Session 34PD, Initiative 18/11: What Can We Do About the Cost of

Health Care?

Moderator/Presenter: Joe L. Wurzburger, FSA, MAAA

Presenters:

Joan C. Barrett, FSA, MAAA Larry Levitt

Brian E. Pauley, FSA, MAAA

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SPONSORED BY

About Initiative 18/11Brian Pauley

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Initiative 18 | 11

• The story of Initiative 18|11• What can we do about the cost of health care?

• The Path• Funding• Contributors• Inaugural event on March 7, 2018• Next steps

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About Kaiser Family FoundationLarry Levitt

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What we are not:Connected with Kaiser PermanenteA foundation

What we are:A health information organization that analyzes policy issues, tracks public opinion through polling, and informs the public through journalism

About the Kaiser Family Foundation

www.kff.org

www.khn.org

www.healthsystemtracker.org

• Drug pricing• All-payer rate setting• Price transparency• Single payer/Medicare for All• Opioids

Potential upcoming policy debates and opportunities for influence

Inpatient hospital prices grew faster for private insurance than for Medicare/Medicaid

Average inflation-adjusted, standardized payment rates per inpatient hospital stay, by primary payer

Source: Thomas M. Selden analysis of AHRQ’s Medical Expenditure Panel Survey for the Kaiser Family Foundation.Update of earlier analysis, available here: https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2015.0706

$0

$5,000

$10,000

$15,000

$20,000

$25,000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Private insurance Medicare Medicaid

https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2015.0706

Key FactsJoan Barrett

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Per Capita Expenditures

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Comments:• The 2016 per capita expenditures in the U.S. is $10,348, roughly twice that of comparable countries.• This translates to 18% of GDP for the United States compared to 11% for comparable countries.

Source: Health System Tracker, https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/?_sf_s=compare#item-average-wealthy-countries-spend-half-much-per-person-health-u-s-spends

https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/?_sf_s=compare#item-average-wealthy-countries-spend-half-much-per-person-health-u-s-spends

Healthcare Systems Models

Model Description Applications

Bismarck Model • Private Initiatives/companies• Non-Profit only• No pre-existing conditions• Government cost-control

• Germany and Japan• U.S. commercial, except for non-

profit requirement and government cost control

Beveridge Model • Government is single-payer• Most doctors are government employees

• United Kingdom• U.S.: Native Americans, military

personnel and veterans

National Health Insurance • Government is single-payer• Providers are private entities

• Canada• U.S. Medicare

Out-of-Pocket • Most services paid out of pocket• Some core services may be available

• India, most poor countries• U.S. uninsured

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Source: T.R. Reid, “The Healing of America: A Global Quest for Better, Cheaper and Fairer Health”

Comments:• Micro-insurance and non-government organizations play a key role in out-of-pocket countries like India

and many African countries.

Price Comparisons

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Comments:• Cost control strategies

• U.K.: Global budget, but running at a deficit• Spain: a conglomeration of health centers, mostly salaried physicians• Switzerland: private and public funding of hospitals. New cost cutting proposals include reducing

mandatory benefits, revision of current fee schedules, further concentration of specialized care to reduce duplication

Source: • http://static1.squarespace.com/static/518a3cfee4b0a77d03a62c98/t/57d3ca9529687f1a257e9e26/1473497751062/2015+Comparative+Price+Report+09.09.16.pdf• http://healthcare-economist.com/2008/04/16/health-care-around-the-world-spain/

http://static1.squarespace.com/static/518a3cfee4b0a77d03a62c98/t/57d3ca9529687f1a257e9e26/1473497751062/2015+Comparative+Price+Report+09.09.16.pdf

Health Care System Performance Rankings

AUS CAN FRA GER NETH NZ NOR SWE SWIZ UK US

Overall Ranking 2 9 10 8 3 4 4 6 6 1 11Care Process 2 6 9 8 4 3 10 11 7 1 5

Access 4 10 9 2 1 7 5 6 8 3 11

Administrative Efficiency 1 6 11 6 9 2 4 5 8 3 10

Equity 7 9 10 6 2 8 5 3 4 1 11

Health Outcomes 1 9 5 8 6 7 3 2 4 10 11

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Comments:• The U.S. ranks in the middle on Care Process with stronger performance on the subdomains of prevention, safety

and engagement.• The U.S. tends to excel on measures that involve the doctor-patient relationship including wellness counseling,

chronic disease management and end-of-life discussions.• The U.S. performs poorly on coordination measures like information flows between PCPs and specialists and

social service providers.

Source: Commonwealth Fund, http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror

http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror

Risk Factors

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Comments• The U.S. tends to be younger than comparable countries and has fewer

smokers.• The obesity rate, however, is 88% higher than in other countries.

Source: https://www.healthsystemtracker.org/chart-collection/know-social-determinants-health-u-s-comparable-countries/?_sft_category=health-well-being#item-though-u-s-population-aging-younger-average-age-smaller-elderly-population-comparable-countries

Relative Resources

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Comments• The U.S. has fewer hospitals and physicians than comparable countries.• The U.S. has more MRI machines and does more diagnostic tests than comparable

countries.

-33% -41%-24%

-3%

115% 105%

-100%

-50%

0%

50%

100%

150%

200%

Acute Beds/1000 ALOS PracticingPhysicians/1000

Nurses/1,000 MRI Machines DiagnosticExams/1000

U.S. as a Percent Difference From Comparable Countries

Source: https://www.healthsystemtracker.org/chart-collection/u-s-health-care-resources-compare-countries/?_sft_category=quality-of-care#item-u-s-fewer-practicing-doctors-per-1000-people-comparably-wealthy-countries

National Expenditures by Source of Funds

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Comments• Total spending in the U.S. in 2016 was approximately $3.3 trillion or 18% of GDP.

• In 2016 dollars, a 1.0% change in expenditures translates to $33 billion and a 0.1% change translates to $3 billion.

• There has been a significant decrease in out-of-pocket spending since 1990 offset by increases in private health insurance, Medicare and Medicaid spending.

• Additional explanatory comments on note page.

Source: CMS, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

Chronic Disease Overview

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$1,177 $2,915 $4,731 $6,751 $9,162 $15,954

14.2% 14.8% 13.0%11.8%

11.2%

35.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

$-

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

No Chronic Conditions 1 Chronic Condition 2 Chronic Conditions 3 Chronic Conditions 4 Chronic Conditions 5+ Chronic Conditions

Chronic Disease Costs

Per Capita Costs % of Total

Comments• Chronic diseases are those that are expected to last at least 3 months. For adults, the most prevalent

conditions are uncontrolled hypertension (high blood pressure) and hyperlipidemia (high cholesterol and high triglycerides). For children the most common conditions are asthma and allergies.

• 86% of healthcare spending is for patients with one or more chronic conditions; 71% of spending is for patients with more than one chronic condition.

Source• https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/decision/mcc/mccchartbook.pdf• https://www.cdc.gov/nchs/data/hus/hus16.pdf#053

https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/decision/mcc/mccchartbook.pdfhttps://www.cdc.gov/nchs/data/hus/hus16.pdf#053

Distribution of Patients

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Comments• The top 5% of all patients account for 50% of the costs.• From 2013 to 2015, less than 40% of the top 5% spenders were in the top 5% in the previous years.• About 25% of all traditional Medicare spending is for patients in the last year of life and this proportion

has held for many years.

Sources:http://www.healthcostinstitute.org/wp-content/uploads/2018/02/HCCI-Issue-Brief-Top-Spenders.pdfhttps://www.kff.org/medicare/fact-sheet/10-faqs-medicares-role-in-end-of-life-care/

What Can We Do About It?

1. The health care identity: Global budgets/price controls2. Pricing and transparency3. Consumerism and chronic disease4. Care transformation models/Managed care 3.05. Administrative simplicity and effectiveness: Fraud, systems

compatibilities6. Work force structure: More emphasis on lower licensure levels7. Local and state solutions8. Sub-populations, disparities, income levels, etc.9. Access and financing10. Key cost drivers: An academic study of the drivers

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Our Toolkit• The SOA

• Funded Research• Health Section Council strategic initiatives• Open Health Section Council Sub-groups• Continuing/basic education

• The Academy• Issue briefs• Hill visits• Letters to policymakers

• Initiative 18/11• Joint sponsorships with other organizations: Research, webinars, etc.

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Key Challenges to the Profession

• What skills do we need to build or enhance?

• What can we do to build our knowledge base?

• How can we make sure the voice of the actuary is heard?

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Your Input

• Question/comments today• Coming soon to the resources tab of the Health Section

website: soa.org/health • Email joan.barrett@axenehp.com or jwurzburger@soa.org• Join us for further conversation on the dedicated Initiative 18/11

Channel in the SOA Event App

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mailto:joan.barrett@axenehp.commailto:jwurzburger@soa.org

Recap: Questions and Comments

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What can we do about the cost of health care?1. The health care identity: Global

budgets/price controls2. Pricing and transparency3. Consumerism and chronic disease4. Care transformation models/Managed care

3.05. Administrative simplicity and effectiveness:

Fraud, systems compatibilities6. Work force structure: More emphasis on

lower licensure levels7. Local and state solutions8. Sub-populations, disparities, income levels,

etc.9. Access and financing10. Key cost drivers: An academic study

Challenges to the profession• What skills do we need to build or enhance?• What can we do to build our knowledge base?• How can we make sure the voice of the actuary

is heard?

Our toolkit• The SOA

• Funded Research• Health Section Council strategic initiatives• Open Health Section Council Sub-groups• Continuing/basic education

• The Academy• Issue briefs, Hill visits, letters to policymakers

• Initiative 18/11• Joint sponsorships with other organizations:

Research, webinars, etc.

Provider shortages

VBC

Lifestyle influences

Quality

Public health connection, innovation, collaboration with all aspects of the system

How nutrition studies and education can influence American health spend.

Incentive structures

Quality

Political impediments

Hospital finances

Cost of educating medical professionals

Virtual doctors

Life style and culture

Better health: prevention

End of life care

Quality

Malpractice reform

Public readiness

Market competition

Cost incentive

Value based outcomes

Payer provider relationship

Multiple diagnoses/complexity of each case

Legal environment

Healthcare is set up as a monopoly

Quality

Accountability at the personal level (for example, taking care of ourselves)

Individual involvement

Medical Tourism

consumer attitudes about their health

Quality of care

Trends in health/ disease

Profit expectations of all supply chain items

EMS

Premiums

Value based outcomes

Provider training

Doctor immigration

Cost of Medical School and Nurse training

For profit companies all trying to make money off of healthcare

Primary care accounts for 1/3 of physicians in the US, as opposed to 2/3 in other countries

Supply - incentivize med school

Employment costs

Competition

Limited FDA regulations regarding alternative medicine. Overall life quality. Diverse population in the US, majority of all races and backgrounds are represented in the USA with unique challenges. Overall lifestyle changes-cutting processed food, lowering plastic use, reducing stress, increasing knowledge, etc. Expecting short term results when long term view is needed.

Investment in public health/social determinants

waste on healthcare that has not proven efficacy

Reducing obesity

The affect of capitalism a

Gaming the system

Technology

Preventive health incentives

Patient’s rights/privacy

Personal responsibility verses public policyLack of political willOversight on drug company pricingThe ever increasing cost issueQualityAccess for lower income demographicsWhat is driving chronic conditions like inflammation/obesity (our food source, preservatives, etc)Diabetes should become the public enemy that smoking once wasSugar consumptionQualityPrivate monopoly30/11Provider cooperationCost of doctors virtuallyDemographic impact on trendPoliticsLow cost unhealthy food, high cost healthy foodsice cream pricesQualityHealth Education for the PublicWhat unpopular things will have to be implemented?QualityAccess to preventative care for lower incomeAttractiveness of becoming a PCP vs. a specialistDietMember/public educationMarket CompetitionEnd of lifehealth outcomesNeed more Public Health campaignsIncentives for payers and providers to keep cost of care highEnd of life spendingConsumerism doesnt work when you can’t control what tests, procedures, etc that your doctor orders.Increasing costs associated with technological advancements

Responses by Poll

What are the three top priorities for the cost of health care?

ChoiceVotesPercentage

The health care identitity Global budgetsprice controls3733%

Pricing and transparency9081%

Consumerism and chronic disease6760%

Care transformation modelsManaged care 3.02220%

Administrative simplicity and effectivenessFraud, systems compatibilities1514%

Work force structure More emphasis on lower licensure levels1211%

Local and state solutions109%

Sub-populations, disparities, income levels, etc.1614%

Access and financing3027%

Key cost drivers An acadmeic study of the drivers2422%

What are the three least important priorities for the cost of health care?

ChoiceVotesPercentage

The health care identitity Global budgetsprice controls1310%

Pricing and transparency43%

Consumerism and chronic disease65%

Care transformation modelsManaged care 3.04535%

Administrative simplicity and effectivenessFraud, systems compatibilities6047%

Work force structure More emphasis on lower licensure levels7054%

Local and state solutions5946%

Sub-populations, disparities, income levels, etc.3426%

Access and financing2519%

Key cost drivers An acadmeic study of the drivers5442%

What else should be considered when reviewing the cost of health care?

Short Answer questions are not currently available in this view. Please check the 'Responses by Attendee' Worksheet

Jump to Responses by Attendee

Poll Charts

What are the three top priorities for the cost of health care?

ChoiceThe health care identitity Global budgetsprice controlsPricing and transparencyConsumerism and chronic diseaseCare transformation modelsManaged care 3.0Administrative simplicity and effectivenessFraud, systems compatibilitiesWork force structure More emphasis on lower licensure levelsLocal and state solutionsSub-populations, disparities, income levels, etc.Access and financingKey cost drivers An acadmeic study of the drivers0.333333333333333310.810810810810810860.603603603603603660.19819819819819820.135135135135135090.10810810810810819.0090090090090086E-20.144144144144144090.270270270270270290.2162162162162162

What are the three least important priorities for the cost of health care?

ChoiceThe health care identitity Global budgetsprice controlsPricing and transparencyConsumerism and chronic diseaseCare transformation modelsManaged care 3.0Administrative simplicity and effectivenessFraud, systems compatibilitiesWork force structure More emphasis on lower licensure levelsLocal and state solutionsSub-populations, disparities, income levels, etc.Access and financingKey cost drivers An acadmeic study of the drivers0.10077519379844963.1007751937984499E-24.6511627906976737E-20.348837209302325590.465116279069767380.542635658914728650.45736434108527130.263565891472868190.193798449612403110.41860465116279072

Responses by Attendee

What are the three top priorities for the cost of health care?What are the three least important priorities for the cost of health care?

Total Responses111129

Pricing and transparency, Work force structure: More emphasis on lower licensure levels, Sub-populations, disparities, income levels, etc.The health care identitity: Global budgets/price controls, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Access and financing

Pricing and transparency, Consumerism and chronic diseaseLocal and state solutions, Sub-populations, disparities, income levels, etc., Key cost drivers: An acadmeic study of the drivers

The health care identitity: Global budgets/price controls, Pricing and transparency, Consumerism and chronic diseaseCare transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levels, Local and state solutions

Pricing and transparency, Access and financing, Key cost drivers: An acadmeic study of the driversCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels

The health care identitity: Global budgets/price controls, Consumerism and chronic disease, Care transformation models/Managed care 3.0Local and state solutions, Sub-populations, disparities, income levels, etc., Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Care transformation models/Managed care 3.0, Key cost drivers: An acadmeic study of the driversAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Local and state solutions, Sub-populations, disparities, income levels, etc.

Pricing and transparency, Consumerism and chronic disease, Key cost drivers: An acadmeic study of the driversCare transformation models/Managed care 3.0, Local and state solutions

Pricing and transparency, Consumerism and chronic disease, Care transformation models/Managed care 3.0Work force structure: More emphasis on lower licensure levels, Local and state solutions, Key cost drivers: An acadmeic study of the drivers

The health care identitity: Global budgets/price controls, Pricing and transparency, Key cost drivers: An acadmeic study of the driversCare transformation models/Managed care 3.0, Local and state solutions, Access and financing

The health care identitity: Global budgets/price controls, Pricing and transparency, Consumerism and chronic diseaseAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Sub-populations, disparities, income levels, etc.

Consumerism and chronic disease, Care transformation models/Managed care 3.0, Sub-populations, disparities, income levels, etc.Administrative simplicity and effectiveness:Fraud, systems compatibilities, Access and financing, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Consumerism and chronic disease, Local and state solutionsCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels

The health care identitity: Global budgets/price controls, Pricing and transparency, Key cost drivers: An acadmeic study of the driversAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Local and state solutions

The health care identitity: Global budgets/price controls, Pricing and transparency, Care transformation models/Managed care 3.0Administrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Local and state solutions

The health care identitity: Global budgets/price controls, Pricing and transparency, Consumerism and chronic diseaseWork force structure: More emphasis on lower licensure levels, Local and state solutions, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Consumerism and chronic disease, Administrative simplicity and effectiveness:Fraud, systems compatibilitiesWork force structure: More emphasis on lower licensure levels, Local and state solutions, Key cost drivers: An acadmeic study of the drivers

The health care identitity: Global budgets/price controls, Pricing and transparency, Consumerism and chronic diseaseLocal and state solutions, Sub-populations, disparities, income levels, etc., Key cost drivers: An acadmeic study of the drivers

The health care identitity: Global budgets/price controls, Pricing and transparency, Care transformation models/Managed care 3.0Work force structure: More emphasis on lower licensure levels, Local and state solutions, Sub-populations, disparities, income levels, etc.

The health care identitity: Global budgets/price controls, Consumerism and chronic disease, Care transformation models/Managed care 3.0Care transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Key cost drivers: An acadmeic study of the drivers

Consumerism and chronic disease, Key cost drivers: An acadmeic study of the driversThe health care identitity: Global budgets/price controls, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Access and financing

Pricing and transparency, Consumerism and chronic diseaseCare transformation models/Managed care 3.0, Local and state solutions

Pricing and transparency, Local and state solutions, Access and financingThe health care identitity: Global budgets/price controls, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels

The health care identitity: Global budgets/price controls, Pricing and transparency, Care transformation models/Managed care 3.0Administrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Local and state solutions

Pricing and transparency, Consumerism and chronic disease, Care transformation models/Managed care 3.0Administrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Sub-populations, disparities, income levels, etc.

Pricing and transparency, Consumerism and chronic disease, Administrative simplicity and effectiveness:Fraud, systems compatibilitiesCare transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levels, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Sub-populations, disparities, income levels, etc., Access and financingCare transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levels, Local and state solutions

Consumerism and chronic disease, Local and state solutions, Key cost drivers: An acadmeic study of the driversThe health care identitity: Global budgets/price controls, Care transformation models/Managed care 3.0, Sub-populations, disparities, income levels, etc.

Pricing and transparency, Consumerism and chronic disease, Key cost drivers: An acadmeic study of the driversCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels

The health care identitity: Global budgets/price controls, Consumerism and chronic disease, Access and financingAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Local and state solutions

Pricing and transparency, Sub-populations, disparities, income levels, etc., Key cost drivers: An acadmeic study of the driversAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Local and state solutions, Sub-populations, disparities, income levels, etc.

Pricing and transparency, Consumerism and chronic disease, Key cost drivers: An acadmeic study of the driversThe health care identitity: Global budgets/price controls, Local and state solutions, Sub-populations, disparities, income levels, etc.

The health care identitity: Global budgets/price controls, Pricing and transparency, Care transformation models/Managed care 3.0Administrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Access and financingLocal and state solutions

Consumerism and chronic disease, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Sub-populations, disparities, income levels, etc.Care transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levels, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Consumerism and chronic disease, Access and financingCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels

The health care identitity: Global budgets/price controls, Consumerism and chronic disease, Access and financingCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Local and state solutions

Pricing and transparency, Sub-populations, disparities, income levels, etc., Access and financingCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Consumerism and chronic diseaseAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Access and financing, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Consumerism and chronic disease, Local and state solutionsAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Work force structure: More emphasis on lower licensure levels, Access and financingThe health care identitity: Global budgets/price controls, Care transformation models/Managed care 3.0, Local and state solutions

Pricing and transparency, Consumerism and chronic diseaseWork force structure: More emphasis on lower licensure levels

The health care identitity: Global budgets/price controls, Pricing and transparency, Consumerism and chronic diseaseAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Local and state solutions

Pricing and transparency, Consumerism and chronic disease, Care transformation models/Managed care 3.0Care transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levels, Local and state solutions

Pricing and transparency, Care transformation models/Managed care 3.0, Access and financingAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Local and state solutions

The health care identitity: Global budgets/price controls, Consumerism and chronic disease, Local and state solutionsWork force structure: More emphasis on lower licensure levels, Sub-populations, disparities, income levels, etc., Access and financing

The health care identitity: Global budgets/price controls, Pricing and transparency, Consumerism and chronic diseaseCare transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levels, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Access and financing, Key cost drivers: An acadmeic study of the driversAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Local and state solutions, Sub-populations, disparities, income levels, etc.

The health care identitity: Global budgets/price controls, Pricing and transparency, Care transformation models/Managed care 3.0Sub-populations, disparities, income levels, etc., Access and financing, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Sub-populations, disparities, income levels, etc., Access and financingAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Local and state solutions

The health care identitity: Global budgets/price controls, Consumerism and chronic disease, Access and financingCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Consumerism and chronic disease, Administrative simplicity and effectiveness:Fraud, systems compatibilitiesCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels

Pricing and transparency, Consumerism and chronic disease, Access and financingAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Sub-populations, disparities, income levels, etc.

Pricing and transparency, Consumerism and chronic disease, Key cost drivers: An acadmeic study of the driversWork force structure: More emphasis on lower licensure levels

Pricing and transparency, Sub-populations, disparities, income levels, etc., Access and financingWork force structure: More emphasis on lower licensure levels, Local and state solutions, Key cost drivers: An acadmeic study of the drivers

The health care identitity: Global budgets/price controls, Pricing and transparency, Consumerism and chronic diseaseLocal and state solutions, Sub-populations, disparities, income levels, etc., Access and financing

The health care identitity: Global budgets/price controls, Pricing and transparency, Consumerism and chronic diseaseSub-populations, disparities, income levels, etc., Access and financing, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Local and state solutions, Access and financingNo Response

Pricing and transparency, Local and state solutions, Key cost drivers: An acadmeic study of the driversCare transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levels, Local and state solutions

The health care identitity: Global budgets/price controls, Pricing and transparency, Consumerism and chronic diseaseWork force structure: More emphasis on lower licensure levels, Local and state solutions, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Work force structure: More emphasis on lower licensure levels, Key cost drivers: An acadmeic study of the driversSub-populations, disparities, income levels, etc., Access and financing, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Consumerism and chronic disease, Work force structure: More emphasis on lower licensure levels, Access and financing, Key cost drivers: An acadmeic study of the driversThe health care identitity: Global budgets/price controls, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Local and state solutions

The health care identitity: Global budgets/price controls, Consumerism and chronic disease, Work force structure: More emphasis on lower licensure levelsLocal and state solutions, Sub-populations, disparities, income levels, etc., Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Consumerism and chronic disease, Work force structure: More emphasis on lower licensure levelsCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Consumerism and chronic disease, Work force structure: More emphasis on lower licensure levelsAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Sub-populations, disparities, income levels, etc., Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Consumerism and chronic disease, Work force structure: More emphasis on lower licensure levelsCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Work force structure: More emphasis on lower licensure levels, Key cost drivers: An acadmeic study of the driversThe health care identitity: Global budgets/price controls, Local and state solutions, Access and financing

The health care identitity: Global budgets/price controls, Pricing and transparency, Access and financingConsumerism and chronic disease, Care transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities

The health care identitity: Global budgets/price controls, Pricing and transparency, Access and financingAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Consumerism and chronic disease, Access and financingAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Local and state solutions

Pricing and transparencyAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Key cost drivers: An acadmeic study of the drivers

The health care identitity: Global budgets/price controls, Pricing and transparency, Administrative simplicity and effectiveness:Fraud, systems compatibilitiesConsumerism and chronic disease, Care transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levels

Pricing and transparency, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Key cost drivers: An acadmeic study of the driversLocal and state solutions, Sub-populations, disparities, income levels, etc., Access and financing

Pricing and transparency, Consumerism and chronic disease, Administrative simplicity and effectiveness:Fraud, systems compatibilitiesSub-populations, disparities, income levels, etc., Access and financing, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Key cost drivers: An acadmeic study of the driversCare transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levels, Local and state solutions

The health care identitity: Global budgets/price controls, Consumerism and chronic disease, Sub-populations, disparities, income levels, etc.Administrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Consumerism and chronic disease, Administrative simplicity and effectiveness:Fraud, systems compatibilitiesNo Response

Pricing and transparency, Consumerism and chronic disease, Access and financingWork force structure: More emphasis on lower licensure levels, Local and state solutions, Sub-populations, disparities, income levels, etc.

Consumerism and chronic disease, Care transformation models/Managed care 3.0, Sub-populations, disparities, income levels, etc.Administrative simplicity and effectiveness:Fraud, systems compatibilities, Local and state solutions, Access and financing

Pricing and transparency, Consumerism and chronic disease, Key cost drivers: An acadmeic study of the driversNo Response

The health care identitity: Global budgets/price controls, Consumerism and chronic disease, Care transformation models/Managed care 3.0Work force structure: More emphasis on lower licensure levels, Local and state solutions, Key cost drivers: An acadmeic study of the drivers

The health care identitity: Global budgets/price controls, Pricing and transparency, Consumerism and chronic diseaseCare transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levels, Key cost drivers: An acadmeic study of the drivers

Consumerism and chronic disease, Sub-populations, disparities, income levels, etc., Access and financingWork force structure: More emphasis on lower licensure levels, Local and state solutions, Sub-populations, disparities, income levels, etc.

Pricing and transparency, Consumerism and chronic disease, Care transformation models/Managed care 3.0Work force structure: More emphasis on lower licensure levels, Local and state solutions, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Consumerism and chronic disease, Work force structure: More emphasis on lower licensure levelsAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Key cost drivers: An acadmeic study of the drivers

The health care identitity: Global budgets/price controls, Pricing and transparency, Care transformation models/Managed care 3.0Work force structure: More emphasis on lower licensure levels, Access and financing, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Access and financingCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels

Pricing and transparency, Care transformation models/Managed care 3.0, Access and financingWork force structure: More emphasis on lower licensure levels, Local and state solutions, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Consumerism and chronic disease, Care transformation models/Managed care 3.0The health care identitity: Global budgets/price controls, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Consumerism and chronic disease, Key cost drivers: An acadmeic study of the driversCare transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levels, Sub-populations, disparities, income levels, etc.

The health care identitity: Global budgets/price controls, Pricing and transparency, Key cost drivers: An acadmeic study of the driversCare transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levels, Local and state solutions

Pricing and transparency, Consumerism and chronic disease, Access and financingAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Sub-populations, disparities, income levels, etc.

Pricing and transparency, Consumerism and chronic disease, Sub-populations, disparities, income levels, etc.Work force structure: More emphasis on lower licensure levels, Local and state solutions, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Access and financing, Key cost drivers: An acadmeic study of the driversWork force structure: More emphasis on lower licensure levels, Local and state solutions, Sub-populations, disparities, income levels, etc.

Pricing and transparency, Consumerism and chronic disease, Sub-populations, disparities, income levels, etc.Work force structure: More emphasis on lower licensure levels, Local and state solutions, Access and financing

Consumerism and chronic disease, Care transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levelsAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Local and state solutions, Key cost drivers: An acadmeic study of the drivers

The health care identitity: Global budgets/price controls, Pricing and transparency, Consumerism and chronic diseaseCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Key cost drivers: An acadmeic study of the drivers

Consumerism and chronic disease, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Sub-populations, disparities, income levels, etc.Care transformation models/Managed care 3.0, Access and financing, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Consumerism and chronic disease, Administrative simplicity and effectiveness:Fraud, systems compatibilitiesWork force structure: More emphasis on lower licensure levels, Sub-populations, disparities, income levels, etc., Access and financing

The health care identitity: Global budgets/price controls, Pricing and transparency, Local and state solutionsPricing and transparency, Care transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levels

The health care identitity: Global budgets/price controls, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Key cost drivers: An acadmeic study of the driversCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels

The health care identitity: Global budgets/price controls, Consumerism and chronic disease, Sub-populations, disparities, income levels, etc.Administrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Access and financing

Consumerism and chronic disease, Care transformation models/Managed care 3.0Administrative simplicity and effectiveness:Fraud, systems compatibilities, Access and financing

Pricing and transparency, Consumerism and chronic disease, Administrative simplicity and effectiveness:Fraud, systems compatibilitiesNo Response

Pricing and transparency, Work force structure: More emphasis on lower licensure levels, Access and financingCare transformation models/Managed care 3.0, Local and state solutions, Sub-populations, disparities, income levels, etc.

Pricing and transparency, Consumerism and chronic disease, Access and financingAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Sub-populations, disparities, income levels, etc.

Pricing and transparency, Access and financing, Key cost drivers: An acadmeic study of the driversCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels

The health care identitity: Global budgets/price controls, Pricing and transparency, Care transformation models/Managed care 3.0Administrative simplicity and effectiveness:Fraud, systems compatibilities, Sub-populations, disparities, income levels, etc., Key cost drivers: An acadmeic study of the drivers

Pricing and transparencyWork force structure: More emphasis on lower licensure levels, Local and state solutions, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Local and state solutionsThe health care identitity: Global budgets/price controls, Care transformation models/Managed care 3.0, Key cost drivers: An acadmeic study of the drivers

Pricing and transparency, Sub-populations, disparities, income levels, etc., Access and financingThe health care identitity: Global budgets/price controls, Local and state solutions, Key cost drivers: An acadmeic study of the drivers

The health care identitity: Global budgets/price controls, Local and state solutionsCare transformation models/Managed care 3.0, Local and state solutions, Key cost drivers: An acadmeic study of the drivers

No ResponseAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Work force structure: More emphasis on lower licensure levels, Local and state solutions

No ResponseCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities

No ResponseCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Key cost drivers: An acadmeic study of the drivers

No ResponseAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Local and state solutions, Key cost drivers: An acadmeic study of the drivers

No ResponsePricing and transparency, Consumerism and chronic disease, Key cost drivers: An acadmeic study of the drivers

No ResponseAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Local and state solutions, Key cost drivers: An acadmeic study of the drivers

No ResponseCare transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levels, Key cost drivers: An acadmeic study of the drivers

No ResponseWork force structure: More emphasis on lower licensure levels, Local and state solutions, Sub-populations, disparities, income levels, etc.

No ResponseThe health care identitity: Global budgets/price controls, Work force structure: More emphasis on lower licensure levels, Local and state solutions

No ResponseAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Access and financing, Key cost drivers: An acadmeic study of the drivers

No ResponseWork force structure: More emphasis on lower licensure levels, Sub-populations, disparities, income levels, etc., Key cost drivers: An acadmeic study of the drivers

No ResponsePricing and transparency, Consumerism and chronic disease, Access and financing

No ResponsePricing and transparency, Consumerism and chronic disease, Access and financing

No ResponseCare transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities, Key cost drivers: An acadmeic study of the drivers

No ResponseCare transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levels

No ResponseCare transformation models/Managed care 3.0, Work force structure: More emphasis on lower licensure levels, Sub-populations, disparities, income levels, etc.

No ResponseWork force structure: More emphasis on lower licensure levels

No ResponseThe health care identitity: Global budgets/price controls, Work force structure: More emphasis on lower licensure levels, Key cost drivers: An acadmeic study of the drivers

No ResponseLocal and state solutions, Sub-populations, disparities, income levels, etc., Access and financing

No ResponseWork force structure: More emphasis on lower licensure levels

No ResponseConsumerism and chronic disease, Care transformation models/Managed care 3.0, Administrative simplicity and effectiveness:Fraud, systems compatibilities

No ResponseAdministrative simplicity and effectiveness:Fraud, systems compatibilities, Local and state solutions, Access and financing

No ResponseNo Response

No ResponseNo Response

No ResponseNo Response

No ResponseNo Response

No ResponseNo Response

No ResponseNo Response

No ResponseNo Response

No ResponseNo Response

No ResponseNo Response

No ResponseNo Response

No ResponseNo Response

No ResponseNo Response

Worksheet 1

What else should be considered when reviewing the cost of health care?

0

Provider shortages

VBC

Lifestyle influences

Quality

Public health connection, innovation, collaboration with all aspects of the system

How nutrition studies and education can influence American health spend.

Incentive structures

Quality

Political impediments

Hospital finances

Cost of educating medical professionals

Virtual doctors

Life style and culture

Better health: prevention

End of life care

Quality

Malpractice reform

Public readiness

Market competition

Cost incentive

Value based outcomes

Payer provider relationship

Multiple diagnoses/complexity of each case

Legal environment

Healthcare is set up as a monopoly

Quality

Accountability at the personal level (for example, taking care of ourselves)

Individual involvement

Medical Tourism

consumer attitudes about their health

Quality of care

Trends in health/ disease

Profit expectations of all supply chain items

EMS

Premiums

Value based outcomes

Provider training

Doctor immigration

Cost of Medical School and Nurse training

For profit companies all trying to make money off of healthcare

Primary care accounts for 1/3 of physicians in the US, as opposed to 2/3 in other countries

Supply - incentivize med school

Employment costs

Competition

Limited FDA regulations regarding alternative medicine. Overall life quality. Diverse population in the US, majority of all races and backgrounds are represented in the USA with unique challenges. Overall lifestyle changes-cutting processed food, lowering plastic use, reducing stress, increasing knowledge, etc. Expecting short term results when long term view is needed.

Investment in public health/social determinants

waste on healthcare that has not proven efficacy

Reducing obesity

The affect of capitalism a

Gaming the system

Technology

Preventive health incentives

Patient’s rights/privacy

Personal responsibility verses public policy

Lack of political will

Oversight on drug company pricing

The ever increasing cost issue

Quality

Access for lower income demographics

What is driving chronic conditions like inflammation/obesity (our food source, preservatives, etc)

Diabetes should become the public enemy that smoking once was

Sugar consumption

Quality

Private monopoly

30/11

Provider cooperation

Cost of doctors virtually

Demographic impact on trend

Politics

Low cost unhealthy food, high cost healthy foods

ice cream prices

Quality

Health Education for the Public

What unpopular things will have to be implemented?

Quality

Access to preventative care for lower income

Attractiveness of becoming a PCP vs. a specialist

Diet

Member/public education

Market Competition

End of life

health outcomes

Need more Public Health campaigns

Incentives for payers and providers to keep cost of care high

End of life spending

Consumerism doesnt work when you can’t control what tests, procedures, etc that your doctor orders.

Increasing costs associated with technological advancements

Cover pagePauleyLevittBarrett