Our Uncertain but Bright Healthcare Future. Jennifer Searfoss, Esq., CPOM, CHCI, CMCS o e

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1 Our Uncertain but Bright Healthcare Future Jennifer Searfoss, Esq., CPOM, CHCI, CMCS o e jen@scghealth.com

2 About Jennifer Jennifer Searfoss, Esq., CPOM, CHCI, CMCS is the CEO of the Searfoss Consulting Group, LLC since its founding in 2011 and is focused on value improvement, revenue cycle management and strategic planning in this post-health reform world. Jennifer was the Vice President of External Provider Relations for UnitedHealthcare, a Minnesota-based health insurance company. From 2007 to April 2011, she established and led the Provider Communications & Advocacy unit. Before going behind the iron curtain, Jennifer served as the External Relations Liaison for the Washington, DC-based Government Affairs Department of the Medical Group Management Association.

3 In accordance with the Accreditation Council for Continuing Medical Education s Standards for Commercial Support I publicly declare that: I don t have any direct financial control or relevant relationships over any of the healthcare products or services now or in the past 12 months. All rights reserved SCG Health, LLC. To distribute or copy, please contact jen@scghealth.com.

5 National Healthcare Expenditure 2014: $3.0 trillion or $9,523 per person As one economist said we don t have a debt problem in this country we have a healthcare problem. - Dan Munro, Forbes

72 million Boomers by 2030 1 Seniors age 85+ are predominately female 2 1:8 Americans 65+ will have Alzheimer s disease by 2030 1 They are familiar with health insurance.

6 72 million Boomers by Seniors age 85+ are predominately female 2 1:8 Americans 65+ will have Alzheimer s disease by They are familiar with health insurance. They like Medicare Advantage plans 3 Sources: (1) Alzheimer s Association Alzheimer s Disease Facts and Figures. (2) Administration on Aging, A Profile of Older Americans: (3) HHS press release. Medicare Advantage premiums remain stable; enrollment at all-time high. Sept. 21, All rights reserved SCG Health, LLC. To distribute or copy, please contact jen@scghealth.com.

7 Enough clinicians?

8 Starting in a different place The story of the music industry

Music industry evolution Units sold in millions Digital music sales now considered a marketing expense to drive Concert sales Merchandise Ringtones Royalties for commercials, movie, etc.

9 Music industry evolution Units sold in millions Digital music sales now considered a marketing expense to drive Concert sales Merchandise Ringtones Royalties for commercials, movie, etc. New artist requirements No only studio bands MUST have a stage presence and connect with audience Can sell tickets (fanbase) Chart by David Allen. Data by the International Federation of the Phonographic Industry. All rights reserved SCG Health, LLC. To distribute or copy, please contact jen@scghealth.com.

12 Parable to healthcare Death of fee for service and drive-thru medicine Hay-day of compensation as we knew it peaked 3-5 years ago Lessons for the healthcare industry Customer service & bedside manner matter Appeal to the individual consumer Accessible Establish and maintain a lifelong relationship TRENDS Transparency Resources Engagement technology Data Simplify All rights reserved SCG Health, LLC. To distribute or copy, please contact jen@scghealth.com.

16 Affordable Care Act 1:5 will close by 2020 predicts Emanuel wrote Ezekiel Emanuel, an architect of the Affordable Care Act in his book Reinventing American Health Care.

Technological advancement Early Majority Late Majority QuickStat. Office of the National Coordinator for Health Information Technology, US Department of Health and Human Services.

17 Technological advancement Early Majority Late Majority QuickStat. Office of the National Coordinator for Health Information Technology, US Department of Health and Human Services. Early adopters Innovators Laggards years for technology maturation SOURCE: Bohlen, Joe M.; Beal, George M. (May 1957), "The Diffusion Process", Special Report No. 18 (Agriculture Extension Service, Iowa State College) 1:

18 Making up for the industry s lack of ongoing investment Healthcare has unique security needs and is more like the banking industry. Overall costs decreased by move to secure cloud subscription services. The average year-over-year maintenance, upgrade and investment in IT is 2.5% of revenue for all sectors. That s $7,581 per user. Source: Computer Economics IT Spending & Staffing Benchmarks. All rights reserved SCG Health, LLC. To distribute or copy, please contact jen@scghealth.com.

19 Institute for Healthcare Improvement Triple Aim Simultaneous pursuit of three aims Improving the experience of care Improving the health of populations Reducing per capita costs of healthcare All rights reserved SCG Health, LLC. To distribute or copy, please contact

20 Inspiring dramatic cultural change Involvement of patients and families Design principles A clear vision The cultural change required to succeed with team-based medicine is considerable. The organizational culture needs to embrace standardization and reliability and to act every day on the belief that the center of the care is the patient. Teamwork Cultural change Triple Aim focus Source: Rank, B. Triple Aim 2.0: Designing Culture and Care to Support Better Health, Better Experience at a Lower Cost. Group Practice Journal, February All rights reserved SCG Health, LLC. To distribute or copy, please contact jen@scghealth.com.

21 Different Experience Transparency Satisfaction OUR Future: The informed consumer No longer a patient, the informed consumer is looking for a different experience in health care. Experience matters to consumers; not necessarily outcome Price transparency is part of the experience; low dollar leaders are not always the winner in a consumer model Patient satisfaction is the third-party measure Lessons for the health industry Appeal to the individual consumer Accessible Establish and maintain a lifelong relationship All rights reserved SCG Health, LLC. To distribute or copy, please contact jen@scghealth.com.

Technology and the Convenience Factor 68% of Americans have Smartphones 77% of patients would schedule appts electronically 60% of appts can be scheduled

22 Technology and the Convenience Factor 68% of Americans have Smartphones 77% of patients would schedule appts electronically 60% of appts can be scheduled electronically Source: 2015 Pew Research Study on technology device ownership All rights reserved SCG Health, LLC. To distribute or copy, please contact

Access to Care Is Telehealth the Future?

Future with MIPS 15% SCORE Episodic 10% SCORE Attributed benes 25% SCORE 100 points Options for pts 50% SCORE 80-90 points Quality Choose 6 measures Clinical Practice Improvement Cost Advancing Care

24 Future with MIPS 15% SCORE Episodic 10% SCORE Attributed benes 25% SCORE 100 points Options for pts 50% SCORE points Quality Choose 6 measures Clinical Practice Improvement Cost Advancing Care Info Status Quo QRUR shows some data that may be helpful QRUR reports show attribution data 10 all or nothing objectives Non-participation = automatic -4% cut Choose 9 measures or a measure group or participate in an MSSP Non-participation = automatic -6% cut All rights reserved SCG Health, LLC. To distribute or copy, please contact jen@scghealth.com.

26 Getting to plug-and-play The Quest to Interoperability

27 Interoperability promise HHS announcement (1) consumer access; (2) information flow; and (3) data sharing standardization Big systems committed (90% hospital) Allscripts; AthenaHealth; Cerner, Epic, GE Centricity; NextGen More to come on what this will mean

30 Care coordination spectrum & payment models Fee for Service Pay for Performance Shared Savings Bundled Payment Provider in 5 years Provider in 2 years Provider today Health plan today Shared savings with up and downside risk Global payment Capitation Source: State of Value-Based Reimbursement, McKesson, 2014 All rights reserved Searfoss Consulting Group, LLC. To distribute or copy, please contact jen@scghealth.com.

31 Consumer perceptions High Health Pulse Driven by self esteem, seek confidence 25% Low Health Pulse Driven by passions, seek relaxation 25% Responsibility vs Accountability Middle Health Pulse Driven by interrupted routine 50% I have free will so I am responsible for my actions. I can t be held accountable for my health status! My health is my business. And I can t control getting sick. Source: Jennifer Haid, Iconoculture, AHIP Institute 2014 All rights reserved Searfoss Consulting Group, LLC. To distribute or copy, please contact jen@scghealth.com.

32 Culture of Consumerism If not quality, then what? Value Florida hospital model Service A dissatisfied customer tells 13 other people about their experience Reputation We want our system to be a place where patients choose to come for care; where physicians want to practice; and where employees want to work. All rights reserved Searfoss Consulting Group, LLC. To distribute or copy, please contact jen@scghealth.com.

33 Patients as they are

34 Health literacy

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WORKING WITH EHR VENDORS

WORKING WITH EHR VENDORS No two EHRs are the same, even when they re sold from the same vendor. This system variance can make it difficult to forecast integration projects accurately unless you understand