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Angel Capital Association keynote - April 2017
HEALTHCARE COLLATERAL
DAMAGE
$1M LESS SAVED FOR RETIREMENT
BY AVG BABY BOOMER FAMILY DUE
TO 20+ YEAR WAGE
STAGNATION/DECLINE
70% OF AMERICAN HOUSEHOLDS
HAVE LESS THAN $1K IN SAVINGS
LARGEST GENERATION IN HISTORY (MILLENNIALS)
SLATED TO SPEND > HALF OF LIFETIME EARNINGS ON
HEALTHCARE
MEDICARE TAXES & PREMIUMS
DEDUCTIBLES & OUT-OF-POCKET EXPENSES
INSURANCE PREMIUMS
EMPLOYER PREMIUMS
EMPLOYER MEDICAID TAXES
FEDERAL & STATE TAXES
VISIBLE
PAYMENTS
$.6M
HIDDEN
PAYMENTS
$1.3M
+
$1.9MGRAND TOTAL
TOTAL LIFETIME EARNINGS $3.8M
CATASTROPHIC MISALLOCATION OF
RESOURCES
+37%
HEALTHCARE
SPENDING
-50% LOCAL AID
-31% PUBLIC HEALTH
-22% MENTAL HEALTH
-14% INFRASTRUCTURE, HOUSING & ECON.
DEV.
-13% LAW & PUBLIC SAFETY
-12% EDUCATION
-11% HUMAN SERVICES
HEALTHCARE SPENDING DEVASTATES SOCIAL DETERMINANTS OF HEALTH
(FY01 - FY14 - STATE OF MASSACHUSETTS)
Angel Capital Association keynote - April 2017
Care Team
Cost
$500B Annual Citizen-driven Economic
Stimulus
Stopped: Redistribution from kids, families &
businesses to “morbidly obese” healthcare
$3,000,000,000,000
50+ years of optimizing for
flawed financial incentives.
Healthcare’s root cause of dysfunction
Operational waste
Clinical waste
Paid for volumeCost-plus models
Would be world’s
16th largest
economy
Who pays for healthcare
$2.7T in annual spending (2014)
(excluding pharma)
Government 48%
Employers 52%
($1.4T)
Medicare
24.8%
Medicaid
19%
Fully
insured
19.7%
Self-insured
32%
Least flexibility
Most homogenous
Most politicized
Most flexibility
Least homogenous
Least politicized
Other
4.5%
$191B
Operations waste
Fraud
Excessive admin costs
Unnecessarily high prices
28% of $1.4T is systemic “obesity”
$204B
Clinical waste
Unnecessary services
Inefficient delivery
Missed prevention
$395
B
annually in
employer
segment
Individual behaviors like obesity = ~$200B
1
Improve care
team experience
Enhance patient
experience
Improve health
outcomes
Lower
health costs
2
34
Healthcare’s Square Deal: Quadruple Aim
Watch where your insight comes from
Beware of throwing tech on top of broken models
Status quo business models are highly vulnerable
hospitals = newspapers
98% of Digital Health Startups are Zombies
Winners possess:
1)Unique biz model & GTM
2)Experienced, yet
unshackled teams
Align investments with biggest opportunities
Tech
Avoid conflating these tech & model transformations
- No/low-touch
- Many patients
- Payment & ops SaaS,
data analysis, etc.
Services
- High-touch
- Fewer patients
- Care delivery, ancillary
services, benefits, etc.
5% patients
80% costs
Operational
Next-gen operations
mgmt. & supply chain
Disintermediation &
financial/clinical
integration
Reduce pricing failure
Full-stack services
Enablement
High-performance
benefits
Payment integrity
& infrastructure
Next-gen networks,
esp. primary care &
major procedures
Clinical
Evidence-based care in
high-cost specialties
Identifying and treating
outlier patients
Team-based care &
next-gen facilities
Upstream intervention
Key categories that address
the largest systemic waste
Twitter/LinkedIn:
@chasedave
Health Rosetta Institute:
www.healthrosetta.org
Health Rosetta Group:
www.healthrosetta.com
The Big Heist:
www.bigheistmovie.com

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Angel Capital Association keynote - April 2017

  • 2. HEALTHCARE COLLATERAL DAMAGE $1M LESS SAVED FOR RETIREMENT BY AVG BABY BOOMER FAMILY DUE TO 20+ YEAR WAGE STAGNATION/DECLINE 70% OF AMERICAN HOUSEHOLDS HAVE LESS THAN $1K IN SAVINGS
  • 3. LARGEST GENERATION IN HISTORY (MILLENNIALS) SLATED TO SPEND > HALF OF LIFETIME EARNINGS ON HEALTHCARE MEDICARE TAXES & PREMIUMS DEDUCTIBLES & OUT-OF-POCKET EXPENSES INSURANCE PREMIUMS EMPLOYER PREMIUMS EMPLOYER MEDICAID TAXES FEDERAL & STATE TAXES VISIBLE PAYMENTS $.6M HIDDEN PAYMENTS $1.3M + $1.9MGRAND TOTAL TOTAL LIFETIME EARNINGS $3.8M
  • 4. CATASTROPHIC MISALLOCATION OF RESOURCES +37% HEALTHCARE SPENDING -50% LOCAL AID -31% PUBLIC HEALTH -22% MENTAL HEALTH -14% INFRASTRUCTURE, HOUSING & ECON. DEV. -13% LAW & PUBLIC SAFETY -12% EDUCATION -11% HUMAN SERVICES HEALTHCARE SPENDING DEVASTATES SOCIAL DETERMINANTS OF HEALTH (FY01 - FY14 - STATE OF MASSACHUSETTS)
  • 8. $500B Annual Citizen-driven Economic Stimulus Stopped: Redistribution from kids, families & businesses to “morbidly obese” healthcare
  • 10. 50+ years of optimizing for flawed financial incentives. Healthcare’s root cause of dysfunction Operational waste Clinical waste Paid for volumeCost-plus models Would be world’s 16th largest economy
  • 11. Who pays for healthcare $2.7T in annual spending (2014) (excluding pharma) Government 48% Employers 52% ($1.4T) Medicare 24.8% Medicaid 19% Fully insured 19.7% Self-insured 32% Least flexibility Most homogenous Most politicized Most flexibility Least homogenous Least politicized Other 4.5%
  • 12. $191B Operations waste Fraud Excessive admin costs Unnecessarily high prices 28% of $1.4T is systemic “obesity” $204B Clinical waste Unnecessary services Inefficient delivery Missed prevention $395 B annually in employer segment Individual behaviors like obesity = ~$200B
  • 13. 1 Improve care team experience Enhance patient experience Improve health outcomes Lower health costs 2 34 Healthcare’s Square Deal: Quadruple Aim
  • 14. Watch where your insight comes from Beware of throwing tech on top of broken models Status quo business models are highly vulnerable hospitals = newspapers
  • 15. 98% of Digital Health Startups are Zombies Winners possess: 1)Unique biz model & GTM 2)Experienced, yet unshackled teams
  • 16. Align investments with biggest opportunities Tech Avoid conflating these tech & model transformations - No/low-touch - Many patients - Payment & ops SaaS, data analysis, etc. Services - High-touch - Fewer patients - Care delivery, ancillary services, benefits, etc. 5% patients 80% costs
  • 17. Operational Next-gen operations mgmt. & supply chain Disintermediation & financial/clinical integration Reduce pricing failure Full-stack services Enablement High-performance benefits Payment integrity & infrastructure Next-gen networks, esp. primary care & major procedures Clinical Evidence-based care in high-cost specialties Identifying and treating outlier patients Team-based care & next-gen facilities Upstream intervention Key categories that address the largest systemic waste
  • 18. Twitter/LinkedIn: @chasedave Health Rosetta Institute: www.healthrosetta.org Health Rosetta Group: www.healthrosetta.com The Big Heist: www.bigheistmovie.com