Health Care Business

The health systems we enjoy today, and expected medical advances in the future, will be difficult to finance from public resources without major reforms. Public health spending in OECD countries has grown rapidly over most of the last half century. These spending increases have contributed to important progress in population health: for example, life expectancy at birth has increased, rising on average by ten years since 1970. The challenge now is to sustain and enhance these achievements in a context of tight fiscal constraints in many countries combined with upward pressure on health spending from factors such as new technological advances and demographic changes. Finding policies that can make health spending more sustainable without compromising important achievements in access and quality requires effective co-operation between health and finance ministries. Sound governance and co-ordination mechanisms are therefore essential to ensure effective policy choices. Prepared by both public finance and health experts, this report provides a unique detailed overview of institutional frameworks for financing health care in OECD countries. One of the main features of this book is a comprehensive mapping of budgeting practices and governance structure in health across OECD countries.
`See here !

A lot of people ask me about the future of medicine and healthcare. What’s coming next, what about the future of radiology, genomics or health sensors. They ask me to make really sharp predictions. But instead of this, let’s do something else now. Let’s look back from 2050, and see what today’s healthcare included, what barbaric elements played an important role in today’s healthcare in the 2010s....

See also here and here

Growth And Dispersion Of Accountable Care Organizations In 2015 | The Policy Journal of the Health Sphere

David Muhlestein

March 31, 2015

In January, an additional 89 provider organizations joined the Medicare Shared Savings Program (MSSP) as accountable care organizations (ACOs). While this year’s new entrants are a smaller cohort than those that joined in 2013 and 2014, they represent a continuation of the expansion of the accountable care movement.

The recent Department of Health and Human Services (HHS) announcement of its goal to move 50 percent of Medicare payments to alternative payment models (including ACO-based arrangements) indicates the government’s strong backing of the model and, coupled with continuing endorsement of the approach from state Medicaid programs and commercial insurers, there is strong support for this care delivery approach to continue.

In an ACO, health care providers accept responsibility for the cost and quality of care for a defined population. Each ACO’s laudable goal is to achieve what Don Berwick has called the “triple aim” — to improve quality, increase patient satisfaction, and lower costs. The key to reaching those goals is to change how providers are paid, based on reaching certain cost and quality benchmarks. In effect, the objective is to change incentives so that it is in providers’ best interest to maximize health, rather than focus on increasing the volume of services rendered.

Leavitt Partners has been actively tracking ACOs since 2010, maintaining a database that is updated regularly from publicly available information and personal and industry interviews. Over the past year, approximately 120 organizations have become ACOs in public and private programs, bringing the total to 744 since 2011 (Figure 1). The historical ACO growth data shown in Figure 1 are slightly different from our past estimates, as they are now based on the start date of the ACO’s contract, not on when the ACO was announced.

For example, the 89 ACOs announced in December 2014 are listed as beginning in January 2015, which is the start of their contract. Regardless of how many contracts an ACO is engaged in, both public and private, an ACO is counted only once. Note that some of the new Medicare Shared Savings Program participants already had commercial contracts, and are thus tracked beginning at the start of their first contract.

Figure 1. Total Public and Private Accountable Care Organizations, 2011 to January 2015 (See top)

Source: Leavitt Partners Center for Accountable Care Intelligence

In addition to growth in the total number of ACOs, there has been continued growth in the number of people covered by ACO arrangements

Read on the original blog here

Healthcare is Headed Down a New Road with New Rules

The healthcare industry is entangled in a transitory phase in which therapeutics, products and services are sold into traditional care settings that are saturated and exhausted. At the same time, opportunities for new services and care, such as ambulatory, mobile, and home care, lack the appropriate level of maturity to provide robust revenue streams. The webinar examines the degree to which we can expect the impact to take hold and transpire over the upcoming year.

Preditctied trends for 2015 in healthcare:

1. Increase in out of pocket spending and welness by consumers;
2. E commerce giants enter ehalthcare..?
3. Employers more agressive and Incentivize mHealth;
4. Price Free fall for Medical Products
5. Telecoms launch Home Health Platforms
6. Rise of the Private Exchange market place
7. Data breaches in Health Care Spark Action
8. Rise of Articificial intelligence

Top trends: Pharma: Product as a service - Platform as a service - Data as a Service -

• Beyond Oncology for Companion Diagnostics,
• "Beyond the pill" for pharma,
• Regenerative Medicine promise fuels investment
• Orphan disease represent strong ROI
• Oncology, diabetes and anti-inflammatory dominate investment
• Global Innovation necessitate Supply Chain Innovation

Top trends Medical technology - Is your healthcare in your smartphone -

• mHealth apps
• smart wearables
• vanishing devices
• micro segementation
• 3d/4d printing spurs customization
• Brain interface devices
• Top trends HCIT Is your health in the cloud?
• Conquering the Cloud
• End of Meaningful Use Incentives
• Monetization for Chronic Disease Care Coordination
• More Robust Payer IT services
• Integrating telehealth with enterprise IT

See the link for downloadable presentation and stream of the webinar!

Watson Analytics now open for everyone see here (TheNextWeb) and try yourself here (IBM)  or find out more about WatsonAnalytics by IBM itself here !!

Enjoy.. however, to me? ...

Dig deep: Increases in consumer health care OOP spending also impact hospitals, life sciences companies and health plans. How should stakeholders respond?

Even though more consumers are gaining health insurance coverage, they are by no means insulated from the burden of health care costs. Consumers are paying more of their health plan premiums and experiencing higher out-of-pocket (OOP) cost-sharing for all types of health care services. Moreover, government estimates of health care spending do not take into account discretionary consumer spending on a number of products and services; Deloitte’s Hidden Costs Analysis shows these purchases add considerably to the total.

OOP spending increases extend beyond consumers to impact hospitals, life sciences companies and health plans. What are the implications for these stakeholders?

This report:

• Examines the impacts and implications of the increasing consumer health care cost burden.
• Shares results from Deloitte’s Hidden Costs Analysis, which reveals how consumers’ OOP purchases add considerably to the total cost of health care.
• Explores anticipated OOP spending changes resulting from the 2014 expansion of coverage through health insurance marketplaces and Medicaid.
• Suggests strategies for hospitals, life sciences companies and health plans to deal with the impacts of rising consumer OOP costs.

Earlier this month, Kaiser Health News reported that "more hospitals are receiving penalties than bonuses in the second year of Medicare’s quality incentive program, and the average penalty is steeper than it was last year" (here). Kaiser wasn't the only troubling news that appeared recently for Americans who are 65 and older and rely on Medicare for their healthcare coverage.  

In a report issued last week, The Commonwealth Fund found that the U.S. ranked poorly compared to 10 other countries on key indicators for those who are 65 and older. It’s an important and valuable comparison for 3 reasons.

1. Seniors (65+) are relatively easy to isolate for comparative studies in all major populations.
2. Seniors (65+) typically represent the highest healthcare needs and spending of a given population.
3. It’s the only category where the U.S. system of Medicare coverage (for everyone 65 and older) can compare directly to other countries with “universal coverage.”

Like The Commonwealth Fund report earlier this year (U.S. Healthcare Ranked Dead Last Compared To 10 Other Countries), this new survey used 11 countries for their comparative analysis. The survey was conducted from March through May of this year and the number of respondents for each country is indicated in parentheses...(see orgiginal post)..

Perhaps the biggest surprise was the fact that older Americans (age 65+) said that cost was the primary reason for skipping medical care or treatment. This was significant because Medicare is often presumed to be free and universal health coverage for every American over the age of 65 [..].

The other big takeaway was the fact that older Americans had the highest prevalence of chronic conditions. The survey found that 87% of older Americans had at least one chronic health condition and 68% reported 2 or more chronic conditions. The next highest was Canada which reported 83% with at least one chronic condition and 56% with 2 or more. Whether this is the result of delayed healthcare or other socioeconomic factors is unknown and was also outside the scope of the survey.... For further reading see original post..!

The applications at the start of the three-month enrollment period showed that in contrast to initial problems last year, HealthCare.gov was working.

While great strides have been made in the reduction of 30-day all-cause hospital readmissions, CMS still penalized more than 2,200 hospitals in 2013 for exceeding 30-day readmission rates for heart failure, pneumonia and myocardial infarction.

In 2015, CMS penalties will extend to acute COPD and elective hip and knee replacements.

2014 Healthcare Benchmarks: Reducing Hospital Readmissions documents the latest key initiatives and partnerships to reduce readmissions by patients with these costly conditions and others by more than 100 healthcare organizations.

August 29, 2014- Detroit Medical Center Awarded National Health Care Innovation Award

The Detroit Medical Center (DMC) has been selected to receive an award of $9,966,608 as part of the Centers for Medicare and Medicaid Services’ (CMS) Health Care Innovation Awards program. The Principal Investigator and DMC Chief Medical Officer Dr. Suzanne White is one of only 39 recipients of about 3,000 applicants across the United States. The award will enable the DMC to test an innovative primary care and preventative health model that reaches patients who use some of Detroit’s busiest emergency departments.

The project, entitled Gateway to Health: An Innovative Model for Primary Care Expansion in Detroit, will make patient-centered medical care immediately accessible to individuals without existing primary care physicians, arriving to four DMC emergency departments at DMC Harper University Hospital, DMC Detroit Receiving Hospital, DMC Sinai-Grace Hospital and DMC Children’s Hospital of Michigan. By embedding primary care services in those areas of highest emergency department use, the DMC project intends to meet patients where they are already seeking care to develop meaningful doctor-patient relationships, improve care coordination and implement strategies to promote wellness. The ultimate goals are to deliver improved health care access, quality and efficiency for the surrounding community.

“As a Detroit emergency physician, I understand the challenges and barriers our patients face as they try to access high quality primary care services. I see each day how the system could be improved. Patients lack access to after hours care, unscheduled visits, transportation, and most importantly, a welcoming environment where they feel comfortable and safe,” said Dr. White. “This award is an incredible opportunity for DMC to create a culture of patient partnership, where we start by listening to each patient's story, try to understand their unique challenges and goals, and then match them with the best health caremore team.”

The focus will be on improving the care provided to patients with diabetes, asthma, hypertension, heart failure, chronic lung disease, depression and HIV.  Emergency department “super-utilizers” who have 10 or more visits annually are another program target group. Medicaid, Children’s Health Insurance Program (CHIP) and Medicare fee-for-service beneficiaries will be the dominant populations.

A multidisciplinary team of caregivers will work closely with each patient to help them achieve wellness through prevention and self-management of their conditions. Face-to-face visits, telephone contact and texting will all be used to better connect patients to the care team. Patient coaches and navigators are essential to the model as well. Read more here