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Harnessing Decision-Support Systems to Deflate Medical Bills Neel Shah Executive Director Mary Zarkhina VP Research
The Opportunity Every 30 seconds medical bills bankrupt an American family Doctors decide what goes on the bill Many commo...
The Opportunity “ We seem to have as much as  $700 billion a year  in health care tests and services that are unnecessary,...
Medical Decision-Making Safety Efficacy Cost
Top-Down Solutions “ Nonclinical” Administrators Clinical Healthcare Providers information <ul><li>Managed care </li></ul>...
Bottom-up solutions <ul><li>Consumer-Driven Healthcare </li></ul><ul><li>Decision-support systems </li></ul><ul><li>consum...
Our Solution Transparent price information at the point of care <ul><ul><li>Sensitive to provider workflow </li></ul></ul>...
Our Solution Transparent price information at the point of care Cost Charge Price <ul><ul><li>Hospital accounting ledgers ...
Display Transparent price information at the point of care <ul><ul><li>Coded order-of-magnitude </li></ul></ul><ul><ul><li...
Display Transparent price information at the point of care <ul><ul><li>Displayed explicitly when quantifiable, else a refe...
Display Transparent price information at the point of care <ul><ul><li>Coded with a provided benchmark </li></ul></ul><ul>...
Setting: Emergency Room Transparent price information at the point of care <ul><ul><li>Emergency rooms operate in deficits...
Value Chain Costs of Care services Physicians (target) Patients (1 °  beneficiary) Emergency Rooms (2 °  beneficiary) Heal...
Our Goals Costs of Care services Physicians (target) Patients (1 °  beneficiary) Emergency Rooms (2 °  beneficiary) Health...
Measuring Impact Costs of Care services Physicians (target) Patients (1 °  beneficiary) Emergency Rooms (2 °  beneficiary)...
Our Theory of Change All doctors should understand how the decisions they make impact what patients pay.  We believe that ...
Our Strategy: Nonprofit Learning Enterprise <ul><ul><li>6 month pilot in a local emergency department </li></ul></ul><ul><...
Our Team Neel Shah MD, Executive Director Mary Zarkhina, VP Research Jeff La Fave MBA, VP Finance Devin DeCiantis BBA, VP ...
Thank you
©  Copyright 2009 <ul><li>This confidential publication is the property of Cost of Care, Inc. No part of this presentation...
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Costs Of Care Primer

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An introduction to www.CostsOfCare.org, a 501c3 nonprofit venture dedicated to helping doctors understand how the decisions they make impact what patients pay for care.

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Costs Of Care Primer

  1. 1. Harnessing Decision-Support Systems to Deflate Medical Bills Neel Shah Executive Director Mary Zarkhina VP Research
  2. 2. The Opportunity Every 30 seconds medical bills bankrupt an American family Doctors decide what goes on the bill Many commonly ordered tests and treatments do not improve health outcomes
  3. 3. The Opportunity “ We seem to have as much as $700 billion a year in health care tests and services that are unnecessary, that don't improve health outcomes, and that just add to costs ... The way to get at that has been started in the stimulus bill in which we invest [$20 billion] in health information technology , we start to better measure what works and what doesn't, and we start to pay for better care rather than more care.” Peter Orszag, Director of the White House Office of Management & Budget. February 19th, 2009
  4. 4. Medical Decision-Making Safety Efficacy Cost
  5. 5. Top-Down Solutions “ Nonclinical” Administrators Clinical Healthcare Providers information <ul><li>Managed care </li></ul><ul><li>Pay-for-performance </li></ul>
  6. 6. Bottom-up solutions <ul><li>Consumer-Driven Healthcare </li></ul><ul><li>Decision-support systems </li></ul><ul><li>consumer agency </li></ul><ul><li>consumer capacity </li></ul><ul><li>provider autonomy </li></ul><ul><li>price transparency </li></ul>Limitations
  7. 7. Our Solution Transparent price information at the point of care <ul><ul><li>Sensitive to provider workflow </li></ul></ul><ul><ul><li>Sensitive to health delivery business operations </li></ul></ul>User-interface Decision support
  8. 8. Our Solution Transparent price information at the point of care Cost Charge Price <ul><ul><li>Hospital accounting ledgers </li></ul></ul><ul><ul><li>Payer claims databases </li></ul></ul>reconciled estimate
  9. 9. Display Transparent price information at the point of care <ul><ul><li>Coded order-of-magnitude </li></ul></ul><ul><ul><li>Displayed in the order-entry menu </li></ul></ul>
  10. 10. Display Transparent price information at the point of care <ul><ul><li>Displayed explicitly when quantifiable, else a referenced clinical guideline </li></ul></ul><ul><ul><li>Displayed in a second-level box </li></ul></ul>
  11. 11. Display Transparent price information at the point of care <ul><ul><li>Coded with a provided benchmark </li></ul></ul><ul><ul><li>Displayed with efficacy in a second-level box </li></ul></ul>
  12. 12. Setting: Emergency Room Transparent price information at the point of care <ul><ul><li>Emergency rooms operate in deficits </li></ul></ul><ul><ul><li>Patients are most likely to be underinsured </li></ul></ul><ul><ul><li>Physicians are salaried </li></ul></ul><ul><ul><li>Workflow incentivizes formulaic ordering </li></ul></ul>
  13. 13. Value Chain Costs of Care services Physicians (target) Patients (1 ° beneficiary) Emergency Rooms (2 ° beneficiary) Healthcare System (3 ° beneficiary)
  14. 14. Our Goals Costs of Care services Physicians (target) Patients (1 ° beneficiary) Emergency Rooms (2 ° beneficiary) Healthcare System (3 ° beneficiary) <ul><li>Drive a paradigm shift in medical decision-making towards cost awareness </li></ul><ul><li>Prevent personal bankruptcy caused by medical bills </li></ul><ul><li>Create a “bottom-up” approach to curbing cost-growth </li></ul>
  15. 15. Measuring Impact Costs of Care services Physicians (target) Patients (1 ° beneficiary) Emergency Rooms (2 ° beneficiary) Healthcare System (3 ° beneficiary) <ul><li>Provider practices </li></ul><ul><li>Patient benefits </li></ul><ul><li>System-level benefits </li></ul>
  16. 16. Our Theory of Change All doctors should understand how the decisions they make impact what patients pay. We believe that drawing an explicit link between these decisions and the potential to bankrupt the patient in front of them will induce doctors to consider costs. We believe doctors who consider costs will continue ordering tests and treatments patients need to get better, but will be less likely to order superfluous tests that inflate medical bills unnecessarily.
  17. 17. Our Strategy: Nonprofit Learning Enterprise <ul><ul><li>6 month pilot in a local emergency department </li></ul></ul><ul><ul><ul><li>Academic medical center </li></ul></ul></ul><ul><ul><ul><li>Safety net hospital setting </li></ul></ul></ul><ul><ul><li>Start-up through research grants </li></ul></ul><ul><ul><ul><li>Aligned private foundations and government RFPs </li></ul></ul></ul><ul><ul><ul><li>Analysis of provider cost-sensitivity </li></ul></ul></ul>
  18. 18. Our Team Neel Shah MD, Executive Director Mary Zarkhina, VP Research Jeff La Fave MBA, VP Finance Devin DeCiantis BBA, VP Strategy <ul><li>Former Harvard Law Health Policy Fellow </li></ul><ul><li>Inaugural MHDC Elliot Stone Fellow </li></ul><ul><li>MD and MPP candidate, Harvard Kennedy School of Government </li></ul><ul><li>Worked in health management and IT consulting at Accenture </li></ul><ul><li>Conducted a utilization and profitability analysis in academic emergency department </li></ul><ul><li>Master of Health Policy and Management candidate, Harvard School of Public Health </li></ul><ul><li>Former cost analyst, Congressional Budget Office </li></ul><ul><li>Former manager of citywide consumer credit education campaign </li></ul><ul><li>Two former business degrees and MPP candidate, Harvard Kennedy School of Government </li></ul><ul><li>Worked as a strategy consultant for McKinsey & Co. </li></ul><ul><li>Former investment banker, UBS </li></ul><ul><li>Managed digital media for the Walrus Foundation </li></ul><ul><li>MPP candidate, Harvard Kennedy School of Government </li></ul>
  19. 19. Thank you
  20. 20. © Copyright 2009 <ul><li>This confidential publication is the property of Cost of Care, Inc. No part of this presentation may be reproduced, translated into another language or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written consent of Cost of Care, Inc…. </li></ul><ul><li>Some or all of the information contained herein may be protected by patent numbers………. </li></ul><ul><li>All other trademarks are owned by their respective owners…… </li></ul>

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