Transcript Serving Communities: The Role of the Triple Aim, the

DU Strategic Issues Panel
Jay Want, MD
December 9, 2010
Today’s Agenda
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Why health care has to change, and why it
has to now
How health care will change over the next two
decades
What part information technology will play
Other cost containment mechanisms
What’s Not On Today’s Agenda
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The magic bullet (single factor solutions)
How IT will magically improve health care without any
effort on anyone’s part
Ways to “build a seawall” against health care reform
How to find $10 trillion of other people’s money over the
next decade to allow us to continue with the current FFS
mess (the Chinese are on to us)
Why can’t health care cost grow
infinitely?
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Health care costs compete with all other costs:
transportation, investment in innovation, education
Competitors who spend more on raw materials generally
lose to competitors who spend less; health care is a raw
material for all other goods and services
We are losing global competitiveness, partly because it
costs too much to provide health care to our people
relative to other countries
Poor global competitiveness=high unemployment for a
really long time
What’s The Problem?
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Theories about what’s wrong with health care:
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Cost
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Access
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It’s greedy (insurance companies, doctors, hospitals,
pharmaceutical companies); if they were eliminated from the
equation, cost would come into control.
It’s that I’m paying for everyone else; if I just weren’t paying for
the uninsured, I could afford it. Or, if I could eliminate the cost
shift associated with the uninsured, I could afford it.
Quality
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It’s that the quality is so poor; if everyone would just do the right
thing, health care would be affordable.
Okay, There Are At Least Two More
Problems
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Problem 1: We think there’s only one problem.
Problem 2: Even if we think there’s a problem, not
everyone’s sure they want to fix it.
The Road To Hell Is Paved With Good
Intentions And Other People’s Money
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Third party payer system creates gigantic pool of
unsupervised money
Innovators learn how to provide more stuff, in bigger
billable chunks
Giant sucking sound: providers of care hooking hoses up
to government/business treasuries and turning on the
vacuum
Managed care clogs up hose, open access clears clog
Designing larger bore vacuums is a growth industry
American health care inflation roughly double what it is in
other developed nations since 1965
International Comparison of Spending on Health
1980–2004
Average spending on health
per capita ($US PPP)
Total expenditures on health
as percent of GDP
Data: OECD Health Data 2005 and 2006.
Schoen C, Davis K, How SKH, Schoenbaum8 SC. US health system
performance: A national scorecard. Health Aff. 2006;25(6):w457-w475.
“Ask not what your country can do for you, ask what
you can do for your country.”
John F. Kennedy, POTUS
“Somebody has to do something, and it's just incredibly
pathetic that it has to be us.”
Jerry Garcia, Grateful Dead
What Will Oppose The Status Quo:
Megatrends
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Consumerism/free markets (health care as
service industry):
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Data and transparency:
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retail clinics,
commercial telemedicine,
concierge medicine
performance reports for providers on the web (I think there’ll be an
app for this),
need for aggregation into larger entities for measurement
purposes/performance improvement
Globalization:
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offshoring,
medical tourism
Believe It Or Not, PPACA Is Here To
Help: Little Understood Provisions
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Near universal coverage, phased in
Center for Medicare/Medicaid Innovation
Independent Payment Advisory Board
(replaces RUC?)
ACO pilot modeled after Physician Group
Practice Demonstration Project
The Role of IT: Will It Save Us?
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“Information is not knowledge. The world is drowning
information, but slow in the acquisition of knowledge.
There is no substitute for knowledge.”—W.E. Deming
More than ever in the information age, information
translated into knowledge is power.
IT is a means to knowledge, not an end in itself
IT requires the user to change workflows—this is a good
thing
IT is an equalizing force; it will reduce the power
asymmetry between providers and patients—also a good
thing
Other Mechanisms You’re Likely To See
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Intensive care management and coordination
by whatever entity is at financial risk
(provider, health plan, ACO, government,
business)
Predictive modeling
Guideline adherence incentives for both
patient and provider
Patient activation coaching
Assembly of patient care teams
Take Homes
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American health care is unsustainable in its current form, and it is no
accident that reform is upon us now
The change in the market dynamics will be from accountable for
volume only to accountable for cost and quality outcomes
The new markets will be driven by consumerism, data and
transparency, and declining relevance of geography in service
delivery, like other goods and services
IT will enable, but not be a mission unto itself; it will reduce the power
asymmetry between providers and patients/consumers, and reward
those that can turn information into knowledge to serve customers
better
Teams will win over individuals as complexity increases; this will drive
aggregation and larger units of delivery