This is the presentation for Vizient at their June conference. I provided an overview of the US economy, the 2016 US presidential race and the outlook for future growth in the healthcare space.

1. 2016 Political Economy
Impact On HC

2. A National Tragedy

3. Main Topics Today
Current Economic Situation
2016 Presidential Race
Future Growth for HC

4. US GDP

5. Q2 2016 GDP Estimate

6. Unemployment: U-3 and U-6

7. Fed’s Fav Inflation Gauge

8. 5yr US Dollar Index

9. US 2yr Treasury Yield

10. Political Econ Growth Pts.
Free Trade=lower tariffs
Reg. Relief=reduced costs
Tax reform=capital formation
w/incentives
Infrastructure=efficiency

11. Why it matters for HC

12. Trump Plan
Cut Corp Tax to 15%
Limit Pass Thru 15%
1x 10% Repat Tax
Ag TPP and NAFTA
Impose tariffs on
imported goods
Big Drop in Interest
Deductibility

13. Trump HC Plan
Allow health insurance to cross state lines
Full individual deduction of HC premiums
Repeal Obamacare: no individual mandate
HSA: tax free and allowed to accumulate
Price Transparency
Medicaid Block Grants
Allow access to imported drugs

14. Trump HC Contradictions
2/18 “I like the mandate.”
3/1: Repeal mandate and ACA
Repeal Obamacare: no individual mandate
Feb. CNN: he wants to “take care of”
poor people “through maybe concepts
of Medicare”
Next day, tweets his proposal
would use “private plans”

15. Trump plans help/hurt
Help: big tech & big pharma
Hurt: debt heavy balance sheets
Help: industrials & manufacturers
Hurt: free trade
Hurt: ACA managed care,
hospitals, Medicaid HMOs

16. CLINTON PLAN
No Change 4 Corp
or Pass Thru Taxes
Tax Credits for
Profit Sharing/
Apprenticeships
New BABs and College
Tuition Plan
No Free Trade
$275b Infrastructure

17. Big Change to Cap Gains
Tax Foundation

18. Clinton HC Plan
Defend the Affordable Care Act
Crack down on rising prescription drug prices
100% 3yr match for states joining
expanded Medicaid coverage
$5,000 tax credit per family for excessive out-of-
pocket and premium costs above 5% of their income.
Transform HC to reward value and quality
via bundled payments and ACOs

19. Clinton’s Comments
“We have to go after price gouging
and monopolistic practices and get
Medicare the authority to negotiate.”
“…I’ll defend ACA, build on its successes,
and go further to reduce costs.”
“What we have to do, I think,
is defend ACA and fix it.”
“I will direct the government to reevaluate
Medicare and Medicaid payment practices to remove
obstacles to reimbursement and help
integrate care for addictions into standard practice.”

20. Clinton plans help/hurt
Help: ACA managed care,
hospitals, Medicaid HMOs
Hurt: raises taxes on top earners/
capital formation
Help: construction, enginering firms
Help: cities and students

21. 2016 Difference Recap
Clinton: no big biz tax plans,
large infrastructure plans,
build on current regulations,
build on ACA HC
Trump: tax cut plans,
reduce regulations, full expensing,
hurt free trade, hurt ACA related HC,
block grants for Medicaid

22. 2016 HC Similarity Recap
Increased price transparency
Allow Medicare to negotiate
drug prices directly with pharma

23. 1st Time Ever: Trump is ahead!

24. Maybe not…

25. Don’t Forget The Senate!

26. Future HC growth is value
Do you deliver a better outcome?
Do you deliver a superior customer experience?
Do you deliver a lower price and cost?

27. Chronic Care Focus
CMS recognizes care management as one of the
critical components of primary care that contributes
to better health and care for individuals, as well as
reduced spending. Beginning
January 1, 2015 Medicare pays separately under the
Physician Fee Schedule (PFS) under American
Medical Association Current Procedural Terminology
(CPT) code 99490, for non-face-to-face care
coordination services furnished to Medicare
beneficiaries with multiple chronic conditions.

28. Pressure on Price
Over the period from 2005 to 2014, premiums for
employment-based insurance grew by 48 percent
for single coverage and by 55 percent for family
coverage. CBO and JCT expect them to grow at
similar rates over the next decade—by about 5
percent per year, on average, or about 2 percentage
points faster than income per capita. As a result of
that growth, average premiums for employment-
based coverage are projected to be about $10,000
for single coverage and about $24,500 for family
coverage in 2025, nearly 60 percent higher than
they were in 2016.
CBO Feb 2016

29. Pricing Transparency
Castlight: mission is to empower people to make
the best choices for their health, and help
companies make the most of their health benefits.
MD Insider: we analyze doctor performance
using big data
Guroo: At guroo.com, you'll find data on health
care costs and quality. We have national, state,
and local prices.
Strata Decision: Our passion and our mission is
to help hospitals and health systems
drive margin to fuel their mission.

30. New Research Methods
Miroculus

31. New Models/Competitors

32. Final Thoughts…