emoryhealthcare.org

HEALTHCARE FINANCING REFORM IN

THE U.S.: TRUMPING THE ACA AND

MEDICARE?

TRANSFORMING HEALTHCARE

SWISS RE CENTRE FOR GLOBAL

DIALOGUE

William A. Bornstein, MD, PhD

Chief Medical Officer and Chief Quality Officer

Emory Healthcare

WHSC Strategic Planning Office 2

Emory – At a Glance

● Most comprehensive system in Georgia

● 7 hospitals

● 1,958 beds

● 1,400+ physicians

● 575 medical students

● 510 allied health

● 1,266 residents/ fellows

● 104 accredited programs

● 2,555 full/part-time faculty

● $348m in research funds (#17 nationally)

● 1,140 master degree students

● 189 PhD students

● 296 full/part-time faculty

● $95m in research funds (#9 nationally)

● 374 bachelor degree students

● 291 master/PhD/ doctoral students

● 121 full/part-time faculty

● $15m in research funds (#1 nationally)

● Only NCI cancer treatment center in Georgia

● $83 million in research funds1

● One of 7 NIH funded primate centers in the U.S.

● 357 staff members

● 58 faculty scientists

● 3,000 non-human primates

● $79m in research funds (#1 nationally)

●3,035 faculty

●5,207 students / trainees

●24,067 employees

●$4 billion enterprise

●$540 million research funding

02/01/2017

1 Spread across multiple schools and included in school totals

Sources: 2016 WHSC At-A-Glance, SOM Strategic Initiatives Department, Press Releases, Websites

WHSC Strategic Planning Office 3

Overview of Clinical Platform

02/01/2017

2,555Faculty

631Volunteer Faculty

575Medical students

510Academic Health

Students in 5 programs

1,266Residents & Fellows in

104 training programs

16,000 + Employees

1,500+Employed Physicians

7 Hospitals

106Operating rooms

139,000Surgeries Annually

1,958Beds

597,000+Patients Served

Annually

200,000+Patient Portal Users

16,598Clinical Research

Patients On StudiesMagnet Designated

Hospitals

3

481Solid Organ

Transplants Annually

2,000 +Open Heart

Surgeries Annually

69,000+Inpatient Admissions

Annually

4,100,000Outpatient Visits

Annually

37%Retention rate of

Emory MD graduates

practicing in Georgia

emoryhealthcare.org

5

Emory Healthcare Network

Physician Membership Requirements• Alignment with EHC• Initial Application Fee of $1,500 per physician• Approved by EHN Participation Committee• Certified interoperable EMR with approved vendor• Connected to Emory Health Information Exchange

emoryhealthcare.org

WHAT ARE THE BIGGEST HEALTHCARE PROBLEMS

CONFRONTING THE US?

• Cost

• Quality (Health of

Americans)

– Access?

– Social Determinants?

– Public Health?

5

• Value = Quality/Cost

Health Expenditures as a Percentage of Gross Domestic Product (GDP) in Selected OECD Countries, 1960–2009.

Fineberg HV. N Engl J Med 2012;366:1020-1027

7

Blumenthal D et al. N Engl J Med 2015;372:2451-2458.

Percentage of Adults 19 to 64 Years of Age Who Are Uninsured.

Blumenthal D et al. N Engl J Med 2015;372:2451-2458.

Percent Change in Hospital-Acquired Conditions from 2010 to 2013.

emoryhealthcare.org

TECHNOLOGY AS A HEALTHCARE COST DRIVER

Uwe Reinhardt, Waste vs. Value in American Health Care,

NYT Blog, 9/13/2013,

http://economix.blogs.nytimes.com/2013/09/13/waste-vs-value-in-american-health-care/#more-168145

Average value=AB/OB

emoryhealthcare.org

WHO SHOULD CONSTRAIN THE HIGH COST “LOW

VALUE” TECHNOLOGIES

• The payer (including governmental payers)?

• The patient?

• The provider?

• The government (as regulator)?

16

These episodes usually pass quickly. But the

most recent one, which Jha experienced after a

bruising international business trip, was a

particularly bad bout. At half-an-hour, his heart

was still racing. After an hour, his wife

urged Jha to go to the Emergency Room.

"And I was resisting it. She actually asked me,

'if a patient of yours called you with this, what

would you recommend to them?' And I said, ‘oh,

yeah, that’s easy. Go to the [Emergency

Department],'" Jha said.

Though he knew he could be experiencing a

heart attack, Jha didn’t want to spend $2,000 or

more getting checked out in the ER — even

though he said he could afford that. In

retrospect, Jha said he should have gone to the

hospital.

"But, you know, I knew there was a big bill

waiting for me if I did, and I rolled the dice," he

said.

Jha got lucky. After an hour his heart rate began

to slow.

emoryhealthcare.org

20

emoryhealthcare.org

21

22

SGRRepeal 2015

MACRA2015

APM2019

MIPS2019

Sustainable Growth RateWas positioned for a 25% cut

in Medicare FFS for 2015

Medicare Access and CHIP Reauthorization Act of 2015

New framework for value based care

Merit-Based Incentive Payment SystemPQRS+MU+VM

Quality, Resource Use, Practice Improvement, EHR Use

Alternative Payment ModelsAt-risk business model

ACO, Bundled Payments, Medical Homes

Medicare Moving to Population Health

Distribution of the IOM's Recommended CER Priorities.

Iglehart JK. N Engl J Med 2009;361:325-328.

CAN THIS PROBLEM BE SOLVED WITHOUT

REGULATORY FORCES?

Science, 1968

emoryhealthcare.org

SUMMARY

• Non-sustainable health care cost increases are occurring throughout

the world, with the US leading the pack

• In the US, there are major shifts of cost risks underway to patients and

to providers with mixed results

• These shifts constitute “grand experiments” and will have intended

and unintended consequences

• Inevitably, health care spending must be rationalized (or “rationed”)—

how this happens will in large part be a reflection of a society’s values

THE BEST OF TIMES AND THE

WORST OF TIMES

29

"It was the best of times, it was the worst of times; it was the age of wisdom, it was the age of foolishness; it was the epoch of belief, it was the epoch of incredulity; it was the season of Light, it was the season of Darkness; it was the spring of hope, it was the winter of despair; we had everything before us, we had nothing before us; we were all going directly to Heaven, we were all going the other way."

-- Charles Dickens

Basic Copyright Notice & Disclaimer

©2017 This presentation is copyright protected. All rights reserved. You may download or print out a hard copy for your private or internal use. You are not permitted to create any modifications or derivatives of this presentation without the prior written permission of the copyright owner.

This presentation is for information purposes only and contains non-binding indications. Any opinions or views expressed are of the author and do not necessarily represent those of Swiss Re. Swiss Re makes no warranties or representations as to the accuracy, comprehensiveness, timeliness or suitability of this presentation for a particular purpose. Anyone shall at its own risk interpret and employ this presentation without relying on it in isolation. In no event will Swiss Re be liable for any loss or damages of any kind, including any direct, indirect or consequential damages, arising out of or in connection with the use of this presentation.