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There ’ s a movement Happening In Healthcare…

There ’ s a movement Happening In Healthcare…. Are You Ready?. #1 Healthcare Topic 2013 * According to Forbes. A. ACA B. Population Health Management C. Healthcare Transparency.

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There ’ s a movement Happening In Healthcare…

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  1. There’s a movement Happening In Healthcare… Are You Ready?

  2. #1 Healthcare Topic 2013*According to Forbes • A. ACA • B. Population Health Management • C. Healthcare Transparency

  3. “Health organizations can hear the thundering footsteps of 30 million newly insured Americans on the horizon. .....pressure from states, employers and consumers to operate more like a consumer-focused, retail industry,” - Kelly Barnes, PwC’s U.S. health industries leader. Medical Economics Jan 23-2013

  4. Learning Objectives • Identify consumer trends in healthcare • Discuss strategies to manage the HDHP & cash pay patient population • Create methods to manage and benefit from cost transparency

  5. What are your goals for 2014? Implement EHR meaningful use level X? Transition to ICD-10 ? Build X ? Increase patient satisfaction surveys? OBTAIN MORE PATIENTS THAT PAY THEIR BILL UPFRONT?? Reduce re-admission rates? Improve hospital acquired infection? Start an ACO? End an ACO? Raise prices with my current insurers? Implement a new payment system / cost estimator?

  6. A very popular subject - http://www.azcentral.com/video/2784394952001

  7. Price Transparency - Agenda Defining “consumer driven” healthcare. Market forces affecting consumer behavior. Identify ways the hospital system can help this population.

  8. Actual Exchange Rate Enrollment 464,000 Potential

  9. Exchange Plans 2013 Projected Actuarials Bronze – 60% 80-93% traditional PPO/HMO Silver – 73% Gold – 93%

  10. High Deductible Health Plan (HDHP), Catastrophic only or “consumer driven” plans: • Deductible $1,250 Individual - Maximum out of pocket allowed is $6,350 • Deductible $2,500 Family - Maximum out of pocket allowed is $12,700 *As Defined by the IRS

  11. High Deductible Health Plan (HDHP), Catastrophic only or “consumer driven” plans: Less than 3% of patients tend to hit their deductible when in these types of plans. Average family out of pocket costs with HDHP - $ 3,897 And RISING…. 2012 Kaiser Health News

  12. Exchanges are accelerating high out of pocket costs for care. Exchange product example: Patients making > 45K per year have $ 5000 out of pocket, 30% of hospitalizations beyond that with a max out of pocket of $ 11,750. Preventative is covered. “yes ma’am, your mammogram is covered, but your breast cancer is going to cost you….” “just be glad you aren’t pregnant”

  13. Are we going to have even more uninsured? Walgreens moves workers to private health-care exchange By Michael A. Fletcher,September 18, 2013 Walgreens said on Wednesday that it is moving 160,000 workers to a new health-insurance model, joining a growing list of large employers seeking to control costs by having employees shop for coverage in a private marketplace. The drugstore chain said that beginning in 2014, it will give employees a set amount of money to choose health insurance coverage from a wide range of offerings in a fast-expanding private online marketplace run by Aon Hewitt, a benefits firm. Walgreens joins Sears Holding, Darden Restaurants and other firms in pushing its workforce into the private exchanges, part of what employee benefit analysts call a historic shift in health-care benefits accompanying the implementation of the Affordable Care Act, known as Obamacare. The Washington Post

  14. ACA By The Numbers

  15. Are we going to have even more uninsured? More Americans In 3 States Have Had Their Insurance Canceled Under ObamaCare Than Have Filed An Exchange Account In All 50. “The president’s promise that you could keep your plan if you like it never was credible.  So sad that millions of Americans are only now discovering that hard truth.” - Forbes 10.24.13

  16. Are we going to have even more uninsured? Consider these 3 factors: • Employers “punting” employee’s to the exchanges. • Payers dropping patients. • Healthcare.gov challenges.

  17. % of HDHP in 2014 • A. 50% • B. 38% • C. 67%

  18. In 2014, up to 50% of all insurance plans Are considered “High-Deductible”

  19. Some things to think about…. 1. What types of systems have you implemented to address this growing patient population? 2. How your action affected the “patient experience” when they come to your system? 3. What strategy do you have to obtain new patients?

  20. Price Transparency - Agenda Defining “consumer driven” healthcare. Market forces affecting consumer behavior. Identify ways the hospital system can help this population.

  21. What percentage of your patients could pay a $ 2000 bill? How about their actual deductible? Max out of Pocket: Individual - $6,350 Family - $12,700 * Study Conducted By National Bureau of Economic Research

  22. MGMA Survey: 1st 120 days of Obamacare • 75% reported that patients were very or extremely likely to have high-deductible health plans • For those practices that didn’t accept Obamacare most reported that payment risk (typically associated with a high-deductible) was the primary reason for declining service “Patients have been very confused about benefits and their portion of the cost. Once the patients find out their deductible, they’ve cancelled appointments and procedures.”

  23. Strategies and Outlook Outlook: Patients will begin to focus on cost vs. the actual care they are receiving. “I’ll go to Walgreens instead of my Dr., it’s cheaper….” – Tennessee Patient Strategy: Reconnect your consumer with the product. Focus on actual care being delivered and the quality of that care vs. being solely cost driven.

  24. Strategies and Outlook Outlook: Shift in high deductible plans. Strategy: Engage the HDHC patient: • Offer competitive pricing. • Your catchment area is larger. Patients drive farther to save money. • Effectively market seasonal services. • Keep patient out of retail medicine clinics.

  25. Patient Behavior on HDHP -18% Outpatient Services -16% Rx Traditional PPO *Patients self diagnose via Google search *May 20, 2013 Health Affairs

  26. What happens to Rx Usage with the uninsured or HDHP?

  27. Consumer Prescription Behavior • Prescription Drug behavior on HDHP shows tendency to skip drugs for silent chronic conditions. EX: High Cholesterol Blood Pressure • Continued Use of Drugs for Depression or Pain with decreased dosage usage in some

  28. Spending in Low Income Families with Chronic Conditions Low Income High Income: $92,000 Family 4 High Income *Jan ‘13 “Journal of General Internal Medicine

  29. Catastrophic effects due to delayed care. • Blindness • Septicemia • Psychosis • Emergency Surgery • Low birth rates • Unreimbursed care • Diabetes • Infections • Depression • Abdominal Pain • Miscarriages • Simple office visit results in hospital stay.

  30. Biggest Spending Challenge HDHP? “Mid-Range Stuff” MRI Ultrasound CT Scans

  31. What Strategies Are Your Patients Utilizing To Manage Out of Pocket Costs??

  32. Advice Found Online to Patients on How to Negotiate Pricing • Request the Cash Pay Price • Pay cash out of pocket and self file with your insurance company • Ask for Medicare’s Rates Often a 73% discount • Negotiate a “one time payment” as opposed to a monthly payment plan at a lower cost

  33. What are consumers doing to save money? Choosing transparent providers Utilizing Health Savings Accounts Requesting the cash price Paying cash out of pocket and self filing with insurance. Shopping for less expensive care online and by phone Looking for billing errors Negotiating a lump discounted payment vs. a monthly payment plan at a lower cost Double checking the necessity of the test Asking for Medicare rates

  34. Internet Advice on Negotiating Healthcare

  35. Utilizing Health Savings Accounts The limit for the contribution often is not as high as the deductible you might be facing. Deductible Cap For Family: $12,700 Health Savings Account Cap: $6,450 Deductible Cap For Individual: $ 6,350 Health Savings Account Ca $3,250

  36. Debate the necessity of the test • How fun is this for your physicians? Your neighborhood radiology office would be happy to provide this service for your patients. Imaging R-US

  37. Shopping for care – “I have a bladder infection” Market Research in a town with 3 competing hospital systems in one southern market. • Walgreens - $79-89 • CVS Minute Clinic- $79-$89 • Hospital System #1 – Exact price unattainable. • “$ 100-300 dollars depending on the level” • Hospital System #2 – Exact price unattainable. • “We charge $ 116.07, and then tack-on a doctors fee” • Hospital System #3 – $108-$120   • Plus the urinalysis between $13-$20

  38. All Systems took 3-4 calls, transfers, put on hold, and call backs CMS Pays $365.21 Modified $316.60

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