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Presentation by Carl W. Taylor, JD, Executive Director, Fraser Institute for Health Research
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Carl W. Taylor JDFraser Institute for Health and Risk Analytics
Telehealth Before Sequestration?
Where Did We Begin?• Fragmented silos of episodic
FFS care with some risk in some markets
• Push for EHR and connectivity with only a vague notion of why
• Explosion in the aging and chronic population
• No accountability for costs• Disconnect between wellness
as a preference and illness as a business
PPACA Is An Attempt To Try Something New
The First Barrier: Them vs. Us
The Second Barrier: Us vs. Us
The Third Barrier: Us vs. Them
The Health Reform Uncertainty
• There is a difference between Risk and Uncertainty
• We have always had risk in healthcare but now we have uncertainty
And The Current Future
• PPACA’s Contribution– Supreme Court ruling and election gives certainty
for today but leaves a Medicaid hole for some states
– Medicare Advantage cuts may impact benefits/MLR– CMS driven ACOs with likely un-eveness in
performance and higher market costs– CMS Duals Office- Un-eveness on its journey– Health Insurance Marketplaces (f/k/a exchanges)
will emerge in some form but with what populations
– CMS –CMMI will test a wide variety of programs to save money will any of them work
Reform Has Forced Consolidation Across All Players
And Created A Dilemma for Physicians
And The Doctor Question
• It is 3 a.m. in the morning I just finished delivering Mrs. Jones baby- what am I paid?
The FearsWill any of this workCan we balance the 3 R’s (risk, reward
and regulation)Who wins and more importantly how do I
win
When Choosing A Path Becomes Confusing
Some Options
1. Wait and do nothing-Keep The As Is State2. Build an expanded enterprise to create more leverage and market dominance- Some ACOs fall into this category.3. Build a risk bearing broader bio/psycho/social clinical enterprise where all professions are focused on coordinated quality and outcomes to overcome our common challenges……
Our 9 Common Challenges
• 1. We Must Re-invent the Physician Practice• 2. We Must Improve Our
Access/Understanding of Data• 3. We Must Accelerate The Adoption of
Successful Programs to Improve Patient Adherence and Physician Skills
• 4. We Must Improve Quality and Consistency of Outcomes Across All Domains
Common Challenges Together
• 5.We must reduce readmissions• 6. We must keep mom at home• 7. We must deliver more healthy babies and
raise healthier children• 8. We must create interdisciplinary
approaches to dealing with complexity• 9. We must reach the unreachable
Telehealth Under Health Reform
Our Future Is Now World
The Rise of Connected Knowledge
And Then How Do We
• Embrace, absorb, deploy or reject the 40,000 or so apps for healthcare?
What I Think I Think• We will navigate from episodic
encounters to continuous interactions.• Narrow networks will prevail not only by
offering quality and cost advantages but by achieving them through the appropriate use of emerging technology
A Confidential Secret: We Can Make This Work
If We Can Re-Language The Solution