Due to the volume of “hate” e-mail that I sometimes receive following one of my presentations, my attorneys have advised that I issue the following disclaimer.: Due to the volume of 'hate' e-mail that I sometimes receive following one of my presentations, my attorneys have advised that I issue the following disclaimer. The following presentation is for mature audiences only. It may contain sarcasm, irony, and facetious metaphors that you may find offensive. There may even be data to suggest that the American health care system is not the greatest thing since sliced bread. These remarks should not be construed as insults aimed at President Bush, the Government of Canada, the people of France, or New Jersey Healthcare Financial Managers. Viewer discretion is advised.


Slide2: Reforming U.S. Health Care … Will it be the Same Old Jalopy or 'Pimp My Ride' Jeanne Scott talking-head-in-chief health-politics.com


Reforming US Health Care: Reforming US Health Care Will it be the Same Old Jalopy or 'Pimp My Ride' 1. The IOM Vision of Quality: Charles Schwab meets Nordstrom meets the Mayo Clinic Two Competing Visions of Quality


Jeanne Scott’s Not Very Sophisticated Guide to the Politics of the United States of America: Jeanne Scott’s Not Very Sophisticated Guide to the Politics of the United States of America Liberals Conservatives Markets fuel growth Americans believe in fairness not equity Inspire don’t conspire Willingness to change and innovate A Call for Sacrifice Unions Hard working people who believe in bad luck Rich People from Hollywood Macrobiotics and Vegans Pro Choice Advocates And assorted left wing wackos, including but not limited to: hippie scum, tree-huggers, philanderers, reprobates, left leaning columnists, and outright communists). Social Conservatives Hard working people who don’t believe in bad luck Rich People (Non-Hollywood) Pro Life Advocates And assorted right wing wackos, including but not limited to xenophobic talk show hosts and their followers and a small number of powerful members of the NRA who exercise disproportionate power The Great 'Unwashed' Middle


Change: As Viewed By Each: Change: As Viewed By Each Liberals Conservatives Delivery system reform is the priority Transparency of BOTH cost and quality Value Purchasing to exploit the variation in cost and quality Capitation/P4P/ Reimbursement Reform Delivery system can and should be completely re-engineered Access is the priority Cost control through wrestling for resources: top down budgeted and even price controls Discounted FFS as payment Hamster Care that is cheaper Nothing wrong with the delivery system just need to get people access to it Over-insurance is the problem Increase HDHP Expand Consumer engagement Hamster care Nothing wrong with the delivery system as long as consumers are willing to pay for it The Great 'Unwashed' Middle


Consumers View of Health Care Industries:Percent “Saying Industry Does a Good Job.”: Consumers View of Health Care Industries: Percent 'Saying Industry Does a Good Job.' * In 1997 'computer companies' were rated together (I.e. hardware and software companies were not measured separately ** Because airlines were not included in 1997, the trend for airlines is from 1998 - 2002 Source: Harris Interactive, 2006


Activities the Public Feels Should be More or Less Regulated: Activities the Public Feels Should be More or Less Regulated Should Be More Regulated Generally Honest andamp; Trustworthy Hospitals Managed Care Companies Health Insurance Companies Pharmaceutical Companies


Slide8: Rising Health Insurance Costs


Average Wage vs. Health Costs: Average Wage vs. Health Costs


Slide10: Outsourcing is no longer limited to blue collar industrial and back-office white collar jobs Software development and programming Accounting and legal services Health care claims processing (Northern Ireland, the Philippines) And the latest new developments: Medical transcription Radiology and other telemedicine services Sending patients to India and other Asian locations for surgeries and specialty services, (already an option under the British NHP) Blue Cross-Blue Shield of South Carolina offering 'overseas' option to members and marketing nationwide Blue Shield of California, HealthNet offering 'Mexican' HMOs Outsourcing of Health Care ???


Slide11: Companion Global Healthcare in the News: Overseas Option for S.C. BlueCross Members Featured on NBC Nightly News - May 16, 2007 Companion Global Healthcare, Doctors Care Reach Agreement for Aftercare Services - May 10, 2007 BlueCross BlueShield of South Carolina and BlueChoice HealthPlan Pioneer Global Healthcare Alternative - February 8, 2007 I took the above masthead from a web site -- Companion Global Healthcare – a subsidiary of Blue Cross-Blue Shield of South Carolina.


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Slide13: 'Rising medical costs are taking a toll on the auto industry’s bottom line and ultimately are threatening American manufacturers' ability to compete in the global marketplace. Congress needs to apply some serious medicine to address the nation's severe health care problems.' -- General Motors chairman and CEO G. Richard Wagoner Jr.


Slide14: Health care insurance, once an employment benefit taken virtually for granted, has become a bed-rock issue in today’s American industrial labor-management environment. As the employee share of the cost has increased, people are starting to become more aware of the actual cost of health care – and increasingly are seeing the cost of health care insurance as a critical political issue – one upon which they will make a voting decision. A new study from the University of Michigan indicates that 27% of employers surveyed would like to eliminate health care coverage for their employees entirely. 85% said that the employee share will have to go up by 50% or more.


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Slide16: 'I fear that we may have already committed more physical resources to the baby-boom generation in its retirement years than our economy has the capacity to deliver.' Alan Greenspan: November 25, 2005 'Congress in the future will have to weigh the benefits of continued access, on current terms, to advances in medical technology against other fiscal initiatives.'


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Slide18: Gosh Darn All Those Pesky Uninsured People… 46.6 Million 'officially' Uninsured in 2005 9.5M of which are children 60+ Million 'Effectively' Uninsured 29 Industrialized Nations, 28 With NHI EMTALA-Driven Uncompensated Care/Emergency Room Crisis 37th Ranking in World 15.9% GDP (go to 20% by) 2010 Movement Away From Employment-Based Coverage Grass Roots Movements: Oregon, Maine, New Hampshire, California I, Maryland, Massachusetts, California II, Pennsylvania, California III, Wisconsin, Texas 44.8


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Caring for the “uninsured” is estimated to cost $115 Billion in Transferred Costs to other Payers and Bad Debt… how many would that same $115 Billion cover in a better system? : Caring for the 'uninsured' is estimated to cost $115 Billion in Transferred Costs to other Payers and Bad Debt… how many would that same $115 Billion cover in a better system?


This is How Americans Currently Get Their Healthcare Insurance: This is How Americans Currently Get Their Healthcare Insurance Uninsured 46.8M (16%) Employer 153.7M (52%) Private Non-Employer 9.5M (3%) Medicaid/ SCHIP 37.5M (13%) Medicare 31.9M (11%) TriCare 3.4M (1%) Dual Eligible 8.0M (3%) Employer Retiree 3.3M (1%)


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Slide23:


Health Care Value: An Overview: Health Care Value: An Overview HC is failing to deliver value except for generics Consumer deflected healthcare improves the game for employers, hospitals (maybe) and esoterica providers, but is not good for drugs or primary care PhRMA under the gun No organized backlash yet by the public, partly because the Democrats are clueless Building pressure of unaffordability, uninsured and underinsured, budget deficits, and lack of any new cost containment ideas means HC as a share of GDP will rise but a lot of unhappy campers Quality and safety a key concern among elites HIT, process redesign, and big business discipline only bright signs But the expectations of these maybe too high


Health Care Costs and Consequences: Health Care Costs and Consequences For the Uninsured: Rising from 46 million today to 56 million in 2013 For the Working Poor: In 1970 health benefits cost 10% of the minimum wage, today it is nearly 100% For the Median Household: Health benefits are 20% of median compensation will rise to 60% by 2020 if trends continue For Retirees: A couple on retirement at 65 needs $200,000 in cash to pay for lifetime out of pocket costs for medical care For Small Businesses: Only 60% of firms offer insurance in 2005 down from 69% in 2000, Going to andlt;50% by 2010 For Big Business: Delphi and the airlines go bankrupt, Big Auto renegotiates because corporate healthcare costs surpasses the net profit of all business For Big Labor: UAW, SEIU, AFL, CIO conflicts, challenges and opportunities for strife


International Health Comparisons: International Health Comparisons Source: OECD 2003-2005


Slide27: Per Capita Health Expenditures, U.S. and Selected Countries, 2003   


Slide28: Health Expenditures as a Share of GDP, U.S. and Selected Countries, 2003    


Inflation-Adjusted Physician Income is Decreasing Across The Board: Inflation-Adjusted Physician Income is Decreasing Across The Board SOURCE: Center For Studying Health System Change Community Tracking Study #15 June 2006


Quality Shortfalls: Getting it Right 50% of the Time: Quality Shortfalls: Getting it Right 50% of the Time Adults receive about half of recommended care 54.9% = Overall care 54.9% = Preventive care 53.5% = Acute care 56.1% = Chronic care Source: McGlynn EA, et al., 'The Quality of Health Care Delivered to Adults in the United States,' New England Journal of Medicine, Vol. 348, No. 26, June 26, 2003, pp. 2635-2645


Quality of Care Today: We are Worse than Shaq from the Line: Quality of Care Today: We are Worse than Shaq from the Line Reported October 30 that several hospitals have hired airline pilots to explain safety procedures and processes to their staff


International Obesity 2003 Percent of Population over 15 with BMI >30: International Obesity 2003 Percent of Population over 15 with BMI andgt;30 Source: OECD, 2005


Obesity Drivers: Obesity Drivers We are eating more (duh!) We are eating out more (In 1970 34% of the food budget was consumed outside the home in late 1990s it was 47%) Everything is supersized at home and at McDonalds We stopped smoking We are all working too much especially women We don’t exercise enough because we are all working too much The only people who are exercising and eating right are people who were thin in the first place or bulimic celebrities or rich people who don’t work or French fashion models


Obesity is an Illness: Obesity is an Illness


The Future of Health Care : The Future of Health Care Fat People Meet Skinny Benefits


Consumer Responsibility:Arguments For and Against: Consumer Responsibility: Arguments For and Against Consumers insulated from the cost of care If they had to pay they would use it less If they had to pay they would take more responsibility Consumers should have the right to choose When consumers choose and pay the market is working The 5/55 Problem One day in an American hospital and consumers exceed maximum deductible, so Catastrophic coverage is a green light for esoterica Does it save money overall? Poor people with chronic illnesses will be disproportionately affected For Against


Across the board, HDHP consumers have more compliance problems: Treatment compliance problems Across the board, HDHP consumers have more compliance problems * Currently insured in employer-sponsored or self-purchased plan ** Currently enrolled in high deductible health plan


The Good, the Bad and the Ugly of Non-Compliance: The Good, the Bad and the Ugly of Non-Compliance The Good: Unnecessary care is foregone The Bad: You don’t take the Lipitor and it hurts in the long run The Ugly: You don’t take the asthma medication you go to the ER


Internet Information is ALWAYS Helpful: Internet Information is ALWAYS Helpful


Reforming US Health Care: Reforming US Health Care Will it be the Same Old Jalopy or 'Pimp My Ride' 1. The IOM Vision of Quality: Charles Schwab meets Nordstrom meets the Mayo Clinic Two Competing Visions of Health Care Quality


Slide41: Disruptive Innovation: 'Wal-Martization' of Health Care Jeanne’s Odds: 5-1 Tiering of Healthcare: 'Tiers Я’ Us' Jeanne’s Odds: 3-2 Minor Delivery System Reform Major Delivery System Reform Four Scenarios for US Health Care 2007-2017 Bigger Government by Request: 'Daughter of Single-Payer' Jeanne’s Odds: 2-1 Mostly or Almost Universal Health Care Jeanne’s Odds: 4-1


Scenario 1: Tiers Я’ Us: Scenario 1: Tiers Я’ Us SUVing of health care CDHC (Consumer-Directed Health Care) and HDHP (High-Deductible Health Plans) Continued disparities and tiers High end providers do well, low end suffers Probability over 10 years: 40%


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The Bush SOTU 2007: The Bush SOTU 2007 Using Tax Policy to Address the Uninsured Families buying individual insurance could deduct up to $15,000 of the costs, regardless of the cost to them (thus encouraging people to buy low-cost, high-deductible coverage) Families with employment-based insurance would be taxed on the value of that insurance in excess of $15,000 Amounts would be indexed to inflation but not to increases in health costs


Slide45: President Bush Puts His Eggs in the Health Savings Account Basket Expand Health/Medical Savings Accounts: Allow Individuals and Families to Set Aside as Much as $5,150 a Year, Tax Free Bush’s FY2007 Budget would increase the allowable amount to $10,300


CDHC Will Only Work If …: CDHC Will Only Work If … Meaningful information is made available to the consumer… your buzzword for the year: TRANSPARENCY… for both prices and quality (b) The American population comes to ACCEPT it… but we’re dumber than bricks


Slide47: 'No one knows what they pay for their health-care services. No one knows cost or quality. . . . We don't have any reason to care financially.' -- Mike Leavitt Secretary of Health and Human Services Transparency


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Slide49:


Reforming US Health Care: Reforming US Health Care Will it be the Same Old Jalopy or 'Pimp My Ride' 1. The IOM Vision of Quality: Charles Schwab meets Nordstrom meets the Mayo Clinic Two Competing Visions of Health Care Quality


Scenario 1: Tiers Я’ Us: Impact on Health Care System: Scenario 1: Tiers Я’ Us: Impact on Health Care System Health Plans Move toward HDHP and CDHC Sell whatever anyone will buy But always experience rate Rising numbers of uninsured and underinsured Pharmaceuticals More consumer behavior: trading down twice as often as trading up Innovation is celebrated by the wealthy and the covered Biotech is aimed at lifestyle improvement and well being not just rare dread diseases Providers Well-heeled, well situated, well run providers continue to thrive and distance themselves from the pack on quality, safety, and service (one third) aided by P4P Basket cases that deal with the poor and the lower middle class A health system for the top third


Scenario 2: Bigger Government by Request: Scenario 2: Bigger Government by Request Baby-Boomer backlash against cost-shifting Democrats run on shoring up and expanding Medicare for middle aged and elderly Government regulates health care even more Slowing innovation, reducing provider payment, and limiting profiteering Probability over 10 years: 30%


Slide53: What Will the Majority Democratic Congress Do? Well, according to Speaker Nancy Pelosi: Revamp Part D to Allow Government to 'Negotiate' Prices with the Drug Companies Currently, the Government Essentially Pays 'Retail' Prices Close the Part D 'Donut Hole' Address the Growing Number of Uninsured in America Tax credits and incentives to employers to continue coverage Review alternative coverage proposals: Mandatory Individual Health Insurance with government subsidies (the 'Massachusetts' plan) Mandatory Employment Coverage (i.e., the 'Maryland' plan) Over the past 5 years, the number of uninsured has increased by over 5 million, estimated to continue to grow by more than 1 million a year


Slide54: Expand S-CHIP, the Children’s Health Insurance Program Enrollment has declined during Bush years Re-open the Issue of Embryonic Stem Cell Research 'Investigate' the Health Care Industry: Health Insurer Profits Drug Company Anti-Competitive Activity Blocking Generics, Predatory Pricing Practices (PhRMA gave 15-1 PAC money to Republicans) Non-Profit Hospital Collection and Charity Practices Overpayments to Medicare Managed Care Providers and their 'Favorable' Status Under Bush But remember, George W. Bush will still be President and the Dem 'majority' is very, very slim!


Hillary-care; Giuliani-care; Obama-care; McCain-care; etc.; etc.: Hillary-care; Giuliani-care; Obama-care; McCain-care; etc.; etc. Would-be, Wanna-be, Could-be, Might-be 2008 Presidents are falling over one another in proposing health plans for Americans


Democrats on the Attack: Democrats on the Attack


What the Democrats are Saying…: What the Democrats are Saying… John Edwards: 'Any politicians who say they can provide universal health care and other promises while ending the federal deficit are not being honest.' Medicare+ plan for all Americans, but not necessarily a 'single-payer' plan; that will be decided by giving everyone a choice Competition between private insurers and government 'Cost containment' (hmm, does this mean more regulation?) Will raise taxes on those making more than $250,000/year Barack Obama: 'The public will judge my presidency by what I do for healthcare.' Promises to deliver 'universal' healthcare by the end of his first term Few other specifics


What the Candidates are Saying…: What the Candidates are Saying… Bill Richardson: 'The cornerstone of my plan will be to allow all Americans to buy the same coverage as Congress.' Expand Medicare to those 55 and older Establish a 'cooperative relationship' between individuals, businesses and states 'catalyzed by the government' No need to raise taxes, his plan will be financed through savings by 'getting out of Iraq' and reducing military spending. Hillary Clinton: 'I’m battle-scarred but ready to take on the issue.' Require employers who do not purchase private health insurance for their employees to pay into a pool for a Medicare-for-all-type plan Universal coverage wouldn’t be achievable until near the end of her second term


But a few Republicans are also talking health care…: But a few Republicans are also talking health care… But one can’t run…


The GubernatorGov. Arnold Schwarzenegger (R. Calif.): The Gubernator Gov. Arnold Schwarzenegger (R. Calif.) employers with 10 or more employees would have to offer health insurance for workers or pay a fee of 4% of payroll to a state pool that would help workers purchase coverage, with the amount that they pay based on income employees could pay for health insurance with pretax income health insurers would be required to sell policies to all state residents, regardless of whether they have medical conditions residents who refuse to obtain health insurance could face reductions in their state income tax refunds or have their wages garnished Medi-Cal, the state Medicaid program, would be extended to all adults with annual incomes of as much as 100% of the federal poverty level and to children -- regardless of their immigration status -- in households with annual incomes of as much as 300% of the federal poverty level additional subsidies would be available to help state residents with annual incomes of as much as 250% of the federal poverty level purchase health insurance


The Gubernator: The Gubernator the proposal would increase by $4 billion reimbursements to health care providers under Medi-Cal physicians would have to pay 2% of their revenues hospitals would have to pay 4% of their revenue to help cover the cost of the program the proposal would be financed in part with about $5 billion in federal matching funds that the state will receive as a result of restructured health care programs and with state funds currently used for charity care


The Romney Plan: An Individual Mandate“Healthcare for Everyone”Mitt Romney (R. Mass.): The Romney Plan: An Individual Mandate 'Healthcare for Everyone' Mitt Romney (R. Mass.) employers, most of whom already offer insurance, would be 'encouraged' to continue doing so voluntarily; Romney vetoed a Democratic proposal to 'fine' employers not offering health insurance individuals who don't have insurance would have to sign on to one of two insurance pools Commonwealth Care through which people of moderate income and small businesses could buy insurance from private insurers at a special rate. It would not be subsidized by the state. Safety Net Care for residents with incomes up to 300% of the federal poverty level, which is $28,700 for a single person. Policies would have no annual deductible and would be subsidized by the state, with policyholders paying 1.3% to 5.8% of their income, or $2.30 to $32.31 a week, for an individual plan. individuals who do not get insurance from their jobs or buy it through one of the programs would lose their personal tax exemption of $3,300 — worth about $175 for an average taxpayer — face withholding of their income tax refund, or if they get medical care, their wages could be garnished for payment


The Romney Plan: An Individual MandateMitt Romney (R. Mass.): The Romney Plan: An Individual Mandate Mitt Romney (R. Mass.) Nationally, 17% are uninsured In Texas, the rate is 24%, the highest in the nation Currently, Massachusetts, a heavily-unionized state, has only about 7% of its residents uninsured, costs for the Romney plan even without taxing employers would be far less than for Texas and the nation as a whole


Slide64: Phase-Out the U.S. 'Employment-Based' Health Care System Release Health Care Insurance from State Regulations and Mandates and Allow Cross-Border Purchases All Purchases of Health Insurance Would be Tax-Deductible, Regardless of Whether They Were Purchased Through and Employer or Individually Rudy Giuliani The health care system requires a 'paradigm shift' toward the individual health insurance market. Currently, about 17 million residents have individual health insurance, compared with about 175 million who have employer-sponsored coverage. Giuliani said that he opposes proposals to require all residents to obtain health insurance because government subsidies would be required for those who could not afford a policy, which in turn would drive up costs.


Slide65:


Scenario 2: Bigger Government by Request:Impact on the Health Care System: Scenario 2: Bigger Government by Request: Impact on the Health Care System Health Plans Plans become more regulated Delegated to becoming back-office processors Transaction supporters not market makers Pharmaceuticals Medicare Part D becomes a Regulated Utility Prices are set by government for Medicare and Medicaid drugs Lower Randamp;D spending and Innovations slows Advertising and promotion practices regulated and restrained Providers Hospitals are secure but under-funded for major capital initiatives Top tier institutions make it on philanthropy and differentiated care for the affluent elite Only cost-reducing technologies are rewarded P4P: You gotta perform to avoid a pay cut


Scenario 3: Disruptive Innovation: Scenario 3: Disruptive Innovation Cheapo plans proliferate (high deductibles and retail primary care) forcing cheaper delivery models to emerge New disruptive competitors emerge at a lower price point, e.g., Revolution Health, Wal-Mart, Kaiser Lite Almost as good, and a lot cheaper Probability over 10 years: 10%


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Feature Article “BENEFITS”Going the Distance for Health Savings. Could overseas travel for lower-cost surgeries become an option in employer-sponsored health plans?: Feature Article 'BENEFITS' Going the Distance for Health Savings. Could overseas travel for lower-cost surgeries become an option in employer-sponsored health plans? March 2007 Issue


Slide70: Have Surgery. Go Sightseeing. By PAUL B. BROWN Published: March 24, 2007 WOULD you be willing to have non-urgent medical procedures done overseas, if you could recover in a fine hotel and your employer not only picked up all the costs, but actually paid you for having the work done outside the United States? You may be faced with that decision, if HR Magazine is right in its prediction that 'medical tourism' will become one of the benefits corporations will be offering soon. Medical tourism, or medical travel as it is also called, involves traveling to 'respected medical facilities' in countries like India, Thailand or Singapore to have non-life-threatening medical procedures done, Betty Liddick writes. 'It also often involves recuperation at a resort, or tourist destination, all for less than what treatment alone would cost in the United States.' The price is obviously the appeal to employers. According to examples cited in the article 'Going the Distance for Health Savings,' the cost of sending a worker overseas for procedures like removing a gallbladder can be at least 50 percent less than that of having the work done in the United States, even if the employer pays for the worker to spend recovery time in a fine hotel. To encourage employees to go overseas, some companies are willing to give employees a percentage of what is saved in medical costs. The crucial question about medical tourism, which Ms. Liddick describes as a 'small but growing health care trend,' is, of course, whether the quality of care is equal to what could be received at home. 'No one knows the answer to that,' said one expert quoted in the article. 'Frankly, we’re not in a position to meaningfully evaluate and compare American hospitals, let alone offshore ones.'


Scenario 3: Disruptive Innovation Impact on the Health Care System: Scenario 3: Disruptive Innovation Impact on the Health Care System Health Plans Health Plan HDHP grow enormously New competitors in ambulatory space allow cheaper alternatives Contract with India for the high-tech stuff Pharmaceuticals Established generics are embraced as best value therapy by providers, payers and consumers alike Enormous global competition drives prices down Innovation is rare and only for the rich (e.g. 50% co-insurance on biologicals) Providers Outpatient alternatives grow from Minute Clinics to outpatient surgery chains to federally funded safety net community clinics Hospitals are either struggling as government (under)funded geriatric ICUs or thriving as body repair shops for affluent baby-boomers Primary Care becomes the ultimate P4P: it’s all retail


Scenario 4: “Mostly” Universal Health Care: Scenario 4: 'Mostly' Universal Health Care Mandatory universal individual insurance is passed National policy commitment to restructure health care financing and delivery True managed health care Focus on public health and prevention Probability over ten years: 20%


Slide73:


Scenario 4: Universal Health Care Impact on the Health Care System: Scenario 4: Universal Health Care Impact on the Health Care System Health Plans Health plans as active agents for health delivery transformation Sources of innovation in DSM and new reimbursement models Get smart or get out Pharmaceuticals Reference-pricing and cost-effectiveness criteria for new technology True clinical innovation is rewarded Side by Side clinical trials for new product launches National Technology Assessment System continuously monitors technologies in use Providers Chronic Care management done right: innovation in community based chronic care New reimbursement systems 'Daughter of Capitation' force market leaders into fundamental clinical system redesign Acute care is evidence-based and standardized Innovation concentrated in designated centers of excellence P4P means better payment and earns the provider the right to serve


Slide75: Disruptive Innovation: 'Wal-Martization' of Health Care Jeanne’s Odds: 5-1 Tiering of Healthcare: 'Tiers Я’ Us' Jeanne’s Odds: 3-2 Minor Delivery System Reform Major Delivery System Reform Four Scenarios for US Health Care 2007-2017 Bigger Government by Request: 'Daughter of Single-Payer' Jeanne’s Odds: 2-1 Mostly or Almost Universal Health Care Jeanne’s Odds: 4-1


Issues and Impacts: Issues and Impacts High end patients and providers will always do well How bad will it be for the rest of us? True cost reducing technologies will always have appeal True clinical breakthroughs that are radically better than existing modalities and therapies will always be rewarded Healthcare is a superior good and will take a larger share of national wealth But who pays for what and how will be central difficult questions for business, government, and households around the world forever Transforming for good: It’s all about Information and Incentives


Issues and Impacts: Issues and Impacts No matter what, we will need better value measures and more transparency of measures Value based purchasing and P4P will become more prevalent and have a powerful influence on providers and vendors Consumers will become more engaged in value decisions but we cannot rely on them absolutely The systems of health care need to be continuously improved to deliver greater value Will require clinical skills, process skills, use of cutting edge technology and big-time capabilities Most of all, it will require vision, values and leadership


There’s Not Much We Have to Change….Except………: There’s Not Much We Have to Change…. Except……… Our values Our Strategic Focus: From Pimp My Ride to Primary Care and Prevention Our Reimbursement System Our Delivery System Our Individual and Collective Behavior Our Expectations


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Reforming US Health Care: Reforming US Health Care Will it be the Same Old Jalopy or 'Pimp My Ride' 1. The IOM Vision of Quality: Charles Schwab meets Nordstrom meets the Mayo Clinic 2. The Prevailing Vision of Quality in American Healthcare: 'Pimp My Ride' Three Competing Visions of Health Care Quality… ??? 3. Your Vision of Quality … ???


Slide82: Jeanne Scott (703) 371-4894 www.health-politics.com If you would like to receive the theJeanneScottletter -- send an e-mail: jeanne.scott@health-politics.com Make sure to include your name and organization


From Grandma Jeanne’s World’s Smartest Grandchildren: From Grandma Jeanne’s World’s Smartest Grandchildren When my granddaughters Caitlin and Hannah were 7 and 5, respectively, I started telling them about what I used to do when I was their age. 'We used to skate outside on a pond. I had a swing made from a tire; it hung from a tree in our front yard. We picked wild raspberries in the woods.' Hannah, the littlest one, looked up and said to me: 'Grandma, I sure wish I'd gotten to know you sooner!' Elvis, my now 4-year old grandson once asked me, 'Grandma, do you know how you and God are alike?' I mentally polished my halo, while I asked, 'No, how are we alike?' 'You're both old,' he replied. It was Elvis this year, who called me to wish me a Happy Birthday. He asked me how old I was, and I told him, '63.' He was quiet for a moment, and then he asked, 'Did you start at 1?'


From Grandma Jeanne’s World’s Smartest Grandchildren: From Grandma Jeanne’s World’s Smartest Grandchildren When Caitlin was just 4, she visited me at my office one day and was diligently pounding away on an old typewriter I keep to address envelopes and the like. She told me she was writing a story. 'What's it about?' I asked. 'I don't know,' she replied. 'I can't read.' I didn't know if my two and half year old twin granddaughters, Maggie and Iris knew their colors yet, so I decided to test them. I would point out something and ask what color it was. They would take turns answering me, and they were always correct. But it was fun for me, so I continued. At last Iris headed for the door, saying as she left, 'Grandma, I think you should try to figure out some of these yourself!'


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From Grandma Jeanne’s World’s Smartest Grandchildren: From Grandma Jeanne’s World’s Smartest Grandchildren Eamon, our five-year-old grandson couldn't wait to tell his grandpa about the movie he and I had watched on television, '20,000 Leagues under the Sea.' The scenes with the submarine and the giant octopus had kept him wide-eyed. In the middle of the telling, my husband interrupted Eamon 'What caused the submarine to sink?' With a look of incredulity Eamon replied, 'Grandpa, it was the 20,000 leaks!!' One hot summer night, my grandson Eamon and I were going in to our condo in NC, we kept the lights off until we were inside to keep from attracting pesky insects. Still, a few fireflies followed us in. Noticing them before I did, Eamon whispered, 'It's no use, Grandma. The mosquitoes are coming after us with flashlights.' When Eamon asked me how old I was, I teasingly replied, 'I'm not sure.' 'Look in your underwear, Grandma,' he advised. 'Mine says I'm four to six.'


From Grandma Jeanne’s World’s Smartest Grandchildren: From Grandma Jeanne’s World’s Smartest Grandchildren When Hannah was in second grade, she called me on the phone and I asked her what she had learned in school that day. 'Grandma, we learned how to make babies today.' More than a little surprised, I tried to keep my cool. 'That's interesting,' I said, 'How do you make babies?' 'It's simple,' replied the Hannah. 'You just change 'y' to 'i' and add 'es'.' We took Elvis and his sisters Maggie and Iris to a demonstration at our local fire department. Sitting in the front seat of the fire truck was a Dalmatian dog. Several children nearby started discussing the dog's duties. They use him to keep crowds back,' said one youngster. 'No, said another, 'he's just for good luck.' Elvis brought the argument to a close. 'They use the dogs, he said firmly, 'to find the fire hydrant.'


Slide88: Jeanne Scott (703) 371-4894 www.health-politics.com If you would like to receive the theJeanneScottletter -- send an e-mail: jeanne.scott@health-politics.com Make sure to include your name and organization