drivers of change 2018 - constant...

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DriversofChange2018StrategicImplicationsfortheColoradoMedicalSociety

HealthCare:Top10DriversofChangefor2018

1. Publicinsuranceiscontinuingtogrow.2. Paymentreformisadvancing.3. Consumersaredemandingincreased

technology.4. Newmodelsofcareareemerging.5. Physicianwell-beingiscrucial.

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6. Integrationofbehavioralandphysicalhealthisprogressing.

7. Populationhealthandpublichealthareconverging.

8. Consumersarefacinghigherspending.9. Consumersaredemandingnew(and

expensive)drugs.10. PhysicianscanbringastrongvoicetoD.C.

andDenver

HealthCare:Top10DriversofChangefor2018

1.PublicInsuranceisContinuingtoGrow.

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NewestDataonHealthCoverageinColorado

ExpandedEligibilityPushingMedicaidGrowthMedicaidExpansionEnrollment

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MoreManagedCareinMedicaid?PercentageofMedicaidPopulationinMCOsasofJuly1,2016

Source:2017KaiserFamilyFoundation’sStateHealthFacts

RaysofSunshineamongclouds

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GrowthofMedicareAdvantagePlans

Source:2017KaiserFamilyFoundation

1. Howdothesechangesimpactadministrativeburden?

2. IsColoradoacceleratingtowardcapitation?

3. Howcanpracticesanticipateandleveragebonuses,clinicalmeasuresandotherfinancialincentivesorfinancialpenalties?

QuestionsfortheColoradoMedicalSociety

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2.PaymentReformisAdvancing.

PaymentReform

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• Paymentreformhasbipartisansupportatthefederallevel.

• MedicareandCHIPReauthorizationAct(MACRA)willimpactmostphysicianreimbursementforMedicarestartingin2019.

• ColoradoMedicaidwillbeginpayingprimarycarephysiciansbasedontheirperformancein2018.

PublicInsuranceLeadingtheWay

• InformationfromRAEpresentation.Jeff

PaymentReformAdvances

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•RAEswillbepaid$15.50PMPM.

•RAEswillcontractwithprimarycareproviders;mustoffertopaythematleast$2PMPM.

•HCPFwithholds$4PMPMforRAEtoearnbackifperformancegoalsaremet.

QualityIncentivesinACCPhaseTwo

AdditionalPhaseTwoincentiveopportunities:• Providersshareinfinancialrisk.

• HigherbehavioralhealthcapitationrateifRAEshitperformancegoals.

• Pay-for-performancepooltoencouragehigherstandards.

QualityIncentivesinACCPhaseTwo

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2.7

7.7

14.0

17.1

22.5

28.3

32.4

0

5

10

15

20

25

30

35

2011 2012 2013 2014 2015 2016 2017

LivesCoveredByACCs(inmillions)

IncreasingNumberofLivesCoveredbyACOs

Source:HealthAffairs

LivesCoveredbyACOs(inMillions)

PublicVersusCommercialACOContracts

Source:Authors’analysisofLeavittPartnersACODatabase

ACOLivesPerPayer(inMillions)

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1. Howdomemberspreparefordownsiderisk?2. Whatarethesticks?Whatarethecarrots?3. Howcanmemberskeepupwithrequirementsfor

metrics?4. WhatsupportcanCMSprovide?5. Howcanyoutrainmemberstopreparefor

changes?

QuestionsfortheColoradoMedicalSociety

3.ConsumersareDemandingIncreasedUseofTechnology.

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TechnologyIsAlreadyPartofTheConsumerExperience

2016ConsumerLikelihoodtoUseTelemedicine

ConsumersWantMore

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AnAppleaDay...

1. Willadoptingnewtechnologiesleadtohigherpatienttrust?

2. Howwillmembersensurepatientsafetyandconfidentiality?

3. Howcanmembersincorporatenewtechnologiesintoalargerpatientengagementstrategy?

QuestionsfortheColoradoMedicalSociety

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4.NewModelsofCareAreEmerging.

TheChangingHealthCareDeliveryLandscape

National• Walmart• Lowe’s

Local• Newmarket

entrants• DaVita• Walgreens

Regional• Urban“Centers

ofExcellence”• United

Healthcare

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ARetailCliniconEveryCorner

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TheGrowthofRetailClinics

Source:ConvenientCareAssociation

“Nursepractitionersaremoreindemandthanmostphysiciansasstatesallowdirectaccesstopatientsfortheseincreasingly

popular healthprofessionals.”

ForbesJune2017

TheShiftingHealthCareWorkforce

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1. Howmightpracticesalignorpartnerwithnewcaresettings?

2. Whataretheimplicationsofnewcaresettingsfortraditionaloffices?Hours?Convenience?

3. Withworkforcepatternsshifting,whatstepscanpracticestaketoensurequalityandeffectiveness?

QuestionsfortheColoradoMedicalSociety

5.PhysicianWell-beingisCrucial.

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Source:MedscapeLifestyleReport2017:RaceandEthnicity,BiasandBurnout

LeadingCausesofPhysicianBurnout

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TheReciprocalDomainsofPhysicianWell-Being

Source:2016,StanfordMedicine

1. ImprovingPhysicianLeadership:Aphysician'swellnessisdirectlycorrelatedtowhotheirsuperioris.

2. CultivatingCommunity:Sponsoringlunchtimemeetingswithjustphysicianssotheycanlearnandsharechallenges.

3. SurveyingMembers:UnderstandtheextentofburnoutinColoradoanditsreasons.

ThreeSuggestionsfromMartiSchulte

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1. Whatapproacheswouldmakethebiggestimpactformembers?

2. Aretherespecificprogramsorservicesthatwouldpreventphysicianburnout?

3. HowmightCMS“cultivatecommunity?”

QuestionfortheColoradoMedicalSociety

6.TheIntegrationofBehavioralandPhysicalHealthCareisProgressing.

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DrugOverdoseDeathRatesatAll-TimeHigh

Source:ColoradoHealthInstitute,2015

Age-AdjustedDrugOverdoseDeathRateper100,000,Colorado,2002-2014

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• SIMCohortOne:100• SIMCohortTwo:150• SIMCohortThree:150• ComprehensivePrimaryCareInitiative:71• CPC+:203• ColoradoHealthFoundationPrimaryCarePractices:20• RAEs:550

ColoradoPracticesInvolvedinIntegration

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SixLevelsofIntegratedCare

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1. Whatkindoftrainingandeducationwouldbevaluedforintegration?

2. Howcanyoubetterequipphysicianstointegratepractices?

3. Whatkindofprogramswouldbevaluable?

QuestionsfortheColoradoMedicalSociety

7.PopulationHealthandPublicHealthareConverging.

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Health-RelatedSpending,CityandCountyofDenver

HealthSpendingDwarfsSocialSpendinginDenver

Source:MileHighCapitalStack

SocialandEconomicFactorsAffectHealth

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1. HowshouldCMSpositionphysicianstoparticipateinthisissue?

2. ShouldCMSadvocatefor“non-health”issuesinpopulationhealth?

3. Whereistheopportunityforphysicians,especiallythinkingaboutthisincombinationwithpaymentreform?

QuestionsfortheColoradoMedicalSociety

8.ConsumersareFacingHigherSpending.

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$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

$1,800

$2,000

2002 2004 2006 2008 2010 2012 2014 2016

AverageIndividualDeductible

DeductiblesHeadHigher

Source:MedicalExpenditurePanelSurvey

Source:2017KaiserFamilyFoundation

MoreWorkersCoveredbyHighDeductiblePlans

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ColoradansSkipCareBecauseitCostsTooMuch

1. Ifconsumersaremoreinvolvedinpayingforcare,howwillphysicianpracticesadapt?

2. Istherespecializedtrainingorprogramsthatcouldbenefitpractices?

3. WhatarepotentialrolesforCMSaroundpricingtransparency?

QuestionsfortheColoradoMedicalSociety

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9.ConsumersareDemandingNew(AndExpensive)Drugs.

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1. Whatroledophysicianshaveinofferingalternativesorcounterargumentstoconsumerdemand?

2. Howcanyouhelppreparepracticesforthecomplexreimbursementassociatedwithspecialtypharmaceuticals?

3. Howdopracticesgetinvolved?

QuestionfortheColoradoMedicalSociety

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10.PhysiciansCanBringaStrongVoicetoD.C.andDenver

TheDrivingPrincipleinHealthCareToday?

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“WhileCongresstusslesoverObamacare,theTrumpadministrationisquietlypressingaheadwithplanstogutmajorObama-erarulesandrelaxfederaloversightofswaths

ofthehealthcareindustry.”

“HowtheTrumpadministrationisreshapinghealthcare— withoutCongress.”

September13,2017

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1. WhereshouldCMSshowupinthesediscussions?

2. Isthisapriorityareaforyourmembership?

3. Howcanyoubestrelaythespecificinterestsofyourmembershiptopolicymakers?

QuestionsfortheColoradoMedicalSociety

MicheleLuecklueckm@coloradohealthinstitute.org (720)-382-7073

@MicheleLueck