the us healthcare system by madhav sitaraman
TRANSCRIPT
The US Healthcare System
Madhav Sitaraman – Co‐Founder, Enlightiks
US Healthcare
7% 17.2 %
1970 2012
Share of wallet
Value Good Health
Gross Domestic Product (GDP)
US Healthcare spending
Americans Payer Providers Patients
Fee for Service
Hospital Care $ 882.3 Billion
Physician & Clinical $ 565.0 Billion
Professional Service $ 76.4 Billion
Dental $ 110.9 Billion
Personal Care $ 138.2 Billion
Home Health Care $ 77.8 Billion
Nursing Facilities $ 151.5 Billion
Prescription Drugs $ 263.3 Billion
Medical Equipment $ 95.0 Billion
The problem
Some facts:
Healthcare spend will crowd out all spending other than defence
If city’s and towns were to report their financials for healthcare commitments, most would be BANKRUPT!!!
Millions of uninsured (~48 million Americans)
Increasing premium amounts
Sick people are being excluded / health care cost was capped
Patients with pre-existing conditions were denied insurance or had to pay heft premiums
Payments revolved around ‘Fee for Service’ and performance is not tracked
Healthcare is TERMINALLY ILL!!!!
Patient Protection and Affordable Care Act(Obamacare)
Health coverage for larger population
Continues long term care with no cap
Patients with pre-existing conditions get insurance at the same premium
Medicaid Expansion with in states to accommodate lower income groups
Healthcare Exchange for buying insurance
Individual Mandates requiring everyone to get insurance
Medicare Shared Saving Program to improve care coordination and performance
Obamacare bill is 20,000 pages long
Would be over 7 feet tall if we stacked them
Accountable Care Organization (ACO)
Population Health Management
Patients
ACO must define processes to promote evidence‐based medicine and patient
engagement, monitor and evaluate quality and cost measures, meet patient‐
centeredness criteria and coordinate care.
Querent Overview
Readmission Management
Risk Prediction
Cost & Resource
Compliance
Patient Similarity
Profiling
Outcomes
Optimization
ClinicalPathway
Future stateOf Health
Disease Progression
Preventive Healthcare
Solution ‐ Querent
Models
Hospital Systems
Pattern Recognition
Big DataDomain Expertise
Machine Learning
External Sources
Claims & Insurance Data
Areas for innovation
Care Coordination Care Delivery
Security Innovations
Education Social Media
Healthcare Security & Privacy
HIPAA HITECH MU
94%
Data Breach
48%
Billing & Insurance records
20%
Prescription Details
24%
Payment details
13%
Monthly statements
48%
Medical Files
2769Avg no. of
records stolen
Q & A