Disruptive Innovation Disruptive Innovation & Healthcare Reform: & Healthcare Reform: What's Ahead? What's Ahead? Paul H. Keckley, Ph.D., Paul H. Keckley, Ph.D., Executive Director for the Deloitte Executive Director for the Deloitte Center for Health Solutions Center for Health Solutions
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Disruptive Innovation & Healthcare Reform: What's Ahead? Paul H. Keckley, Ph.D., Executive Director for the Deloitte Center for Health Solutions.
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$1.1B Comparative Effectiveness$10.2B Biomedical research$19 B Health Care IT$1.0B Prevention & wellness
$3B National Science Foundation$.8B Nat’l Oceanic & Atmospheric Assoc.$19.9B Food Stamp increase$4.1B child care services
ImproveInfrastructure
$1.2B VA facilities $7.2B broadband access$38.7B energy & electricity$2.8B Homeland Security$3.1B Indian facilities$2.3B DOD facilities$19.4B clean environment$27.5B highway$20.5B public transportation
Long term: health reform Long term: health reform in two stagesin two stages
Stage One: 2009-2011
Stimulus Package Inclusions
•Focus will be expansion of benefits to newly unemployed, executive orders that extend coverage (SCHIP 2/2/09) and jobs related programs•In additon, certain programs that buoy states against expected increases in Medicaid enrollment•A few campaign promises: EX. HCIT
Stage Two: 2010-2016
Systemic Reforms—Long Term
•Insurance market reforms•Individual mandate + employer pay or play + FEHP2•Comparative effectiveness•Episode based payments•Medical Home•Expansion of role: FDA, CDC•Medicare eligibility•Federalization of Medicaid
Message to Congress Message to Congress February 24, 2009February 24, 2009
• Energy, education and health care: focus of systemic reforms
• Two consistent themes: Reduce costs Expand coverage
FY10 Reserve Fund FY10 Reserve Fund Proposal $634 BProposal $634 B
• FY 10 Budget Preview - February 26, 2009: $634B 10 year health care investment to fund coverage for uninsured & underinsured Funding from…•$318B tax increases (mortgage deduction decrease, Medicare premium increases for wealthy enrollees, $250K HH tax cuts eliminated 2011)•$177B from Med Part D Competitive Bidding•$139B lower payments including $24B Hospital Bundled Payments -- ($17B) and Substandard care ($8B)
Key PlayersKey Players
CHUCK GRASSLEY:
Senior Senator from Iowa
TED KENNEDY:Senior Senator from
Massachusetts
MAX BAUCUS:Senior Senator from Montana
ARLEN SPECTER:
Senior Senator from
Pennsylvania
HENRY WAXMAN: Member of the U.S.
House of Representatives from
California's 30th district
PETE STARK:Member of the U.S.
House of Representatives from
California's 13th district
MIKE ROSS: Member of the U.S.
House of Representatives
from Arkansas's 4th district
ROY BLUNT:Member of the U.S.
House of Representatives from Missouri's 7th District
Key PlayersKey Players
KATHLEEN SEBELIUS: United States Secretary of
Health and Human Services – Nominee
NANCY-ANN MIN DEPARLE: Director of the White House
Office on Health Reform
Long term reforms focus in Long term reforms focus in four areasfour areas
ConsumerismConsumerismFocus: CDHPs,
Transparency, PHRs, Incentives, Value
Comparative Effectiveness/ Evidence Comparative Effectiveness/ Evidence – based Medicine– based Medicine
Focus: (1) Personalized medicine, (2) comparative effectiveness; episode based payments to acute
organizations
2
Health Care Information TechnologyHealth Care Information TechnologyFocus: (1) e-prescribing, ( (2) care coordination (3)
administrative cost reduction 1
3
4
Decreased errors Decreased care gaps Reduced malpractice
premiums Improved efficiency
3 – 7 NMEs per year Center for comparative
effectiveness Knowledge management Prepare for tort reform
New medical homes Reimbursement realignment Primary care workforce MD led clinical care coordination
Coordination of careCoordination of care
Focus: Primary Care 2.0 Model (The New “Medical Home”)
Respond to transparency & PC 2.0– Connected care– Rx reimportation– Medical tourism