2017 Healthcare Economics Summit

March 22, 2017Admin Events White Paper

Meeting Notes for Speaker Sessions

Discussion with Governor Walker, President Ferry and Dean Sem

The path to resolving healthcare costs and quality will be through blending healthcare market forces in a productive way, with business, innovation, and disruptive technology for delivering healthcare more efficiently. Whatever the political environment or opinion, the answer requires us to find a way to drive down costs. Enabling market forces through price transparency is one good way to accomplish this. The movement of the federal government towards a block grant system, where states are allocated fixed healthcare dollars for Medicaid spending, will ultimately require us to find a way to control costs; so, we should work to control costs now. In Wisconsin, 60 percent of nursing home residents are on Medicaid, indicating a particularly pressing need to find a way to ensure our elderly population continues to get quality care, with Medicaid dollars that last.

Governor Walker

Governor Walker spoke specifically about healthcare considerations for Wisconsin, including the fact that Wisconsin did not take the Medicaid expansion, and how in his opinion there is essentially no insurance gap in Wisconsin. He said his goal is to have as few people as possible on Medicaid by enabling people to improve their economic positions sufficiently, so they can access coverage outside of Medicaid. This is based on his personal belief, developed from his pastoral father, that there are two general ways of helping those in need: (1) Emergency needs should be met immediately, and (2) assistance needs are better met by providing people an ability to partially earn or repay the assistance given. People inherently want to work. It brings self-esteem and self-worth. But often people fear loss of an existing safety net if they attempt to work. The governor also commented about the complexity of healthcare, noting that most Americans know more about their cell phone plans than about their healthcare plans. In our opinion, this must change, by educating and empowering consumers.

Governor Walker went on to say he is focused on changes to healthcare that ensure quality, access, and affordability. As an example he noted that corrective eye surgery was exclusively for the wealthy but now consumers can obtain reasonable quality at a lower price because providers learned that the higher volume would overcome the price differential to provide higher quality. Another example (mentioned later in the Summit by Eric Haberichter), is that Smart Choice MRI now offers high quality $600 MRIs, whereas most hospitals charge more than $2,500.

The Governor also discussed the pending block grant issue (i.e. Wisconsin will be getting federal Medicaid dollars via block grants). Whether or not Medicaid moves to a block grant system, the Medicaid process is a significant issue to resolve for Wisconsin. Children are high-volume but very low-cost while the elderly, blind, or disabled (federal terminology) are served at a much higher cost. Members of this higher-cost group are better off both physically and financially the longer they are able to stay in their own homes, so this is an important goal. (Later in the Summit a related point was made by speaker John Torinus about the medical homes concept that helps to achieve this goal) The Governor commented that Wisconsin needs maximum flexibility to help people transition from governmental dependence to true independence. We should seek to make public assistance “…more like a trampoline than a hammock.”

Dr. Jeffrey Bahr (President, Aurora Healthcare Medical Group)

The key stakeholders in healthcare can be identified as payer, provider, and patient. As a process, “disintegrated” healthcare has been our past, but our future should be an integrated health system. Delivering such high-quality integrated is a priority at Aurora. To illustrate the importance of integrated care, Dr. Bahr used the example of a car assembled from disparate parts as contrasted to a car assembled from parts designed to fit together. Integrated healthcare is the latter. Dr. Bahr described an integrated healthcare delivery system as a well-built car – when all the parts fit together, it will work better, break down less, and last longer. In other words, better coordination of the parts and better quality, which should decrease cost. Another goal is to move from purely volume-based healthcare to value-based healthcare; however, it is quite difficult for healthcare practitioners to do both the business and clinical sides of healthcare (i.e. delivering care, while considering cost and quality).

Dr. Bahr also highlighted some problems that he felt are beginning to be addressed more effectively: differences in electronic records usage, communication challenges, unnecessary tests, and erroneous data.

Finally, he noted that the best healthcare providers provide a 360-degree view of each patient, and they allow more preventive and integrated care. Aurora was able to provide a 9-11% decrease in cost for employers joining the network, relative to prior spends. And, Congestive heart failure (CHF) and COPD are diseases for which hospital readmission rates have been decreasing through Aurora’s RN care coordinator programs. Continuing steps that can and are being pursued to improve healthcare delivery include: (a) implementing telehealth, (b) considering the social determinants of health, and (c) considering the impact of meaningful relationships.

John Torinus (Chairman, Serigraph; author of The Grassroots Healthcare Revolution)

The Affordable Care Act was about coverage, insurance, and raising taxes to pay for health care. Ryan/Trump Care is about entitlement reform and tax reduction. Neither plan is about health care cost control. Yet, it is soaring costs that are driving the access problem. At $10,000 in healthcare costs per person (annual cost per capita), access is a problem. If it were $2,000/per person, access would not be as much a problem. The rate of growth in health care costs has caused overall costs to double every eight years. Plus, there is little logic to the large variation in prices for medical treatments. For example, at Serigraph, when researching hip replacement prices, Torinus found a remarkable $26,000 to $90,000 price variation for the same service. So, the problem is cost, combined with a lack of price consistency and transparency. When politicians are attempting to solve a problem, taxes and votes are a top concern. When managers are attempting to solve a problem, cost and value are a top concern. The latter needs to be a part of the discussion more than it is, at present.

The national debate on insurance, access, and taxes covers only half the issue. It does not address affordable cost. Yet cost and access are inextricably intertwined. We must think bigger and more creatively and consider both cost and access. The problem is that most of the current attention and discussion is on insurers as the payer; but, insurers are actually only the middlemen and middlemen seldom reform. Rather than thinking of insurance companies as payers, we should think of private companies as payers. The real costs of healthcare reside with private companies (either directly, or via insurance premiums paid by employers). As the real payers, it is private companies that are most incentivized to look for reforms. Wages and benefits move in tandem. When benefits chew up all the potential increase for employees, there is no room for wage increases and wages remain depressed. So, companies like Serigraph have looked for ways to control healthcare costs. Companies are utilizing management science principles as the missing link to bring costs under control. Where politicians think of votes, companies and business managers think more pragmatically, so they will be the source of solutions to the cost problem in healthcare.

The pragmatic approach is to focus on the link between value and cost. It can be considered a virtuous linkage, since the best way to reduce costs is by keeping people healthier – so wellness programs are an important consideration (i.e. Health Care rather than “Sick” Care). The approach to take is really three- pronged focusing on: consumer-driven healthcare, proactive primary care and value-based healthcare. Value is the combination of cost, quality and service.

John suggested that Paul Ryan should change the dialogue in this direction, instead of seeking yet another partisan solution. Some areas Torinus suggested focusing on included:

Create “Medical Homes” (patient-centered primary care) in every household, like IBM has done: https://www-935.ibm.com/services/us/gbs/bus/html/gbs-medical-home.html
Solve the problem of transparency by single price, bundled pricing (e.g. Access HealthNet)
Provide incentives that encourage individual responsibility (large co-pays already do that)
Allow marketplace dynamics to create value and lower cost

Eric Haberichter (co-founder of Smart Choice MRI; CEO of Access HealthNet)

The overall goals of healthcare systems should be: affordability, access, and sustainability. Haberichter also talked about how we need to take a values-based approach to healthcare, where we restore dignity and affordability to patients. Affordability matters. Your economic situation is part of your health. If you are worrying about your money, you’re not healthy.

The major stakeholders in healthcare are payers, patients, providers, private companies, and insurance companies. However, health insurance is not really insurance but healthcare budgeting, and it does not provide any price transparency that enables consumers to shop. There has now been a trend for companies to move to a self-insurance model. When firms are insured externally, it is all about shopping for rates from insurance companies. But, when firms are self-insured, everyone (at the firm) is in the same boat together, and there are better forces at play to drive down cost and increase quality. At present, there are too many layers of non-value added services in the healthcare system. As noted later in the Summit buy Dr. Tim Bartholow, there is no effective “feedback loop.” Self-insurance avoids these layers, and provide much- needed transparency.

It is in this self-funding world (e.g. in companies like Serigraph; and, via QuadMed that is enabling this model across the US) where action and change are happening. Key areas of benefit in the world of self- insurance are: (a) actionable healthcare (i.e. consumers and payers can shop for best value), (b) transparent pricing, and (c) bundled, episodic pricing. Self-funded companies have the most direct ability to work and negotiate with providers, as compared with companies that simply shop for insurance providers, and then rely on the insurance company to negotiate reimbursement rates. A case in point of the value of bundled pricing is MRI’s. When Haberichter began Smart Choice MRI, the average price for an MRI in Wisconsin I was $2,830. Medicare was paying $900, and Smart Choice MRI was charging $600 (probably the first company to give Medicare a discount). MRI has now become a (high quality) commoditized service.

Haberichter is expanding this model now to a wider range of medical services, at his firm, Access HealthNet.

Valley Elliehausen (COO of West Bend School District)

The West Bend School District has always been a bit on the disruptive side for healthcare. Valley Elliehausen noted that the district is saving significant money per employee while also providing quality care, due to the transition to a self-insurance model. Key elements of their model for delivering care are: (a) consumer driven health plans, (b) targeted wellness, with preventative care using onsite clinics, (c) value cost centers, and (d) their process of measuring performance gaps – metrics and monitoring. The West Bend School District also has a Targeted Wellness On-site Clinic and 99 percent participation in their wellness program, and a partnership with Smart Choice MRI. Elliehausen’s main three points were: 1) with cost containment, you have never arrived—it is a continuous improvement process, 2) don’t fear the dissonance, and 3) know your “why?”.

Dr. Jeremy Normington-Slay (President, Mercy Medical Center, a part of Ascension)

Relationships among providers, patients, and payers is the reverberant and Number One theme in healthcare, for us. A clinically integrated system of care is the route to higher quality and lower cost. So, integrated care is crucial. When care is aligned in a clinically integrated system, patients, employers, and providers all win. Normington-Slay also commented that workplace clinics are the new primary care. Even though they often would take business from larger hospitals such as Ascension, , he is supportive of workplace clinics, and even suggested a kind of “hubs and spokes” model. In this regard, he noted, Ascension wants to work with collaboratively with healthcare innovators and disruptors.

Roundtable Discussion (Facilitated by Curt Gielow)

Panelists: Dr. Masood Wasiullah (SVP, Physician Strategist), Tom Hefty (Retired head of Blue Cross- Blue Shield of United Wisconsin), Donna Owens (VP of Business Development, QuadMed), Dr. Tim Bartholow (Chief Medical Officer at WEA Trust), Dr. LuAnn Moraski (co-founder, YourMD)

The panel discussed a range of topics, but all agreed the cost of healthcare is too high and must be decreased, without sacrificing quality. It was noted that employers should be considered key stakeholders in healthcare decision-making, since they are ultimately the major payer for healthcare. But, in any case, we need more transparency in healthcare. Transparency includes both cost and medical outcomes. This can be obtained more easily in a direct pay situation involving only the patient and provider team (e.g. YourMD), or in a self-insurance model, as is implemented by many companies (e.g. the “QuadMed model”). Donna Owens described how QuadGraphics, through QuadMed (and self-insured companies in general) can measure quality better than insured companies. QuadMed’s success operating in 23 states demonstrates there is a market for this approach to delivering healthcare in a self-insured setting. QuadMed is providing on-site clinical services to a wide range of companies and could serve as a model for how companies implement the self-insurance model.

But, there may also be ways to implement transparency and market forces in an insurance model. Tom Hefty noted that Wisconsin used to have very successful insurance companies and cooperatives that were well designed to serve underserved markets; and, for 20 years Wisconsin had the lowest uninsured rates in the country. It is possible to make insurance work efficiently. Dr. Tim Bartholow (of WEA Trust) added that we need to create a more effective “feedback loop” that includes consumers, providers, and insurers.

This feedback loop, and in general the empowerment of decision making at the patient-provider interface, could be enabled by technology and informatics to consumerize healthcare. This was reinforced by comments from Randy Spaulding, of Spaulding Clinical. In the words of Tom Hefty, we need to bring “business” back into healthcare and think about the patient as a consumer. Central to this is also bringing back the centrality of the doctor (provider)/patient relationship in a productive manner. Audience member (and recognized healthcare thought leader) Dr. Michael Jaeger added that we should also be thinking more about what works to keep people healthy—behavior changes – so that we can focus on healthcare, rather than sick care. Dr. Masood Wasiullah from Aurora reminded everyone that reforms need to take into account that high-risk, high-cost patients can come into hospitals for service and not have to pay (which is not the case for on-site clinics, and is partly why they can keep costs lower). If someone comes to an emergency room, they must be treated – even if they can’t pay. There are no other industries like it. This is an important contributor to the high cost of healthcare. We need to serve these people tool, but it is a major driver of cost.

Drs. Luann Moraski and Rich Lewis described how direct-pay clinics like YourMD can provide better quality care at much lower cost for individuals, and re-establish the patient-physician relationships that seem to no longer exist in larger hospital settings. They also described how doctors get tired of working so hard for mediocre results and are now entering the world of direct-pay as part of a “quiet rebellion” In medicine.

Dr. Lewis pointed out that physicians in large hospitals are measured on quality, patient satisfaction, and quantity. And doctors burn out because a person can usually do two, but quite often, not all three of these well. If a doctor burns out, they have two choices: leave or not care. Perhaps the direct-care model can fill a need by providing more cost-effective and accessible primary care (e.g. for those not insured through their companies, or for those with copays that are too large); and, that later feeds into the larger hospitals, for more severe conditions.

Dr. Jeremy Normington-Slay suggested we view on-site clinics (also medical homes & direct-pay clinics) and urgent care in a “hubs and spokes” model. This may be a way to implement the integrated care model that is promoted by the large providers such as Aurora and Ascension, while still enabling innovation (even disruptive innovation) as per the QuadMed (for companies) or YourMD (for individuals) models – which feeds into the larger hospitals for more serious and catastrophic conditions.

**Panel and audience ideas for Think Tank topics**

Panelists commented on areas of focus for a potential think tank with a mission to address problems in healthcare economics. A listing of topical areas (as well as important concepts) that the panelists and audience members asked the think tank to consider are given below:

Employers should be seen as a central stakeholder; they pay for most of
The cost of healthcare is too high, so focus on how can we reduce costs with new innovative ideas.
Improve the feedback loop between providers, consumers, and doctors. Doctors are often not given enough feedback on performance, and patients’ providers have little information on relative cost and
Apply business practices to health care (e.g. management science). Put emphasis on individual choice. Business can make things more efficient, if there is transparency and
Think of patients as consumers — consumerize
Explore how we can use technology to reduce costs (e.g. empower consumers; create “feedback loops,” provide price and outcome transparency / information).
We do not have a health care system, we have a sick care complex. What can we do to make people healthier? How can we change behaviors?
Explore how can we improve transparency to lower costs and improve
How can we apply lean disciplines from manufacturing (such as Toyota) to health care? How can we listen to the voice of the customers? How can we get the lean thinkers who are leaders in the state of Wisconsin to help improve the system?
The Medicaid budget in Wisconsin is enormous. Wisconsin is the third-highest in Medicaid spending on the elderly and the lowest in Medicaid spending on the children; 60 percent of nursing home residents are on Medicaid. Consider how better to serve this population in a sustainable way, and with the new block grant system that is going to be implemented at the state level.
We need to examine the impact of other social determinants on health care. Bevan Baker (Milwaukee Commissioner of Health) asked what impact do transportation, housing, food insecurity, and crime have on health?

Areas in Which Wisconsin is Unique; and, Potential Areas of Focus for us (identified by Tom Hefty):

Strong integrated health care delivery networks–good integrated care but a growing lack of competition.
Wisconsin private insurance markets remain strong with low uninsured
Wisconsin has a generous Medicaid program—particularly for the elderly, but less so for
The governor did not expand Medicaid under Obamacare; but, what will that mean under the latest federal reform proposals (including block grants).
The QuadMed/Torinuscare self-insurance model of health delivery for larger firms has a much stronger penetration in Wisconsin than other states. Can that model be expanded nationally?
The various national health care quality rankings (United, etc) show an overall good quality for Wisconsin-

-but with some notable exceptions. Can anything be learned by analyzing the exceptions?

PROBLEM DEFINED

The cost of U.S. healthcare (approaching 20 percent of GDP) is too high and its growth is unsustainable. This cost is much higher than in most other countries, while healthcare outcomes fall below those in most other developed countries. From a home state perspective, Wisconsin excels at integrated healthcare systems and healthcare quality (e.g. at Aurora and Ascension), but we also fail at cost or price transparency and control, as is the case across the country. Still, providers claim to struggle to manage profitability in spite of high healthcare prices – particularly providers who have less selection within or control over their care population (e.g. a high fraction on Medicaid).

Insurers, as payers, have been arbiters of much of today’s healthcare, and the system as currently structured has been one of abject failure. It lacks, or perhaps even obscures, the transparency and economic signals necessary to enable cost management. But, it is patients who pay large copays and companies that provide healthcare benefits to employees that are the true payers, and yet they have historically had little input into actual healthcare purchasing decisions. The patient/consumer has little knowledge of cost or outcomes, and no ability to “shop” for the best healthcare value, because the current reimbursement-driven system lacks transparency, and doesn’t empower decision-making at the level of the patient/provider. One could say there are two market inefficieny “problems” that emerged in the discussions at the Summit:

Problem 1: Consumers do not understand the costs associated with healthcare. As stated by Governor Walker, people know more about their cell phone plan than they do about their health care. If questioned about their cost for healthcare, the consumer will most likely cite their monthly premium and co-pay amounts, but not the actual cost of procedures, tests, etc. (i.e. no transparency).

Problem 2: Businesses and patients (i.e. the payers) do not have enough “say” in the costs related to healthcare. John Torinus stated that most people acquire access to healthcare through their employer; however, the business, whichis providing their employees access to healthcare does not have a say in the cost of procedures. A business is unable manage this line item in their business’ budget. Self-insured companies are changing this dynamic (e.g.

QuadMed). Likewise, individual consumers are empowered in direct pay options (e.g. YourMD).

HIGH-LEVEL SOLUTIONS DISCUSSED

Several themes emerged during the Healthcare Economics Summit as to what solution areas could be focused on. These include:

Managing relationships, including empowerment at the patient-provider level; creation of “medical homes” and direct-pay options for patients, while also keeping the advantages of “integrated care”
Normalizing accessibility to and reliance on preventive care; more “health” rather than “sick” care
Creating cost transparency, and quality/outcome metrics for comparison. This could be done most easily within companies that self-insure (e.g. QuadMed; Serigraph); or, via brokers that bundle and provide price transparency (e.g. Access HealthNet). In theory, it could also be implemented in a reimbursement-driven system (insurance; Medicaid) and in a large integrated care setting, if it were more transparent (e.g. EMR (Epic)-integrated technology; enabling a “feedback loop”), providing cost/quality information to patients and providers, to enable more informed decision-making.
Increasing technological alternatives, especially healthcare IT to enable connected medicine and tele-medicine, that better informs and empowers patients and providers (e.g. Intellivisit).

SOLUTION DETAILS

Managing relationships

Relationships within the healthcare delivery system as well as between provider and patient are a core part of resolving issues of cost and provider profitability. One local provider, YourMD, is founded on a belief that membership-based direct-pay models provide a clear and unmoderated relationship with the patient. It pulls focus toward managing healthcare the patient really needs in a cost effective model, and it personalizes care to the “patient” rather than the consumer. Expanding this approach to the level of a company/organization providing more cost-effective quality care is the QuadMed self-insurance model.

Within the broader healthcare system, commonly identified stakeholders are patients, providers, and payers.. Payers are typically assumed as insurers; but, the vast majority of people obtain insurance through employers who act as primary payers through managing the tandem relationship between benefit costs and employee wages. Thus, employers need more recognition and empowerment as a stakeholder in healthcare decision-making, and many are turning to self-insurance as the mechanism for obtaining it (e.g. QuadMed). Cognizance and further research must also occur relative to the social determinants of health. Communities and families are key partners in managing health and solutions must integrate these relationships into the delivery system.

Normalizing accessibility of and reliance on preventative care

Preventative care is by far the most assumptive element in improving quality while managing cost. To address this, employers are more frequently choosing onsite healthcare as a component of self-insurance models – maintaining that they are an effective way to provide preventative care. It addresses cost and quality with healthcare delivered at the right point in time and for the right amount of time. Going beyond managing today’s cost, it focuses on health management to manage future costs.

The most successful providers also pay great attention to reducing and eliminating infection rates, since stewardship of health and resources looks to prevent infections. Providers are also pondering the expansion of patient centered Medical Homes everywhere, to broaden primary and preventative care access. But there remain concerns among others that the approach cannot be generalized since some care must go beyond primary care, and is not truly “integrated care,” And there remains a need for supplementary providers. It is possible that this concern can be addressed through healthcare IT, EMR and telemedicine tools that integrate care that is coming from diverse sources. That would put this solution in the hands of the disruptive innovators in healthcare. Undoubtedly, there are complexities to this solution – but navigating organizational and regulatory complexities to create simplified and improved solutions is what disruptive innovators do best, and what results in better quality at lower cost.

Creating cost transparency

Almost universal agreement exists in the assertion that values-based care begins with cost transparency. Cost transparency comes down to how cost is paid and communicated, and are market place dynamics allowed to operate. Such forces are already more present in self-insured companies who have the most direct ability (and leverage) to work and negotiate with providers. These self-insurers also press for single price (bundled pricing) as a more transparent and efficient method for cost management for medical procedures.

It is interesting that costs are raised as the most critical issue – or at least the most urgent – but most solutions equate cost reduction with price reduction. While final price to payer is the most easily identified and measured metric, we must ultimately identify true cost impacts and structure the cost-price relationship for success among the multiple stakeholders to achieve a sustainable delivery and cost structure. Obtaining the root information for this effort is perhaps dependent on the final theme – increasing technological alternatives.

Increasing technological alternatives

Providers and entrepreneurs agree that we are collecting more data now than ever before in healthcare, but the feedback loop to physicians and patients is non-existent or at least ineffective. There is little information for physicians to identify themselves as high or low performers, and signals drawn from the data are not reaching patients. Technologically, integrated systems are now more feasible – they do not have to mimic the large size of systems such as the Mayo Clinic in order to achieve integration. We now have the communicative technology through loose networks that allows information and connection at a simple level, although there may be regulatory challenges (HIPAA) as well as software and database tool integration challenges (e.g. rigidity of the existing EMR system). Ultimately, tapping this technological capability (connected and telemedicine tools) can improve the flow of information to increase preventative measures, control costs, and inform stakeholder relationships.

SOLUTION DETAILS (from the panel discussion)

The Summit event provided a venue for healthcare organizations and business owners (innovative disrupters) to present their ideas for identifying and solving the major problems in healthcare economics. Some of the solutions presented are in the categories below:

Integrated primary care / value-based care, as being implemented in Wisconsin’s large healthcare organizations like Aurora and Ascension (Aurora, Dr. Wasiullah; Mercy/Ascension,

Normington-Slay)

Direct primary care; direct pay, as being implemented at YourMD. This type of healthcare clinic accepts no insurance and patients know exactly what is provided, and how much it costs (YourMD, Drs. Lewis and Moranski)
Patient-centered care, implemented in an insured market, but with transparency and an effective “feedback loop” (WEA-Trust, Dr. Tim Bartholow; Tom Hefty)

Self-insurance model as implemented by increasing numbers of companies for their employees, and even in the West Bend School District (QuadMed, Donna Owens; Serigraph, John Torinus; West Bend School District, Valley Elliehausen)
Bundled and transparent pricing, as implemented at Smart Choice MRI and Access HealthNet (Eric Haberichter, cofounder of Smart Choice MRI and Access HealthNet)

CALL TO ACTION – CREATION OF A HEALTHCARE ECONOMICS THINK TANK

As noted by Bevan Baker, Milwaukee’s Health Commissioner, the timing is right for Concordia to work with healthcare thought leaders across Wisconsin, to create a think tank focused on researching, proposing and enabling solutions for the problems we face in the business of healthcare.

Our think tank will focus on topical areas identified at the Summit, and using a three-pronged approach that spans ideas to implementation (below). But, we seek input on areas of focus from our advisory board.

Ways the Think Tank can help find and facilitate solutions (e.g. for the public policy forum):

Create guiding “roadmaps” for policy-makers, such as Governor Walker and Paul Ryan, so that smart healthcare reforms are made that will put true market forces in place that decrease cost & increase quality
Address regulations and other barriers to healthcare innovation, so that consumers can access their healthcare records – and be incentivized, educated, and empowered to make their healthcare choices
Listen to questions and topics presented by thoughtleaders and stakeholders and then perform research directed toward answers/solutions—these will be the think tank’s deliverables, in the form of whitepapers and an annual Healthcare Economics Summit
Enable the (free) market to work by developing transparency in healthcare cost (and medical procedures); and, by providing resources and support for healthcare innovators who aim to disrupt the current healthcare delivery business model; this includes fostering creation of new business models and technologies that empower consumers

SUMMARY

The Healthcare Economics Summit provided a venue for Governor Scott Walker and Wisconsin thought- leaders in the healthcare industry to come together to discuss the state of healthcare in Wisconsin, identify the problems, and suggest solutions. Concordia University proposed the creation of a Think Tank that would operate by researching the issues identified and then create a roadmap toward solutions that would equip the consumer with transparent pricing as well as propose the advancement healthcare policy at the state and national level. The interest in participation of Concordia’s Think Tank by the majority of attendees at the Healthcare Economics Summit indicates that the Think Tank will consist of a powerful cross-section collaboration, representing healthcare leaders from large health organizations, concierge medicine, insurance companies, healthcare businesses, and businesses who have successfully implemented a self-insurance model. This cross-section collaboration, facilitated by the Think Tank, could cross the usual silos and, instead, allow healthcare experts to come together and share their knowledge in order to address the complex issues currently surrounding healthcare economics; the commonly identified problem being the high cost and lack of transparency in pricing of medical procedures. Associated resources to help implement new healthcare innovations – both incremental and disruptive – will also be provided (incubator space; seed funds and startup mentoring).

Summary of key points from the Healthcare Economics Summit:

The runaway costs of U.S. healthcare services are exacerbating already glaring weaknesses in the S. health care system: inefficiency and inequity
As high-deductible plans continue to multiply, U.S. consumers will continue to pay out-of-pocket for more health care services every year; they are now incentivized to shop for value, but are not empowered to do so
To make informed spending decisions, U.S. consumers need more price and quality comparison data provided in an easy-to-understand format, and they need to be empowered to use this information
Consumers with better price and quality data should allocate more dollars to higher-quality, affordable providers and less dollars to lower-quality less efficient care; this will lead to centers of excellence, and more efficient delivery of care, perhaps in a “hubs and spokes” model of integrated care