3. Where Did We Begin?
• Fragmented silos of episodic FFS
care with some risk in some markets
• Push for EHR and connectivity with
only a vague notion of why
• Explosion in the aging and chronic
population
• No accountability for costs
• Disconnect between wellness as a
preference and illness as a business
8. The Health Reform Uncertainty
• There is a difference between Risk and
Uncertainty
• We have always had risk in healthcare but
now we have uncertainty
9. And The Current Future
• PPACA’s Contribution
– Supreme Court ruling and election gives certainty for
today but leaves a Medicaid hole for some states
– Medicare Advantage cuts may impact benefits/MLR
– CMS driven ACOs with likely un-eveness in
performance and higher market costs
– CMS Duals Office- Un-eveness on its journey
– Health Insurance Marketplaces (f/k/a exchanges) will
emerge in some form but with what populations
– CMS –CMMI will test a wide variety of programs to
save money will any of them work
15. Some Options
1. Wait and do nothing-Keep The As Is State
2. Build an expanded enterprise to create more
leverage and market dominance- Some ACOs fall
into this category.
3. Build a risk bearing broader bio/psycho/social
clinical enterprise where all professions are
focused on coordinated quality and outcomes to
overcome our common challenges……
16. Our 9 Common Challenges
• 1. We Must Re-invent the Physician Practice
• 2. We Must Improve Our
Access/Understanding of Data
• 3. We Must Accelerate The Adoption of
Successful Programs to Improve Patient
Adherence and Physician Skills
• 4. We Must Improve Quality and Consistency
of Outcomes Across All Domains
17. Common Challenges Together
• 5.We must reduce readmissions
• 6. We must keep mom at home
• 7. We must deliver more healthy babies and
raise healthier children
• 8. We must create interdisciplinary
approaches to dealing with complexity
• 9. We must reach the unreachable
21. And Then How Do We
• Embrace, absorb, deploy or reject the 40,000
or so apps for healthcare?
22. What I Think I Think
• We will navigate from episodic encounters to
continuous interactions.
• Narrow networks will prevail not only by offering
quality and cost advantages but by achieving
them through the appropriate use of emerging
technology