Convergence in Healthcare A Vision for Data-Driven Transformation Mike Boswood, President & CEO Truven Health Analytics — June 12, 2014 ©Truven Health Analytics Inc. All Rights Reserved. 1 Agenda The Current Climate 2 Payment Reform Is Driving Market Convergence 3 Today’s Performance, Tomorrow’s Opportunities 4 More than Data. Answers ©Truven Health Analytics Inc. All Rights Reserved. 2 The Current Climate ©Truven Health Analytics Inc. All Rights Reserved. 3 ACA Implementation Caps a Decade of Change, And... 2003 2005 Medicare Prescription Drug, Improvement and Modernization 2006 2009 Medicare Prescription Drug Act Patient Safety and Quality Improvement Act; “Advanced Medical Home" model is developed ©Truven Health Analytics Inc. All Rights Reserved. 4 2010 2010 2014 ACA ARRA HITECH 81 out of ACA’s 90 Reform provisions implemented 8M enrolled Ushers in a Period of Uncertainty States How Expanded will we Medicaid pay for coverage healthcare given Statefiscal health exchange constraints? Federal WillExpanded the midMedicaid term election Subsidy impact Federal reform? exchange for many states Providers How Assumed do we Medicaid manage with eligibility uncertain payment Reduced payment for rates? hospital acquired infections Payers How Essential do weHealth benefits for compete new Multi-state plans members? Medical Loss Ratio limits Employers Should Wellness we programto continue incentives offer health benefits? Deferred employer requirements to 2015 Consumer Impact: Individual Mandate, Premium Subsidies, Guaranteed Insurance Access Political Outcome: Has ACA been accepted as the law of the land? ©Truven Health Analytics Inc. All Rights Reserved. 5 Evolving Coverage: Different Patterns of Enrollment Medicaid opt-out and low Exchange enrollment combine in some states to lessen the impact of Reform. % Expected Exchange Enrollment Over 75% 40 – 75% Less Than 40% Opt Out of Expansion ©Truven Health Analytics Inc. All Rights Reserved. Expand Medicaid 6 The C-Suite Agenda Community Needs ‒ Shift to outpatient ‒ Decreased hospital admissions/ readmissions Best practices/quality/ benchmarking 4 4 1 ‒ Cost containment ‒ Increased productivity ‒ Improved patient experience ‒ Revenue shortfalls ‒ Improved outcomes ‒ Services needed ‒ Increased staff satisfaction ‒ Service locations ‒ Equipment/labor needs Trusted Guide Are We 2 There Yet?2 Population Health Management $ ‒ ACO/medical homes ‒ Total cost of care 3 ‒ Physician alignment ‒ Physician referral ‒ Risk assumption ‒ Shift to payor & provider Source: 2013 Research for Strategy Priorities/ Planning Products ©Truven Health Analytics Inc. All Rights Reserved. Revenue generation/ reimbursement 7 Payment Reform Is Driving Market Convergence ©Truven Health Analytics Inc. All Rights Reserved. 8 ‘Reform’ drives convergence: New payment and delivery models • Value based outcomes • Selective network for outsourcing • Distributed ambulatory network Payers Provider Payer Collaboration Higher Risk of More Medical Costs Consumer Engagement ©Truven Health Analytics Inc. All Rights Reserved. • Stabilize employee health costs • Selective provider network • Employee health Employers Rising Medical Costs Premium Increases Mandate/Insurance Exchanges Defined Contribution 9 • More risk contracting • Expanding networks • Capacity for newly insured Providers Provider Consolidation Clinical Integration Patient Engagement & Acquisition Health Systems Are Forging New Partnerships Voluntary heart program partnership Joint surgery bundled care Heart care, hip, knee procedures + travel + caregiver ©Truven Health Analytics Inc. All Rights Reserved. 10 Finding Value in Bundled Payments Hospitals Employers Volume Savings Gain Share Quality Savings Physicians Consumers Volume Consistency Gain Share Quality Affordability All players need analytics to define their piece of the value exchange ©Truven Health Analytics Inc. All Rights Reserved. 11 Today’s Performance, Tomorrow’s Opportunities ©Truven Health Analytics Inc. All Rights Reserved. 12 PROVIDER FORECAST Possible Clearing Ahead 75 F o If all hospitals perform like a 100 Top Hospital: • More than 165,000 additional lives will be saved. • Nearly 90,000 additional patients will be complication-free. • $5.4 billion will be saved. • The average patient stay will decrease by nearly half a day. Cloudy Houston ©Truven Health Analytics Inc. All Rights Reserved. 13 12°C Extending Your Reach Beyond the Hospital ©Truven Health Analytics Inc. All Rights Reserved. 14 What the Future Holds: Faster, Better, Everywhere PATIENT / CARE GIVER COMMUNICATION DIAGNOSTICS GUIDED HOME TREATMENT PHYSICIANS Healthcare IT PATIENT MONITORING SNF, HOSPICE ©Truven Health Analytics Inc. All Rights Reserved. 15 GLOBAL ACCESS TO SPECIALIST NETWORKS Using Analytics to Tackle Variation in Care Opportunity for reducing Attending Physician variation Comparison Variation is recognized as a quality issue. 4000 Dollars Mean Excess Risk-‐Adjusted Cost 6000 Measure variation in risk adjusted LOS & cost among physicians to spur creation of quality improvement plans. 2000 0 -‐2000 -‐2 0 2 Mean Excess Risk-‐Adjusted LOS 4 P<.000 for LOS and cost comparison: Physician case volume at least 12 Days ©Truven Health Analytics Inc. All Rights Reserved. 16 Focus on Value Brings New Analytics to Solve LongStanding Problems Promoting Right Care in the Right Site Improves Quality and Satisfaction Understand misuse of ED – and develop programs to shift care upstream to primary provider, or medical home Otitis Media Infections - Respiratory NEC Each encounter shifted away from ED to primary setting saves $1000+ Arthropathies/Joint Disord NEC 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Non-Emergent EmergentCare Treatable If just 20% of ED visits were seen inPrimary a lower cost Emergent / Avoidable Emergent Avoidable site- Preventable of care, like a doctors office, the- Not national savings would be $4.4B ©Truven Health Analytics Inc. All Rights Reserved. 17 All Roads Lead to Population Health Business Leaders Clinical Leaders Care Givers Managers Consumers Risk Management Clinical Improvement Care Management Patient Engagement • Population risk management • Clinical outcomes reporting • Performance management • Patient registries • ROI analysis • Population and provider benchmarking • Contract management • Network management • Marketing campaigns • Provider collaboration • Population analytics • Care management • Consumer engagement • Longitudinal, singlepatient record • My medical record • Evidence-based content and decision support • Alerts, surveillance • Secure messaging • Validate predictive risk assessment • Secure messaging • Health-risk appraisal data • Work lists • Integrated health content • Measures and reporting • My patient registry • Manual data capture ©Truven Health Analytics Inc. All Rights Reserved. • Personalized health messaging 18 Data-Driven Organizational Transformation . ©Truven Health Analytics Inc. All Rights Reserved. 19 Truven View of the Healthcare Ecosystem ©Truven Health Analytics Inc. All Rights Reserved. 20 We’re Not New to This 20 million consumers 8,500 customers 1,800 healthcare facilities 3 petabytes Benefits for 100M Americans 87 countries 18 million individuals 50 states 50% of Medicaid beneficiaries ©Truven Health Analytics Inc. All Rights Reserved. 21 4,000 hospitals Foundations for the Consumer-Centric Data-Driven Future Share your data while simultaneously protecting it Acknowledge need for pricing, quality, and value transparency Adopt an evolutionary approach to population health Recognize that organizational transformation is fundamental to positive change ©Truven Health Analytics Inc. All Rights Reserved. 22 Truven and Simpler: The Promise of Data-Driven Enterprise Transformation Using data driven enterprise transformation, Truven and Simpler will partner across the healthcare economy to improve clinical outcomes and business performance Unique data assets, analytics Gold standard operational and clinical benchmark databases Leadership Development from C-Suite to Middle Management to Practitioner Gold standard methodology for Process Improvement 100 Top scorecard Best in class risk adjusted models Clients range from large integrated health systems to critical access hospitals Best in class transformation model ©Truven Health Analytics Inc. All Rights Reserved. 23 Performance Improvement that is: Continuous Transformative Sustainable Analytics Enabled Healthcare: Truven Health’s View of the Future Integrating all relevant data sources Driving tangible value and enabling organizational change through flexible solutions and services Partnering with customers across healthcare Enhancing use of predictive analytics Empowering healthcare recipients to behave like consumers ©Truven Health Analytics Inc. All Rights Reserved. 24 Convergence in Healthcare A Vision for Data-Driven Transformation Mike Boswood, President & CEO Truven Health Analytics — June 12, 2014 ©Truven Health Analytics Inc. All Rights Reserved. 25
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