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Dr. Paul Keckley Paul H. Keckley, Ph.D. Deloitte Center for Health Solutions Washington, DC

Dr. Paul Keckley Paul H. Keckley, Ph.D. Deloitte Center for Health Solutions Washington, DC. KEYNOTE: Health Reform – What does it mean for SE Michigan? What can we do?. The US health system: big, complex, fragmented, uneven…. ADMINISTRATORS/WATCHDOGS. Regulators. Media. Professional

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Dr. Paul Keckley Paul H. Keckley, Ph.D. Deloitte Center for Health Solutions Washington, DC

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  1. Dr. Paul KeckleyPaul H. Keckley, Ph.D.Deloitte Center for Health SolutionsWashington, DC KEYNOTE: Health Reform – What does it mean for SE Michigan? What can we do?

  2. The US health system: big, complex, fragmented, uneven… ADMINISTRATORS/WATCHDOGS Regulators Media Professional Societies/ Special Interests BIOTECH Insurers INNOVATORS Academic Medicine Pharma BioTech Accrediting Agencies Employers HCIT Device SERVICE PROVIDERS Hospitals Long Term Care Outpatient Facilities Allied Health Professionals Disease Management CAM Physicians CONSUMERS

  3. Lack of capital and resources Explosion in clinical knowledge Lack of consumer involvement Lack of appropriate technology Lack of incentives for right behaviors Lack of trust among Key Players Lack of political will, leadership Costs, access and quality are major issues! Runaway Costs Uneven Access CHANGE Poor Quality

  4. The majority support reform: Two in five rate the system unfavorably Unfavorable report card grades are more likely among Gen X and Boomers (4 in 10) than among Gen Y and Seniors (3 in 10)

  5. Most do not understand the “system” and believe it is wasteful. Insecurity about health costs is high:Seniors “in public plan” most favorable. Source: 2009 Deloitte Survey of US Health Consumers, Deloitte Center for Health Solutions

  6. Public opinion about health reform (Deloitte Pulse Survey, September 10-13, 2009) • 54% of U.S. adults believe health care reform will not pass this year vs. 41% who do • 48% believe the U.S. health system needs a major overhaul—among the uninsured (60%) and underinsured (55%) • 73% of respondents believe it is important for every American to have health insurance but 55% do not believe coverage for the uninsured should be the sole focus of the debate • The most trusted sources to reform health care are providers (37%), the White House (21%), Congress (13%), employers (11%) and health insurance companies (7%) • 61% believe that Congress is likely to make the health care situation worse than better • 55% believe government solutions to health care will cost more and deliver less compared to private sector solutions. • 51% believe health reform should not wait until the economy is better compared to • 47% who thought it should wait.

  7. White House #1 domestic issue: Reduce costs, cover everyone • February 24, 2009 to joint session of Congress: Reform energy, education and health care. Pass bill in 2009. • May 11, 2009 to major trade organizations: Cut CAGR to 4.7%, reduce costs by $2 trillion (2008 – 2018). • June 3, 2009: Everything on the table—mandates, employer tax exclusion, employer mandate, public plan, etc. • September 9, 2009: President Obama’s address to joint session of Congress, reiterating commitment. • White House messaging: • Reform is necessary to create competition in the insurance market • Reform is necessary to economic recovery • Reform is a moral imperative • Reform must be deficit neutral

  8. Looking ahead…a bill in December 2009 (~$900 billion) • Major elements of the “Kennedy” reform bill-- • Access--Individual mandate, Medicaid expansion, employer mandate • Quality—comparative effectiveness, episode-based payments, transparency • Cost—insurance regulation, health exchanges 4 • Major Sources of funding • Medicare cuts • Industry fees • Cadillac plans • Income taxes Consumerism Focus: Self care Achieves $ TBD Primary Care 2.0 Focus: Prevention, Chronic, LTC Achieves $24-57B/yr savings 3 Comparative Effectiveness/EBM Focus: (1) Personalized medicine, (2) bundled based payments, (3) provider adherence/performance-based payments Achieves uo to $30B/yr savings 2 Health Care Information Technology Focus: (1) e-prescribing, (2) fraud detection(3) administrative cost reduction , (4) care coordination Achieves $33-70 B/ yr savings 1

  9. As of October 15—40 proposals, 3 major bills

  10. In southeast Michigan, what if… • Every price for every healthcare transaction was known before the purchase? • Every treatment recommendation was based on evidence ? • Every dollar spent for facilities and technology necessary? • Every person knew as much about the industry as they know the auto industry? • Every person lived a healthier life and managed their own care?

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