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Deloitte Center for Health Solutions
November 26, 2012
Monday memo
Health reform update
This week’s headlines: My take
Implementation update - HHS provides guidance on EHB, premium pricing, and wellness programs
- PCORI board adopts methodology strategy for CER
- Court challenge to contraception requirement denied
Legislative update
- HHS priorities in 2013
- Senate committee requests information from state pharmacy boards
- HIV screening recommended for all Americans
- SGR temporary fix to cost $25.2 billion, $7 billion above prior estimate
State update
- Survey: state health departments modernizing IT systems
Industry news - Hospital EHR deadline this Friday
- Meaningful use loans available
- Medicare claims data released
- Study: use of allied health professionals in primary care increases efficiency, panel size
- Study: e-visits associated with fewer diagnostic tests, more prescriptions
- Study: portal use associated with higher utilization of services
Quotable
Fact file
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Upcoming life sciences and health care Dbriefs webcasts
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My take
From Paul Keckley, Executive Director, Deloitte Center for Health Solutions
I love college sports: men’s and women’s, any season, any sport, you name it and I love
it. And right now, it’s a special time—my Buckeyes finished 12-0, my Commodores 8-4
and Bowl eligible, and hoops are around the corner.
But I am also a little confused these days: how can the “Southeastern Conference”
include Texas A&M and Missouri—are they “southeastern”? How is the “Big Ten” actually
12 teams, or possibly 14 if Maryland and Rutgers join? And how can the Big East include
USF and Notre Dame in basketball, but only USF in football—last I checked, Notre Dame
was having a pretty good year on the gridiron too!
It probably boils down to two simple things: brands matter, and teams go where brands
lead to more money. College sports, after all, is a business, and institutions like Ohio
State, Vanderbilt, and Notre Dame guard jealously their brands. It’s understandable.
Health care is no different. It’s about patient care and complex science, but it’s also about
dollars and cents. It’s a $2.8 trillion industry in the U.S. alone, and every sector in the
industry needs revenue growth because demand for health goods and services is
increasing exponentially and medical inflation and labor costs add 3% per year to costs of
operation. And in health care, a strong brand can often lead to more revenue.
But branding in health care can be just as puzzling as college athletic conference
affiliations. Our surveys indicate consumers, for the most part, are confused about the
U.S. system’s performance and seemingly lost in our branding wars. Consider, there are
700 “Top 100 U.S. Hospitals,” Blue Cross plans that don’t have Blue Cross in their names,
and “medical centers” that have fewer than 100 beds. We call lots of folks in health care
“doctor” these days, including many without formal training, and the name game in
prescription drugs requires a thesaurus embedded in a mobile app to stay abreast.
Seems to me everything about the future of health care points to the importance of
branding, but with a substantially different twist. Historically, our brands were built on
impressions by first-hand users (patients, members, clinical trial subjects, et al) or word of
mouth. In some sectors, advertising helped bolster brands—hospitals, drug companies,
and insurance plans invested strategically to win hearts and minds of their customers, and
differentiate to the extent possible from competitors. But that’s changing.
Consumers have more skin in the game now than ever before. They’re able to compare
prices and outcomes for simple medical treatments. And they can access their own
medical records to compare their signs, symptoms, risk factors, and co-morbidities to
clinical algorithms and better understand where to get the appropriate care, and how
much that care will cost.
They’re able to log on to independent websites and compare insurance plans head-to-
head, download applications that let them know about a generic substitute in lieu of the
prescribed drug, and search for a clinician who uses diagnostic techniques they prefer.
And all this while the industry is consolidating and integrating: going big or getting out is
table stakes in most sectors as consolidation takes on many shapes and sizes—plans
and plans, hospitals and hospitals, hospitals and physicians, plans and physicians,
pharma and biotech, bio-pharma and companion diagnostics, device and pharma, over-
the-counter and prescription, and so on.
No industry is as pervasive in its impact financially and personally as health care, and
none has been as insulated from consumerism as this one. Branding matters in most
industries because a trusted brand conveys quality and value to its customers. Branding
in health care has not kept pace. Little wonder most consumers are not convinced of our
value. By two to one, most U.S. adults think the U.S. health care system is expensive,
wasteful, and often ineffective. But it will change. The forces of the market lead to two
simple facts: consumerism in health care is not a fad. Consumers’ increased role as the
direct purchasers of goods and services is certain, and their appetite for demonstrated
value from the health system just as real.
The value proposition for our industry must be re-thought: does Joe Six Pack associate
what’s expected with what’s delivered, or what’s paid vs. what costs truly are? Do non-
traditional competitors pose big threats to incumbents sometimes prone to focus on
traditional competitors only? Is the issue for-profit or not-for-profit ownership status, or
how profit is made and operating surpluses used? I don’t suspect retail pharmacy primary
care clinics needed permission to enter markets. Dramatic adoption of distance medicine,
alternative health, self-care diagnostics, online social networks, probiotics, substitutionary
medicine, and many others validate that the pursuit for value is now impacting our
industry.
Our customers are consumers, not just patients; employers, not just group accounts;
government professionals, not just bureaucrats. In some ways, they see the future better
than we do, they’re pursuing brands that bring value and they’ve long since slain our
sacred cows…
All health care is local.
Everything that’s done is necessary.
Quality can’t be measured.
And costs don’t matter.
So I plan to watch the Big Ten even though it’s actually 12, and the Southeastern
Conference even though it’s now also southwest. I am able to live with the branding of
these conferences because their value propositions to their customers—advertisers, fans,
players, and coaches—seems solid.
Branding in our industry is a whole new ball game.
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Implementation update
HHS provides guidance on EHB, premium pricing, and wellness programs As anticipated, the U.S. Department of Health and Human Services (HHS) is providing a
steady stream of guidance pursuant to the implementation of the Affordable Care Act
(ACA). Tuesday, three proposed rules were issued for comment. Insurers, employers,
consumer groups, and the public have 30 days to weigh in on the essential health benefits
(EHBs) (119 pages) and premium pricing rules (131 pages), and until January 25 for the
wellness rule (81 pages).
Essential health benefits
Insurance plans sold to individuals who buy their own coverage and to employers—except
those that self-insure—must include a core package of services referred as EHBs
covering ten categories including emergency services; hospitalization; pediatric services,
including oral and vision care; mental health; and others. The proposed rule reaffirms
earlier guidance that states can choose the exact package of benefits that insurers must
provide, based largely on what is already offered in the most popular plans currently sold
in their states. One notable change from earlier guidance issued last December: the
original guidance about prescription drug coverage required one class of drugs be
covered for each major diagnostic category (i.e., depression, heart disease, asthma, et
al). The proposed rule says that the minimum standard should be the number of drugs per
category in the state’s chosen benchmark plan or one drug, whichever is greater.
Premium pricing
Consistent with prior reports, the proposed rule allows insurers to vary their rates based
on age, tobacco use, family size, and geography (where a person lives), but disallows
higher premiums for sicker people and any differential based on sex (premiums for
women were traditionally higher than for men since on average women have higher
utilization). The proposed rule allows insurers to charge tobacco users 50% more than
non-users, but offers an exemption to those who participate in smoking cessation
programs.
The proposed rule also clarifies how insurers may increase premiums as a person ages:
the ACA limits premiums for older people to no more than three times what younger
people are charged, thus lowering rates for older adults, but increasing rates for younger
enrollees. The rule prohibits premium rate variation for individuals under age 21, and as
adults age, allows insurers to charge slightly more annually until a person reaches age 64.
Above age 64, all enrollees in the plan would pay the same rate.
Note: the proposal differs from the standard business practices whereby many insurers
now set “age bands,” generally in five- or ten-year increments. The proposal also gives
more flexibility to states and insurers to vary annual deductibles, co-pays, and other
elements of the policies—so long as the policies’ overall coverage meets a minimum
actuarial value requirement, or the average percentage the plan pays toward a typical
consumer’s estimated annual medical costs. Rates must be based on defined geographic
areas within the state. A state can have up to seven zones, and may have one rating for
the whole state, define zones by grouping counties, base its zones on areas that share
the first three digits of a ZIP code, or group by metropolitan statistical areas (MSAs) and
non-MSAs. Each state will be responsible for setting its premium oversight to the zoning
method it chooses. Note: there are 3,068 counties, 455 three-digit ZIP codes, and 367
MSAs in the U.S.
Wellness programs
The ACA allows employers to provide discounts on health insurance to employees who
achieve certain medical or fitness goals targeting areas such as weight loss, cholesterol
level management, or blood pressure control. The proposed rule raises the maximum
permissible reward, discount, or penalty from 20% to 30% of the cost of the health
coverage, and increases the maximum reward to 50% for programs to reduce tobacco
use. The proposed rule adds a provision wherein the wellness programs must offer
alternatives for employees whose health conditions make it “unreasonably difficult” or for
whom “it is medically inadvisable” to meet the specified health-related standard, and it
requires that discounts or other rewards be available to workers annually.
My take: with last Friday’s deadline extension to December 14 for states to submit their
health insurance exchange (HIX) blueprints, and these three proposed rules, the
implementation of the ACA is in full swing. Additional guidance is expected soon—among
the several anticipated: how the 2.3% tax on medical devices will work; how the medical
loss ratio (MLR) will be calculated; how the federal government will operate HIXs in states
that do not choose to operate their own; how states can opt out of the expanded Medicaid
program created by the law given the Supreme Court’s ruling June 28; how the federal
government will allocate reduced disproportionate care funds for hospitals treating
uninsured individuals; and a final rule on how contraception coverage will be provided to
employees of religious universities, hospitals, and religiously-affiliated businesses that
object. Stay tuned. The Supreme Court’s ruling as well as the re-election of President
Obama and party control in the U.S. House and Senate remaining the same affirmed that
the implementation of ACA will continue. Its next chapter will be about implementation and
industry response.
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PCORI board adopts methodology strategy for CER Last Monday, the Patient-Centered Outcomes Research Institute's (PCORI) Board of
Governors approved a 30-page draft of the research methods it will use in the
development of comparative effectiveness research (CER). Tuesday, it announced plans
to award $12 million for up to 14 contracts for studies that will address knowledge gaps
and advance the field of comparative clinical effectiveness research. Application materials
can be downloaded from the “Funding Opportunities” section of PCORI’s website. The
online application system is now open and letters of intent are due January 15, 2013.
PCORI expects to announce research awards in the spring of 2013.
My take: PCORI might be the least understood and most fundamentally transformative
element of the ACA. Its role is three-fold: filling gaps in evidence about treatments,
developing appropriate methodologies to compare and contrast approaches based on
objective criteria, and disseminating its comparative effectiveness studies to industry
stakeholders and end-users—consumers.
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Court challenge to contraception requirement denied The U.S. District Court for the Western District of Oklahoma denied a request from the
Christian owners of the Hobby Lobby Inc. stores that they be exempted because of their
religious beliefs. Judge Joe L. Heaton, a President George W. Bush appointee, said
Hobby Lobby, as a secular company, does not have rights to the free exercise of religion.
The owners, the judge said, are “unlikely to prevail” because the administration's
regulations “are neutral laws of general applicability which are rationally related to a
legitimate governmental objective.” The Becket Fund for Religious Liberty, representing
the owners, is appealing the decision to the 10th Circuit Court of Appeals and, in a
statement, says it faces fines of up to $1.3 million per day if it fails to offer contraception
coverage in its self-funded plan.
Note: this is the second time a judge has denied a preliminary injunction request on the
issue; the first went to the Legatus business group. Three injunctions have been granted.
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Legislative update
HHS priorities in 2013 Last week, the HHS Office of Inspector General (OIG) submitted its summary of the most
significant management and performance challenges facing HHS, required under Public
Law 106-531. The assessment details ten major issues:
Management Issue 1: implementing the ACA
Management Issue 2: identifying and reducing improper payments
Management Issue 3: preventing and detecting Medicare and Medicaid fraud
Management Issue 4: ensuring patient safety and quality of care
Management Issue 5: avoiding waste and promoting value in health care
Management Issue 6: ensuring efficiency and effectiveness of Medicare and
Medicaid program integrity contractors
Management Issue 7: grants management and administration of contract funds
Management Issue 8: protecting consumers of food, drugs, and medical devices
Management Issue 9: integrity and security of health information systems and data
Management Issue 10: fostering an ethical and transparent environment
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Senate committee requests information from state pharmacy boards Senators Tom Harkin (D-IA) and Mike Enzi (R-WY), leaders of the Senate Committee on
Health, Education, Labor, and Pensions (HELP) sent requests to each state’s board of
pharmacy seeking information about any complaints filed against the New England
Compounding Center (NECC)—the facility at the center of the fungal meningitis outbreak
responsible for 33 deaths and 500 diagnosed cases.
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HIV screening recommended for all Americans Last Tuesday, the U.S. Preventive Services Task Force (USPSTF) recommended that all
Americans 15-65 years of age be tested for the human immunodeficiency virus (HIV).
Annually, 200,000 are infected with the virus that can cause acquired immune deficiency
syndrome (AIDS) if not detected and treated. Currently, 1.1 million in the U.S. have AIDS
with 50,000 new cases annually. Previously, only populations at higher risk of contracting
AIDS had been screened for the test, costing $48-$64. The new recommendation, if
finalized, would be subject to inclusion in the set of preventive health services that health
plans are obligated to provide members at no out-of-pocket cost.
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SGR temporary fix to cost $25.2 billion, $7 billion above prior estimate Last Tuesday, the Congressional Budget Office (CBO) announced its updated calculation
for overriding the Sustainable Growth Rate (SGR) formula for 2013, used to set
physicians’ Medicare reimbursement. The cost, $25.2 billion for 2013, is $7 billion more
than earlier predictions. If the SGR is overridden, as is widely anticipated as part of the
fiscal cliff negotiation, the accumulated cost overrun will be added to the accrued liability
for physician payments, estimated at $320 billion. If the SGR was permanently fixed, this
would be added to the federal debt at a time when rating agencies and economists are
concerned about the level of debt now carried by the U.S.
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State update
Survey: state health departments modernizing IT systems Per survey results from 67 state health agencies in 35 states released last week by the
American Public Human Services Association (APHSA) and Microsoft:
43% of agencies have implemented a new HHS information technology (IT) system
within the past ten years
57% have not modernized, although most of these agencies (55%) plan to do so
over the next three to five years
19% of respondents had no plans to modernize, mainly due to lack of funding
22% are very likely to consider the cloud for future system deployment
47% of agencies surveyed experienced an implementation timeframe of more than
three years when implementing a new system; states with larger constituent
populations also report longer implementation timeframes, but the programs
themselves (e.g., Temporary Assistance for Needy Families, Child Welfare, etc.) did
not have a direct correlation
(Source: APHSA and Microsoft, “A Promising Future for HHS Transformation–The Real
Impact of IT System Modernization,” November 14, 2012)
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Industry news
Hospital EHR deadline this Friday Hospitals seeking a Medicare Electronic Health Record (EHR) Incentive Program
payment for fiscal year (FY) 2012 have until this Friday to complete their online
attestation. To receive an incentive payment, a hospital must register with the Centers for
Medicare & Medicaid Services (CMS), use certified EHR technology, meet the meaningful
use criteria, and attest—submit the required quality measurement data generated by
certified EHR technology to CMS. If a hospital is attesting for the first time, it must have
reported on a continuous 90-day reporting period that ended on or before September 30.
If a hospital is attesting for the second time, the reporting period covers all of FY2012
(October 1, 2011 through September 30, 2012).
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Meaningful use loans available Last week, the American Health Information Management Association (AHIMA)
announced its partnership with the Delta Regional Authority (DRA) to provide loans in
increments of $5,000 and $7,500 to eligible health care providers as a down payment for
the purchase of an EHR system, with AHIMA providing the education and provider
recruitment support. The HHS’ Office of Minority Health and DRA will also assist in the
recruitment of eligible health care professionals providing services to racial and ethnic
minorities and underserved communities within the Delta Region.
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Medicare claims data released Wednesday, CMS announced the first three participants in the Medicare Data Sharing for
Performance Measurement program that provides Medicare claims data to certified
groups to report on provider performance: the Health Improvement Collaborative of
Greater Cincinnati, the Kansas City Quality Improvement Consortium, and the Oregon
Health Care Quality Corporation. In its statement, CMS noted that the groups are subject
to privacy requirements and that the agency will enforce penalties for misuse of data.
Background: in a final rule issued December 5, 2011, CMS allowed access to Medicare
claims data about providers for $40,000 for the first year to qualified organizations that
use the data from Medicare Parts A, B, and D to measure performance of physicians,
hospitals, and suppliers. Qualified entities may purchase data for one or more specific
geographic areas and use it in combination with sources other than Medicare data when
evaluating performance. The rule was opposed by the American Medical Association
(AMA) fearing possible misuse of the data.
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Study: use of allied health professionals in primary care increases
efficiency, panel size Primary care faces the dilemma of increasing patient panel sizes and fewer primary care
physicians (PCPs). The researchers used a simulation to estimate an optimal primary
care panel size under different models of task delegation to non-physician members of the
primary care team based on estimates of the time required for a PCP to provide
preventive, chronic, and acute care for a panel of 2,500 patients vs. the same services
provided by non-physician team members. Using three assumptions about the degree of
task delegation that could be achieved (77%, 60%, and 50% of preventive care,
respectively, and 47%, 30%, and 25% of chronic care, respectively), the research team
concluded that a primary care team could reasonably provide recommended care for a
panel of 1,947, 1,523, or 1,387 patients (based on the three sets of assumptions) if
services are delegated to non-physician team members.
(Source: Altschuler et al, Annals of Family Medicine, “Estimating a reasonable patient
panel size for primary care physicians with team-based task delegation,” September-
October 2012, 10(5):396-400)
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Study: e-visits associated with fewer diagnostic tests, more prescriptions A recent study examined the results of 8,100 patient visits to four primary care practices
between January 1, 2010 and May 1, 2011. The study cohorts consisted of 5,165 visits for
sinusitis, including 465 e-visits (9%) and 2,954 visits for urinary tract infections (UTI),
including 99 e-visits (3%).
The research team concluded that physicians were less likely to order a UTI-relevant test
for an e-visit than during an in-person encounter—8% for e-visits and 51% for in-office
visits; and somewhat less likely to order tests, X-rays or CT scans for sinusitis with e-visits
than in-person visits (0% vs. 1.2%).
Physicians were more likely to prescribe an antibiotic for an e-visit than for an in-office
visit: oral antibiotics were prescribed 99% for e-visits for patients with sinusitis and UTIs,
respectively, vs. 94% and 49% of the time during in-person encounters with patients.
(Source: Mehrotra et al, Archives of Internal Medicine, “A Comparison of Care at E-visits
and Physician Office Visits for Sinusitis and Urinary Tract Infection,” November 19, 2012)
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Study: portal use associated with higher utilization of services A study of 89,000 patients enrolled for 24 months (between March 2005 and June 2010)
at Kaiser Permanente in Colorado found that patient use of web-based EHR system
portals was correlated to higher utilization of office visits and telephone calls to providers.
Two cohorts were compared: users of the Kaiser’s MyHealthManager (MHM) patient
online access system and non-users. Among portal users, researchers found significant
increases in the per-member rates of office visits (0.7 per member per year), telephone
encounters (0.3 per member per year), per-1,000-member rates of after-hours clinic visits
(18.7 per 1,000 members per year), emergency department encounters (11.2 per 1,000
members per year), and hospitalizations (19.9 per 1,000 members per year) for MHM
users.
Note: the research team concluded they could not determine a causal relationship
between portal use and increased utilization: were users more inclined to report a medical
problem, or sicker, etc.? Additional study is necessary before it can be concluded that
portal use is predictive of increased utilization.
(Source: Palen et al, Kaiser Institute for Health Research, Journal of the American
Medical Association [JAMA], “Patients with Online Access to Clinicians, Medical Records
Have Increased Use of Clinical Services,” November 21, 2012)
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Quotable “Doctors and hospitals focus on producing health care, what people really want is health.
Health care is just a means to that end—and an increasingly expensive one.”—Asch et al,
New England Journal of Medicine (NEJM), “What Business Are We In? The Emergence
of Health as the Business of Health Care,” 367:10, September 6, 2012
“The best leaders tend to be outsiders who don’t have a great deal of experience…It’s the
unfiltered leaders, the outsiders without lots of experience, who perform the very best.”—Mukunda, Harvard Business Press, “Indispensable: When Leaders Really Matter,” 2012
“As with any new initiative, the Department faces substantial challenges in ensuring
efficient and effective implementation and administration of the ACA so that the programs
achieve their objectives and operate free from fraud, waste, and abuse. Developing
effective oversight strategies to prevent, detect, and correct any problems that occur is
critical. The large number of new and complex program responsibilities under the ACA
makes achieving these twin goals challenging…The Department and its partners should
be vigilant in identifying and addressing existing and emerging fraud, waste, and abuse
risk areas across all ACA-related programs. This will require a comprehensive approach
to program integrity that integrates effective front-end program gatekeeping, sound
payment design, the promotion of provider compliance, vigilant monitoring of program
operations and outcomes, and rapid remediation of detected problems.”—OIG, “Top
Management & Performance Challenges in the U.S. Department of Health and Human
Services,” required under Public Law 106-531
“At the end of the day, the debate is about moneycare—who bills for what and how the
billing pattern influences utilization. Controversies surrounding physician self-referral and
associated incentives wax and wane, and are seemingly repeated each decade. Moving
forward in the current era of health reform, the focus should be less about eliminating
incentives altogether, and more about getting the price right in the first place.”—
Hollenbeck et al, JAMA, “Financial Incentives and the Art of Payment Reform,” November
9, 2012
“Within the subset of Medicare beneficiaries who are age 65 or older, those enrolled in the
private Medicare Advantage program were less likely than those in traditional Medicare to
have premiums and out-of-pocket costs exceed 10% of their income. But they were also
more likely than those in traditional Medicare to rate their insurance poorly and to report
cost-related access problems.”—Davis et al, Health Affairs, “Medicare Beneficiaries Less
Likely to Experience Cost- and Access-Related Problems than Adults with Private
Coverage,” August 1, 2012
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Fact file FDA staffing: the number of U.S. Food and Drug Administration (FDA) employees
increased 31.5% from 11,272 in 2007 to 14,824 in 2010; more than one-quarter
were temporary hires. Key findings: the FDA is losing talent due to its elongated
procedures for hiring, resulting in high turnover among temporary employees, and
FDA employees are generally more satisfied than government workers overall.
(Source: Pew Charitable Trusts, “The State of the FDA Workforce,” November
2012)
Global drug spending: 2006: $658 billion (41% U.S.), 2011: $956 billion (34%
U.S.), 2016: $1.175 trillion (31% U.S.). (Source: IMS Institute for Healthcare
Informatics, July 2012)
Expedited drug approvals: in FY2011, the FDA classified every new molecular
entity as innovative and used expedited review for 16 of the 35 new drugs.
(Source: FDA)
MA differentials: nationally, Medicare Advantage (MA) plans cost 103.4% of
Medicare FFS costs in the same county—102.5% in urban counties, 105.9% in
rural; in 2009, MA plans were paid 14.2% above Medicare FFS rates totaling $12.7
billion or $1,236/enrollee; in 2010, the differential was 8.9% totaling $8.9 billion or
$814 per enrollee; changes in Medicare Part C payments in the ACA will likely
reduce the net differential to $1.4 billion by adjusting payments downward in the
785 highest cost counties, reducing rebates across the board to Part C plan
sponsors, and increasing incentives for highest performing plans—with 3.5 stars or
higher; per the CMS Office of the Actuary, private MA plans have operating costs of 13%, including 3% for profit/retained earnings. (Source: Biles et al, The
Commonwealth Fund, “The Impact of Health Reform on the Medicare Advantage
Program: Realigning Payment with Performance,” October 2012)
Costs of chronic disease: cardiovascular disease, cancer, and diabetes now
cause 70% of U.S. deaths and account for 75% of health expenditures. (Source:
Kelly et al, The National Academies Press, “Promoting Cardiovascular Health in
the Developing World: A Critical Challenge to Achieve Global Health,” 2010)
Supplemental coverage: without supplemental coverage, 14.5% of Medicare
beneficiaries would have had out-of-pocket costs of more than $2,500 in 2009, and
15% would have had at least one year (2000-2009) with expenses in excess of $5,000. (Source: Kelley et al, Journal of General Internal Medicine, “Out-of-Pocket
Spending in the Last Five Years of Life,” September 5, 2012)
Education spending vs. results: global spending on education is 5.6% of gross
domestic product (GDP), or $3.9 trillion. The U.S. spends $1.3 trillion and ranks 24
of 35 countries in math, 17 in science, and 14 in reading. The U.S. is the only
country with high proportions of both top and bottom performers: 20% of 15-year-olds do not have basic science skills, 23% math. (Source: President’s Council of
Economic Advisors, Organisation for Economic Co-operation and Development
[OECD], Program for International Student Assessment [PISA] 2009)
Medicare Part D Participation: 73% of all Medicare beneficiaries enrolled vs.
CBO forecast of 87%. (Source: Kaiser Family Foundation)
Population ethnicity change: projected U.S. population change from 2005 to
2050: +48%: white +4%, black +56%, Asian +192%, Hispanic +205%. (Source:
Pew Research Center)
Expectations about impact of ACA on quality of care: 42% believe no changes,
38% believe quality will decrease, and 20% increase; no major differences by age, income. (Source: Truven Health Analytics, Health Leaders, October 2012)
Income disparity: including capital gains, the share of U.S. GDP going to the top
1% of earners has doubled since 1980, from 10% to 20%; the share going to the
top .01% (16,000 families with average income of $24 million) has quadrupled from
1% to 5%; similar to income trends in UK, Canada, China, India, Sweden. (Source:
The Economist, “For Richer, For Poorer,” October 13, 2012)
Internet access: by 2015, 2.1 billion in the world will have online access—up from
746 million in 2010; in the G20 countries, Internet commerce will account for 5.3% of economic output in 2016, up from 4.1% today. (Source: BCG Analytics)
Physician self-referral: one in five physicians owns/leases in-office advanced
imaging equipment; utilization increased 70% in last ten years, including 200% increase in payments to cardiologists for in-office imaging studies. (Source:
Hollenbeck et al, JAMA, “Financial Incentives and the Art of Payment Reform,”
November 9, 2012)
Observation units: more than one-third of emergency rooms operate observation
units; the average stay in an observation unit is 28 hours per episode; the ratio of
observation stays to inpatient admissions increased 34% between 2007 and 2009;
chest pain, abdominal pain, and shortness of breath are the most frequent
symptoms treated in observation units. (Source: Feng et al, Health Affairs, “Sharp
Rise In Medicare Enrollees Being Held In Hospitals For Observation Raises
Concerns About Causes And Consequences,” June 2012)
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Coming soon: 2012 Survey of U.S. Health Care Consumers – INFOBrief series and Five-year report
Currently available: Understanding the SGR: Analyzing the “Doc Fix”—October 2012. Available online at
www.deloitte.com/us/2012sustainablegrowth
Impact of Health Care Reform on Insurance Coverage: Projection Scenarios Over
10 Years – Update 2012—October 2012. Available online at
www.deloitte.com/us/2012coveragemodel
State Medicaid Program Management: Update and considerations—September 2012.
Available online at www.deloitte.com/us/2012statemedicaid
Meeting the Challenge: Maximizing the value of employer-sponsored health care—
August 2012. Available online at www.deloitte.com/us/meetingthechallenge
2012 Deloitte Survey of U.S. Employers: Opinions about the U.S. health care system
and plans for employee health benefits—July 2012. Available online at
www.deloitte.com/us/2012employersurvey
Deloitte 2012 Survey of U.S. Health Care Consumers: The performance of the health
care system and health care reform—June 2012. Available online at
www.deloitte.com/us/2012consumerism
Health Care Reform: Center Stage 2012 Perspectives from consumers, physicians
and employers—June 2012. Available online at
www.deloitte.com/us/healthcarecenterstage2012
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Read the blog
To stay up-to-date, check out the Center for Health Solutions’ blog: A view from the Center—where policy, innovation, and industry meet
http://blogs.deloitte.com/centerforhealthsolutions/
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Upcoming life sciences and health care Dbrief webcasts Anticipating tomorrow's complex issues and new strategies is a challenge. Stay fresh with Dbriefs – live webcasts that give you valuable insights on important developments
affecting your business.
December 11: What's Around the Corner for Health Care Organizations and
Policymakers?
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Deloitte contacts
Paul H. Keckley, Ph.D., Executive Director, Deloitte Center for Health Solutions
Jessica Blume, U.S. Public Sector National Industry Leader, Deloitte LLP
Bill Copeland, U.S. Life Sciences and Health Care National Industry Leader, Deloitte LLP
Jason Girzadas, National Managing Director, Life Sciences & Health Care, Deloitte
Consulting LLP ([email protected])
Harry Greenspun, M.D., Senior Advisor, Health Care Transformation and Technology,
Deloitte Center for Health Solutions ([email protected])
Mitch Morris, M.D., National Leader, Health Information Technology, Deloitte Consulting
LLP ([email protected])
George Serafin, Managing Director, Health Sciences Governance Regulatory & Risk
Strategies, Deloitte & Touche LLP ([email protected])
Rick Wald, Director, Human Capital, Deloitte Consulting LLP ([email protected])
To receive email alerts when new research is published by the Deloitte Center for Health
Solutions, please register at www.deloitte.com/centerforhealthsolutions/subscribe.
To access Center research online, please visit
www.deloitte.com/centerforhealthsolutions.
To arrange a briefing for your team, contact Jennifer Bohn ([email protected]).
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