Kuwait Healthcare Reform 2009

Presented by Julie B. DeckerManaging Director, Lynxcom Partners

Operating Partner, Director of Healthcare Practice, FocalPoint Partners

Healthcare Market and Growing Costs

Defining the Alternate Site of Care

Home Infusion

Ambulatory Infusion Centers

Hospice

Home Health

2

3

• Law

• Public accounting

• Strategy consulting

• Senior lending

• Payer relations, reimbursement and regulatory affairs

• Business development and operations

• Healthcare information services

4

5

6

7

8

Healthcare Expenditures as Percent of Gross Domestic Product

9

102007 Total Expenditure = $2.241 trillion USD

11

12

TRADITIONAL SITES OF CARE ALTERNATE SITE OF CARE

Hospital Inpatient

Physician Office

Hospital Outpatient

Aggregating disease-specific patients into centers to provide cost effective care

Hospital without walls• Dialysis• Surgery Centers• Infusion Centers• Home Care• Skilled Nursing facilities• Emergency Room• Urgent Care• Retail Clinic

13

14

Pharmacy-based, decentralized patient care• Expertise in sterile drug compounding• Provides care to patients with acute or chronic

conditions in home and alternate sites

Services include:• Professional pharmacy services• Care coordination• Infusion nursing services• Supplies and equipment

15

4,000 pharmacies nationwide Market size $12 Billion Types

• Hospital based infusion pharmacy• National chains• Independent - local and regional

Most are Accredited by JCAHO, CHAP, ACHC

16

17

USP 797-Compliant Sterile Compounding

18

Often providing ongoing therapy for chronically ill patients

• Rheumatoid arthritis• Multiple sclerosis• Neuromuscular disease• Immune deficiency• Crohn’s disease• Psoriasis• Oncology

Common drugs provided• ABC• Rituximab• Remicade (3)• IVIG• Orencia• Tysabri• Methotrexate• SoluMedrol

19

Administration of infusible and injectable therapies• Biologicals• Oncology therapies• Anti-infectives

Patient and caregiver instruction on self-injection PICC and peripheral line placement Additional clinical services

• Clinical trials• Hospital inpatient bed-day reduction programs• Diagnostics and imaging• Vaccinations and flu shots • Wound care • PT/OT

20

One to many relationship (4:1)

Reduces costs

Improves efficiencies

Manages the nursing shortage

21

AIC

Physician Office

Home Infusion

AIC placement determined by understanding utilization:• Patient population• Disease• Drug/Therapy• Physician Spend• Geography

22

X

X

X

XX

X

X

X

X

XXX

XXX

X

X

X

X

XX

X

XX X

X

X

X

X XX

XXX

X

X

XX

X

X

X

XX

X

X

X

X

XXX

XXX

X

X

X

X

XX

X

X

XX

XX

X

XX

X

X XX

X X

XX

X

X

X

XX

X

X

X

X

XXX

XXX

X

X

X

X

XX

XX

XX

X

X

X

XX

X

X XX

X X

XX

MD

MD

MD

MD

MD

MD

MDX

= AIC location

= prescriber location

= patient location

23

End of life and palliative care• Major healthcare costs are at the end of the

patient’s life• Hospice offers cost savings by treating

terminal patients at home Rx, RN, pain management, social services

Covered as a Medicare benefit in 1986• Adopted by commercial payers

24

Utilized during last 6 months of life

Difficult to determine prognosis

25

26

High-touch patient care in the home• Low cost alternative to facility-based care• Provides access to care for the homebound

and non-ambulatory

Licensed in accordance with State or local law

27

Services include:

28

29

How to decide which patients are appropriate for alternate site• Clinical factors: high-risk, severity• Home setting: appropriate assessment• Support/caregiver factors

Understanding utilization• Patient populations and costs• Disease states• Utilization of drugs and services• Geographic distribution of patients

30

Medicare Medicaid Commercial payers

• ER Triage• Bed Day Reduction

Reimbursement is covered in alternate sites of care

31

Understanding patient populations is key

Know the costs associated with the major diseases and therapies

Building hospitals without walls will reduce administrative costs

Patients respond positively to care in the home

Alternate site improves patient wellbeing

32