (Proposed) FY 2016; Pham H, et al., “Medicare’s Vision for Delivery-System Reform – The Role of ACOs,” New England Journal of Medicine, September 10, 2015; Advisory Board interviews and analysis.

1) Inpatient Prospective Payment System; year-over-year estimates based on CBO total projected payment reductions, 2016-2025.

2) Disproportionate Share Hospital; repealed for non-expansion states under BCRA.3) Medicare Access and CHIP Reauthorization Act.

“Productivity” Adjustments and Other Obama-Era Cuts Remain

2017 2018 2019 2020 2021 2022 2023 2024 2025

($32B)

($48B)

($60B)

($71B)($82B)

($94B)

($103B)

($116B)ACA IPPS1 Update Adjustments

ACA DSH2 Payment Cuts

MACRA3 IPPS Update Adjustments ($143B)

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For Providers, a Relatively Limited Impact

Sources: Gaba, C., “Healthcare Coverage Breakout for the Entire U.S. Population in 1 Chart,” ACASignups.net, March 28, 2016, available at: http://acasignups.net/16/04/18/show-your-work-healthcare-coverage-breakout-entire-us-population-1-chart; Advisory Board interviews and analysis.

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1) Student, IHS, CH+.

Employer-Sponsored Insurance (47%) Medicare (17%)

Medicaid and CHIP (19%) Public Exchanges (4%)

Off-Exchange Plans (2%) Other (1%)

Uninsured (9%)

Approximate Coverage of US Population by Payer Sector

As of March 2016

~153MIndividuals with

employer-sponsored

insurance

~11.5MIndividuals with

insurance through

public exchanges

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Beyond the Headlines, a Larger Problem

Sources: Auter, Z., “U.S. Uninsured Rate Rises to 12.3% in Third Quarter,” Gallup News, October 20, 2017; CMS, National Health Expenditures; Gallup, “US Uninsured Rate Edges Up Slightly,” April 10, 2017; MedPAC, “Report to Congress on Medicare Payment Policy,” March 2017; Dobson, A. et al., “ Estimating the Impact of Repealing the Affordable Care Act on Hospitals,” Dobson DaVanzo & Associates, Dec. 6, 2016; Advisory Board interviews and analysis.

Q4 2013 Q4 2014 Q4 2015 Q4 2016

US Adult Uninsured Rate

Q3 2013:

18.0%

Coverage Expansion to Millions… …Drove Spike in Health Care Spending

HHS estimate of adults who gained

coverage as a result of the ACA

$1,000

$3,000

$5,000

$7,000

2010 2015 2020 2025

National Health ExpendituresActual Spend FY2010-2015, Projected FY2016-

2025, in billions

Estimate of increase in hospitals’ net income

due to new coverage under the ACA, 2014-2016

$44.6B22M

Q3 2017:

12.3%

$0

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Plenty of Open Policy Questions What to Watch: 2018

1 2 3Will President Trump use

additional executive

actions and regulations

to advance the GOP’s

health reform agenda?

Will the administration

use waivers to enable

broad flexibility or to

double-down on core

conservative principles?

Will Congress hold off on

legislation until 2019 or

revisit it in 2018 (e.g.,

either through tax reform

or bipartisan effort)?

Leading Indicators:

• Issued 49 executive orders to-

date; very first executive order

was focused on health care

• Has issued several health-care

related actions since FY2017

legislative effort stalled

Leading Indicators:

• Inconsistent in speed, criteria

for approving 1332 waivers

• Pending 1115 waivers could

enact broad Medicaid changes

Leading Indicators:

• 2018 budget resolution

focused on tax reform

• Sens. Lamar Alexander (R-

Tenn.) and Patty Murray (D-

Wash.) leading bipartisan

stabilization efforts


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No Relief Ahead

Sources: MedPAC, “Report to Congress: Overview of the 340B Drug Pricing Program,” May 2015; CMS, “Hospital Outpatient Prospective Payment System,” November 2017; Advisory Board interviews and analysis.

1) Hospital Outpatient Prospective Payment System.

2) Excludes drugs on pass-through and vaccines.

3) Excludes critical access hospitals, which are reimbursed under 340B for “reasonable cost,” not “average sales price.”

Redistributed as higher rates for non-drug services at all HOPPS

reimbursed facilities, including non-340B-covered entities

New Reimbursement3:

Average Sales

Price + 6%

Average Sales

Price – 22.5%

Current Reimbursement:

$1.6BTotal cut to 340B

reimbursement in CY 2018

2018 HOPPS1 Final Rule Cuts 340B Payments,

Redistributes Savings Across ProvidersSignificant Portion of

Hospitals Affected3

320Rural sole community hospitals,

children’s hospitals, PPS-exempt

cancer hospitals exempt from

payment change

45%Of hospitals participated

in 340B in 2014

1,018Hospitals participating in the 340B

program will see payment cuts

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0%

1%

2%

3%

4%

5%

6%

2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029

MACRA Dealing Physicians in on Risk

Sources: The Medicare Access and CHIP Reauthorization Act of 2015; CMS, Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models, April 25, 2016; Advisory Board interviews and analysis.

1) Relative to 2015 payment.

2015 – 2019:

0.5% annual update

(both tracks)

2020 – 2025:

Payment rates frozen

(both tracks)

Annual Provider Payment Adjustments

2026 onward:

0.25% annual update (MIPS track)

0.75% annual update

(Advanced APM track)

Advanced

APM Track

MIPS Track

Baseline

payment

updates1:

APM Bonuses/PenaltiesMIPS Bonuses/Penalties

5%Annual lump-

sum bonus

from 2019-2024

+/-4%Maximum annual

adjustment, 2019

+/-9%Maximum annual

adjustment, 2022

$500MAdditional bonus pool

for high performers

(plus any bonuses/penalties

from Advanced Payment

Models themselves)

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Payment Reform an Increasingly Popular Strategy


1) Patient Centered Medical Homes.2) Per-member per-month.

• Arkansas and

Tennessee

Accountable

physicians

rewarded or

penalized based

on quality and

cost performance

Total Cost of

Care

Upside Risk Only Potential for Downside Risk

• Alabama

Regional Care

Organizations

• Oregon

Coordinated Care

Organizations

• Vermont

Accountable Care

Organizations

• Maryland

Global budget

caps for hospital

services

PCMHs1 Bundled

Payments

Population-

Based, ACOs

• Arkansas

Offers PMPM2

payments and shared

savings potential if

cost and quality

thresholds are met

• Colorado

Distributes PMPM

payments to cover

enhanced services

(e.g. care

coordination)

• New Jersey

Funds private

hospital projects

focused on one

of eight conditions

• New York

Offers provider

coalitions incentive

payments for

delivery reform

Pay-for-

Reporting

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Employer Spending Continues to Grow

Sources: Gaba, C., “Healthcare Coverage Breakout for the Entire U.S. Population in 1 Chart,” ACASingups.net, March 28, 2016, available at: http://acasignups.net/16/04/18/show-your-work-healthcare-coverage-breakout-entire-us-population-1-chart; US Bureau of Labor Statistics, “Employee Tenure Summary,” September 2016 ; Berman, R., “Why Some Conservatives Are Unhappy About Obamacare Cuts,” The Atlantic, Dec. 17, 2015; Lee, B., “Mercer survey shows employers face a 4.3% increase in 2018 US health benefit cost, highest since 2011, but trend stable,” Mercer, September 18, 2017; Advisory Board interviews and analysis.

41%

23%

16%

1) September 2018 Mercer Employer Survey.

0%

10%

20%

30%

40%

50%

2009 2016

3-199 Workers

All Firms

200 or More Workers

Percentage of Workers by Annual

Deductible of $2,000 or MoreBy Firm Size, 2009-2016

Average Annual Growth Rate Among

Private Business’s Health ExpendituresFY 2014-2017

4.0%

5.0%

6.0%

7.0%

2014 2015 2016 20170

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Four Structural Threats to Providers


Near-Term

Volume Impact

Long-Term

Market Share Impact

Decreased

Demand

Extreme

Seasonality

Increased

Shopping

Reduced

Collections

Large out-of-

pocket

obligation

leading to

deferral of care

across all

services

Delaying high-

acuity elective

care until out-of-

maximum

achieved,

accentuating

volume shifts to

the end of the year

Growth of

transparency

apps facilitating

price

comparisons,

shifting

preference to

lower-priced

providers

Inability to pay

out-of-pocket

obligation

leading to

decline in

patient

collections

1 2 3 4

Near-Term

Pricing Impact

Evaluating the Near-Term and Long-Term Impact of Employer Cost-Shifting

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The Next Wave of Health Care Reform

Last Era of Health Reform:

Expanding Coverage

Next Era of Health Reform:

Reducing the Price of Care

Time

National H

ealth E

xpenditure

s

Evolution of Health Reform Goals Shifts Focus from Coverage to Spending

Payers pulling pricing

levers to decrease

health spending and

drive providers to reduce

cost of care


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Not the Best Time for Spending Cuts

Sources: Moody’s Investors Service, Preliminary Medians, 2013, 2014, 2015, 2016; Advisory Board interviews and analysis.

1) Operating margin= (total operating revenue- total operating expense)/ total operating revenue*100.

2) Excess margin= (total operating revenue- total operating expense + non operating revenue)/ (total operating revenue + non-operating revenue) *100.

2013 2014 2015 2016

Aa Baa Median Aa Baa Median Aa Baa Median Aa Baa Median

3.5%

0.8%

2.0%

4.0%

0.6%

2.2%

5.0%

2.0%

3.4%

4.4%

1.6%

2.7%

7.2%

3.3%

5.1%

7.6%

2.8%

5.3%

8.4%

4.2%

6.1%

7.2%

3.8%

5.7%

Operating margin Excess margin

Operating Margin1 and Excess Margin2 Medians of Freestanding Hospitals,

Single-State & Multi-State Healthcare Systems, by Bond Rating Category

3.7%

2.5%

3.1%

3.6%

2.2%

3.1%

3.4%

2.2%

2.7%

2.8%

2.2%

3.0%

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The Inevitable Margin Challenge

Source Advisory Board interviews and analysis.

Direct

reimbursement

pressure

Federalism and

state-based

coverage reform

Dilution of

commercial

coverage

Deregulation

and the new era

of competition

Shifting

demographics and

payer mix evolution

Rising

pharmaceutical

costs

Uncontrolled

labor spending

growth

Increasing

reliance on IT

enablement

Growth in purchased

services

Nine Structural Forces Compressing Provider Margins

1 2 3 4 5

6 7 8 9

Provider Margins

Dow

nw

ard

Pri

cin

g P

ressure

U

pw

ard

Cost

Pre

ssure

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Bad Debt on the Rise

Sources: Medicare Cost Reports 2010-2016; Inpatient Prospective Payment System (IPPS) Final Rule FY 2014-2020; Financial Leadership Council interviews and analysis.

1) Compares charity care levels if they had stayed constant from pre-ACA to charity care decreasing with a 21% CAGR (based on Cost Reports data from 2013 to 2016).

2) Compares bad debt levels if they had stayed constant from pre-ACA to bad debt increasing with a 5% CAGR since 2011 (based on Advisory Board proprietary data from 2011 to 2015), plus Medicare DSH reductions.

Modeled Impact on Hospital Finances350 Bed Hospital

Average Hospital

300-400 beds

$350M in revenue

($1.2 M) ($2.1 M)

($2.8 M) ($3.6 M) ($4.1 M)

$1.9 M$2.6 M $3.2 M $3.2 M $3.2 M

$769 K $561 K $353 K

($391 K) ($896 K)

Yearly Losses from Growing Commercial Bad Debt and Reduced DSH Payments

Yearly Savings from Reductions in Charity Care

Net Impact on Revenue

2014

Yearly Savings1

Dollars saved due to the decline

in charity care as a result of

coverage expansion

Yearly Losses2

Dollars lost to growth in bad debt

due to high deductibles, plus

reduced Medicare DSH payments

2015 2016 2017 2018

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New Tools Aim to Facilitate Consumer Shopping


Employers Entering a New Era of Health Benefits Strategy

Current Phase:

Facilitating Decision Making

First Phase:

Cost Shifting

Shifted costs to

employees by

transitioning to high-

deductible health plans

Curating networks to

incentivize use of higher-value

providers

3

Offering enhanced tools to

simplify value-based shopping

2

Leveraging scale to demand

greater value from delivery

system

1

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Value to Consumers Paramount


• Lower prices: After adjusting

for inflation, airline prices have

declined by 50% since 1978

• Superior delivery model:

Increase in number of routes,

fare classes has made flying

more accessible

• Upgraded infrastructure: Number

of branches grew from 53,000 in

1980 to 71,000 by the end of 1998;

digital banking now on the rise

• Superior delivery model: Wider

range of products and services (e.g.

types of accounts, personal finance)

• Lower prices: Cost of wireless

voice service per minute has

declined by more than 30% since

1993

• Upgraded infrastructure: National

networks now ubiquitous, enabling

affordable long-distance calls

Consolidation and Scale Deliver End-User Value in Other Industries

Imperatives for Health Systems

Reduce Prices

Bring down both unit cost

and total cost of care

Improve Delivery Model

Make care more convenient

and consumer-focused

Upgrade Infrastructure

Use scale to improve and

expand asset base

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Economic Model at a Crossroads


Privately Reimbursed

Procedural Care

Publicly Reimbursed

Medical Care

Largest patient base comprised

of commercially-insured,

middle-aged patients in need of

imaging services and surgeries

Patients covered by Medicare

or HDHPs, in need of medical

management, low-acuity

preventive care

Yesterday's Model: Today’s Model:

Reimbursement Model and Customer Needs Shifting Simultaneously

VP Of Strategy,

Integrated Delivery System in the Northeast

If you have a commercial cost structure and you’re getting public

reimbursement, there’s no silver bullet that will save you. You could pull every

utilization and care management lever under the sun, and you’d still be

underwater.”

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– Telemedicine


• Next Steps

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Strategic Challenges in 2018


Time

Valu

e P

ote

ntial

Long-

Term

Near-Term

Low

Hig

h

• Continued site-

of-care shifts

• Greater total

cost of care

accountability

Transform Care

Delivery Model

Rebuild

Health System

• Outsized pharma cost

growth

• Rapid workforce growth

Reduce Cost

of Operations

• Unsustainable

fixed costs

• Insufficient

scale, market

relevance

• Unrealized

system

advantages

Strategic Imperatives

1. Identify opportunities to

inflect pharma spending

2. Eliminate unwarranted

care variation

3. Rightsize and reconfigure

the clinical workforce

4. Expand to new sites of

care

5. Reevaluate risk strategy,

transition path

6. Reallocate services

across the system

7. Eliminate excess capacity

8. Capitalize on internal

advantages of scale

9. Embrace radical growth

strategies

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IT Contributions to Health System Challenges


Time

Valu

e P

ote

ntial

Long-TermNear-TermLow

Hig

h

• Deploy

telemedicine

Transform Care

Delivery Model

Rebuild

Health System

• Use clinical

decision support

Reduce Cost

of Operations

• Adopt

consumer-

centric

technologies

Strategic Challenges

27





– Telemedicine


• Next Steps

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Manage the Demand

Business and

Clinical Strategy (e.g., care variation

reduction)

Regulatory

Measures

Administrative

Objectives

Niche Clinician

Objectives

Quality Measures Proposed

CDS


? ??

Front-Line

Clinician

CDS Target:

End-User

Too many alerts,

questionable

importance to

patient care

!

Decide

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CDS Lifecycle, IT Implications

Identify Need

Define Rule

Build and Deploy

Measure Results

Refine Rule

• Analytics support

• End-user input

• CMIO, IT,

informatics support

• End-user input

• Select

implementation

route

• Facilitate project

• Analytics

• Visualization tools

• CMIO, IT, informatics support

• End-user input


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Clinical Knowledge Management Cycle

Build new

CDS

Maintain

CDS over

time

Monitor

performance

Investigate

and improveIdentify

• Ensure adherence

to standard of care

• Assign SME1 owner

• Design and

implement with

clinical process

owners

• Review regularly

for clinical,

business currency

• Usage, firing rates,

override rates,

action taken rates,

effects on outcomes

• Investigate and

improve as

indicated based

on performance

data, or retire

• Identify

malfunctioning

CDS from

monitoring data,

log, and repair

1) SME = Subject matter expert.

Manage


CDS Anomalies Detection at Partners HealthCare

• Large integrated health system based in the Northeast

• Described CDS anomalies

• Platforms to track CDS activation rates, trends; detect malfunctioning CDS

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Fewer and Better Alerts

Options for CDS

Regression Analysis for Vitamin D Screening Orders at Cedars-Sinai Following Alert Optimization

0

20

40

60

80

100

120

140

10/8/12 1/16/13 4/26/13 8/4/13 11/12/13 2/20/14 5/31/14 9/8/14

Daily

Ord

er

Volu

me

Date

Pre-Implementation Post-

Implementation

Design, Review, Build

Created an alert

to identify when unnecessary vitamin D

deficiency screenings were ordered

Test in Lab

Identified a clinical

scenario in which vitamin D

alert firings were unnecessary

Optimize Alert

Revised alert logic to suppress unnecessary

alert firing; next test showed significant increase

in accuracy, increased adherence

Optimizations


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A Permanent Clinician-Centered Infrastructure

System-Led Clinical Governance

Structure at Banner Health

Care Management Council

22 Clinical Consensus Groups

29 Acute Care Facilities

Care Management Leadership

Clinical Consensus Groups:

• 22 CCGs2 (e.g., Critical Care, Orthopedics,

Oncology, Primary Care)

• Each co-led by physician and non-physician

(typically a nurse)

• Multidisciplinary membership3 representing

frontline clinicians from across the system

• Define and lead implementation of system-

wide care standards

Care Management Council:

• Led by System CMO

• Includes all CCG1 leaders, CMOs, and CNOs

• Meets quarterly for three hours

• Approves all care standards, averaging 10-15

new or revised standards per quarter

1) CCG = Clinical Consensus Group.2) 22 CCGs: Perioperative, Behavioral Health, Critical Care, Cardiovascular Surgery, Women’s Health, Neuroscience, Emergency

Department, Pediatrics, Pharmacy and Therapeutics, Nephrology, Medical Imaging, Cardiology, Hospital Medicine, Infectious Disease, Primary Care, Orthopedics, Primary Care, Palliative Care, Post-Acute Care, and Oncology.

3) Includes physicians, bedside nurses, clinical informatics, pharmacy, supply chain, and therapy (occupational, respiratory, physical). Sources: Banner Health, Phoenix, AZ; Advisory Board interviews and analysis.

33





– Telemedicine


• Next Steps

34

The Telemedicine Spectrum


1) eICU = electronic intensive care unit.

Work

flow

Im

ple

me

nta

tio

n D

ifficulty

• Texting and Email

• Telephone

Messaging

Remote

Monitoring

Real-Time

Interventions

Data

Exchange

Telepresence

Telehealth Considerations

Technical Feasibility Implementation

Timeline

Financial Rewards

and Costs

Legal and Regulatory

Constraints

Delivery and

Communication

Strategy

• Remote

Radiology

Interpretation

• Dermatology

• E-visits

• Specialist

Consults

• Home Monitoring

• eICU1

• Telesurgery

Technological ComplexityLow High

Hig

hLow

Real Time vs.

Asynchronous

35 Source Advisory Board interviews and analysis.1) NP = nurse practitioner.

Five Key Operational Recommendations

Organizational

• Consider using specialty NPs1 to do

consults that bring in specialty business

(e.g., surgical programs)

• Beware: hopefully, you are now competing

with other strategic programs: welcome to

the big league

2Patient Experience

• Consider virtual care for areas where

waiting room experience is

toxic/suboptimal (e.g., psych)

• Brand your own patient app that links

patient to portal, virtual care access

(Stanford example)—requires EMR

integration with virtual visits program

36Source: Advisory Board interviews and analysis.

Five Key Operational Recommendations

3 Workflow

• Empower practices to determine virtual visit

workflow—no one right answer

• Consider staffing on-demand virtual primary

care calls through walk-in or urgent care

centers—good workflow fit

Case in Brief: Massachusetts General Hospital• Academic medical center based in Boston, MA; part of Partners HealthCare

• Multiple primary care practices; utilize Vidyo

• MGH provides practices with guidelines around training, setup, support,

coordination, documentation, and growth strategy, but practices given freedom to

choose workflow

• Practices converging on common workflow:

– Central coordinator meets with patients to test connections

– Patient dials in/provider picks up

– Use existing providers on staff

37 Source: Advisory Board interviews and analysis.

Five Key Operational Considerations

4Technical

• Monitor endpoints actively: ping spoke

sites and equipment; test for patient

connectivity, etc. Include telemedicine

in your business continuity planning

• Bootstrap new projects on existing

technical and operational

infrastructure. St. Luke’s, ID: telestroke

leverages eICU program infrastructure

Metrics• Select metrics that narrowly

measure success: clinical quality,

financial, efficiency

• Additional metrics to address

niche goals

38





– Telemedicine


• Next Steps

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The Consumer Relationship Platform


1

1. Digital Embeddedness

2. Hardwired Care

Coordination

3. Frictionless Interactions

Establish a Simplified

Consumer Platform

2Create an ROI for

Loyal Consumers

3Cultivate Consumer

Champions

4. Health-Motivating

Rewards Programs

5. Subscription-Based

Memberships

6. Value-Based

Insurance Design

7. Money-Back Guarantee

8. Economic-Focused

Care Support

9. AZ Familiarity

10. Collaborative Care Planning

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Care Team

Remaining Connected Through a Range of Devices

Sources: Milani RV, et al, “Improving Hypertension Control and Patient Engagement Using Digital Tools,” Am J Med, 130, No.1 (2016):14-20; Advisory Board interviews and analysis. 1) The absolute decrease in the percentage of patients with low patient activation in the study population went from 15% to 6%.

Health CoachPharmacist

Physician

Referral

Consent and

Questionnaire

Device

Training

Submission of

Health Data

Care Team

Interventions

Monthly Report

on Performance

Intervenes if patient

stops tracking

medication

Reaches out to patients

who stop tracking

healthy behaviors

Case in Brief: Ochsner Health System

• 28-hospital health system based in

New Orleans, LA

• Digital Medicine Program engages patients

to participate in health management by

tracking relevant health indicators through

digitally connected devices

• Dedicated health coach and pharmacist

ensure compliance with care plan and

make adjustments when needed

Ochsner Digital Medicine Program

Of hypertension patients under

control within 90 days (31% for

control)

9%Decrease in patients

with low activation1

71%

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Patient-Centered Billing Finalizes Transaction

Sources: Rawdan M, “St. Luke’s Bill Pay Eases the Way, Gives Patients a Say,” September 2015, https://www.stlukesonline.org/blogs/st-lukes/news-and-community/2015/sep/st-lukes-bill-pay-eases-the-way-gives-patients-a-say; Advisory Board interviews and analysis.

Case in Brief: St. Luke’s Health System

• Nine-hospital health system based in Boise, ID

• Identified billing and payment as source of most patient

complaints

• In 2014, partnered with local company to implement “patient-

centered billing”

• Users can see exactly what they owe, pay, and set up

payment plans in minutes

• In one year, new system has seen 17,758 unique patient

users, over 58,000 interactions, $9.2M in payments, and

$10.5M in payment plans

Streamlined Information

• Eliminated long paper bills

• Offered access to transaction history

Expedited Process

• Streamlined payment process online

• Reduced time required to pay

Longer Repayment Timeline

• Expanded to 36-month repayment period

• Created automatic payment options

105%Increase in patient

financial experience

scores since 2013

Increase in payment

performance compared to

traditional billing method

30%

It isn’t about charges; it’s about comprehension.

If we can provide patient-centered care, why

can’t we provide patient-centered billing?”

Dr. David Pate, CEO

https://www.stlukesonline.org/blogs/st-lukes/news-and-community/2015/sep/st-lukes-bill-pay-eases-the-way-gives-patients-a-say

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Provide Turn-by-Turn Directions, Campus Assistance

Sources: Kim M, “For Hospitals: Don’t get lost on your way to better wayfinding,” Modern Healthcare, January 21, 2017; Shepard B, “UAB to

offer indoor wayfinding navigation at UAB Hospital and clinics,” UAB News, October 25, 2016; Advisory Board interviews and analysis.

University of Alabama at Birmingham (UAB)

Medicine Beacon-Powered Wayfinding

Technology in Brief: Beacons

• Works off of Bluetooth Low Energy, standard on

most smart mobile devices

• Relatively low-cost and low-energy consumption

• Reasonable and adjustable range—inches to 50

meters

• Ability to communicate directly with end users

(patients, clinicians, staff)

• Widespread use in retail, sports, and hospitality

industries; early adopters in health care industry

• Capability to reach patients can be worked into

existing mobile application

• Vendor options range from startups to

entrenched RTLS firms

Provides turn-by-

turn directions

Recommends

best place to park

Navigates back

to parking spot

1) BLE = Bluetooth Low Energy.

http://www.modernhealthcare.com/article/20170121/TRANSFORMATION01/170119973

: https:/www.uab.edu/news/service/item/7716-uab-to-offer-indoor-wayfinding-navigation-at-uab-hospital-and-clinics

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– Telemedicine


• Next Steps

44

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Transformation, Exponential Technologies, New Role for IT

Sources: Moore J, “Microsoft Digital Transformation: CIOs to See Industry, Partner Focus,” TechTarget, July 2017, http://searchcio.techtarget.com/opinion/Microsoft-digital-transformation-CIOs-to-see-industry-partner-focus; Health Care IT Advisor research and analysis.

Transformative Forces

Fee-for-service incentives

to value and affordability

Acute conditions plus

prevention, precision,

chronic conditions

Encounters and episodes

plus longitudinal care

management, whole

person orientation

Passive patients to

active participants

Technologies Advancing in Parallel

Future, New

Role for IT

Security?

Privacy?

Interoperability?

Usability?

Governance?

Dystopia?

Computer power

and capacity3D printing

Artificial

intelligence

Material

sciences

Networks

and sensors

(IoT)

Virtual and

augmented

reality

Robotics and

drones

Synthetic

biology

Digital transformation is not

about technology. It’s about

redefining an organization's value

proposition and, ultimately, a

redesigning of the organization.”

Dr. Jeanne Ross, Director

MIT Sloan Center for IS Research

http://searchcio.techtarget.com/opinion/Microsoft-digital-transformation-CIOs-to-see-industry-partner-focus

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45

Communicate and Focus on the “IT Value Equation”

Source: Health Care IT Advisor research and analysis.

Be

ne

fits

Costs (and Time)

Automation,

point solutions

justified by ROI

Enterprise apps and analytics,

focus on operational excellence

Centralization, standardization to

reduce IT spending growth rate

Digitization, optimization,

interoperability, focus on IT-

powered strategy enablement

and innovation at scale

Complexity created by multiple

point solutions

“History has repeatedly shown

that arguing against technology

is a losing proposition.”

Dr. Michael Blum, Director, Center for

Digital Health Innovation, UCSF

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Next Steps

Source: Health Care IT Advisor research and analysis.

Utilize IT Benchmarks, Where Available

Develop a Common Vision Across the C-Suite

Build a Full CEO-CIO Partnership

Move IT from the “Backroom to the Boardroom”

Communicate and Focus on the “IT Value Equation”

47

Questions

• My contact information:

Naomi Levinthal, MA, MS, CPHIMS

Practice Manager

The Advisory Board

Email: [email protected]

LinkedIn: www.linkedin.com/in/naomi-levinthal

• Please complete the online session evaluation

mailto:[email protected]

http://www.linkedin.com/in/naomi-levinthal

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