Here We Are!

A Brief Discussion of Health Care in the United States Today

Shawn Evans, PhD
Vice President, Performance Excellence
University of Colorado Health
What we do each day
Our highest aspirations-
Where we want to go.
Intrinsic characteristics that we
bring to our jobs - how we go about
our business
Our Strategic Destination
and Objectives


These seven areas will help us achieve our
Mission and Vision. Focus on achieving excellent
results in these areas differentiates UCHealth
from other health systems.
Plan and Align
Execute the plan and
drive performance
Develop and Align
Learn, share, improve, and innovate
1798
During the 1800s various
proposals and attempts aimed
at helping certain people(s)
with healthcare were tried
1930s
A (very) Brief Introduction
1965
Providers
Payers
NOW
Medicaid Expansion
NOW
NOW


The Cost of Care in the
U.S.
17
OUR NEW WORLD . . .
The challenge of a 2 curve
problem is to prosper in
the 1
st
while you prepare
for the 2
nd

Fee
For
Service
Fee
For
Value
Value =

Quality
Service
Health/Wellness
Cost Control
Payment Models
The Cost of Care
International Comparison of Health Spending, 1980-2009
19
The Cost of Care
Hospital Spending per Discharge, 2009
Adjusted for differences in cost of living
20
21
of Medicare
spending occurs
in the last 12
months of life*
*Riley, Gerald F. Lubitz, James D.
Long-Term Trends in Medicare Payments in the Last Year of Life
Health Services Research, 2010
25
What is Changing?
27
Federal/State Government Initiatives
2011 2012 2013 2014
Dependent coverage extended to 26
$250 "doughnut hole" rebate for seniors
Protections for people with pre-existing
conditions
No dropping when person becomes sick
Medical loss ratio requirement
Ban on lifetime/annual limits
Increased free preventative coverage
More options for high risk people
Tax credits to small business
New commissions
10% tanning tax
Early provisions
2015 2016 2018
Hospital
Readmission
Reduction
Program
Medicare
Advantage
savings
ACOs
Admin-
istrative
simplifi-
cation
Health
Exchanges
Subsidies,
mandate
Medicaid
expanded
Hospital
acquired
condition fee
(2015)
Increased
federal
matching for
CHIP
Bundling
States can
form
health care
choice
compacts
Cad-
illac tax
CMS
Innovation
Center
Patient
Centered
Outcomes
Research
Pharma
fees/rebates

SOURCE: McKinsey Center for U.S. Health System Reform
Regulatory turbulence Market turbulence New normal
Starting in October 2012, Medicare began rewarding
hospitals that provide high-quality care through the
VBP program. Hospitals will be paid, in part, for
inpatient acute care services based on quality of care,
not the volume of services they provide.

28
Value Based Purchasing
1.00%
FY 2013
1.25%
FY 2014
1.5%
FY 2015
1.75%
FY 2016
2.00%
FY 2017 & succeeding years
29
Value Based Purchasing
Clinical Process of Care
Patient
Experience
of Care
Clinical
Process of
Care
Patient
Experience
of Care
Outcome
Clinical
Process of
Care
Patient
Experience
of Care
Outcome
Efficiency
Bundled Payments
Implant cost
Supply cost
Room & board
Overhead
Hospital
Payment
Anesthesiologist
Surgeon
Radiologist
Consultant
Physician
Payment(s)
SNF
Home health
OP physical therapy
Post-Acute
Care
Fee for Service Payment Bundled Payment
Pay 2 or more providers jointly
for the services they provide
Post-Acute
Care
Hospital
Payment
Physician
Payment(s)
Medicare IP vs. OP
An Example
Colorado All Payer Claims
Database
www.cohealthdata.org
Colorado All Payer Claims Database
Dont Use
An Old Map
To Explore
New Worlds!
Thank You!
Comments / Questions