J.D. Kleinke

J.D. Kleinke: Program Outlines

This session examines the concurrent effects of government reform, increasing patient economic empowerment, and emerging patient information technologies on today’s health care organization. Combined with lessons from the emerging field of consumer behavioral economics, and observations from the cutting edge of the patient-centric health information revolution, this session will outline how your organization can navigate a health care system confronting the greatest changes in its bizarre, hundred year history.

Risky Hospital Business 2: Remake of the 1990s Managed Care Classic
Buried not so deep in the health reform legislation are radical changes in provider payment methodologies. Accountable Care Organizations, Medical Homes, Electronic Medical Record-related subsidies and penalties – these are only a few of the latest attempts to correct the health system’s economic, behavioral and organizational disorders a century in the making. The cost and quality problems that gave rise to the national managed care companies in the 1990s have not gone away, inspiring both the government and large health plans to simultaneously revisit many of those same managed care strategies.

Will this second round - and double dose - of harsh economic medicine prove worse than the disease? Or are certain aspects of health care’s cost and quality problems simply incurable? How can provider organizations cope with a system that, as the government and payers attempt to re-engineer it around reimbursement, seems to yield only more chaos? This session will outline how your organization can navigate the latest attempt to re-engineer much of the U.S. health care system.

eHealth 2.0: The Once and Future Health Care Information Revolution
A new generation of health information technology is emerging – and this one may finally ready for primetime, thanks to $17.2 billion in stimulus funding! Beyond the government’s sudden willingness to fund the computerization of health care, there has been explosive growth in e-prescribing and other electronic medical tools, as a new generation of providers comes online - and as patient communities have also emerged online, allowing patients to share exquisite details about their medical conditions and experiences.

To attract and retain the most lucrative (i.e., well-off, well-insured and web-enabled) segments of the market, providers and payers at the vanguard are promoting the use of provider/patient e-visits and remote systems to manage disease, track changes in symptoms, and share data. New reimbursement methods and models – including insurer-paid e-visits and annual “connectivity” fees from patients – are emerging in parallel with these technologies, as the health IT community finally addresses the need for privacy, security, physician income preservation, and liability protection. The sum total of these trends is the long overdue computerization of health care, and the "liquification" of patient data from paper charts and institutional silos - with far-reaching strategic consequences for every organization in health care.

The Patient Is In: Health Care’s Next Economic Revolution
Over the past two decades, the locus of medical decision making – via the rise and fall of “managed care” - has shifted from physician to health plan to patient. Tiered co-payments and the introduction of high-deductible health insurance, coupled with Health Savings Accounts, are ushering in the inevitable decline of first-dollar coverage by health plans and the often irrational demand-inducement behavior of consumers.

How will people behave when they are confronted daily with a financial document that looks like a 401(k) plan statement - one which shrinks with every doctor visit, lab test, new prescription and refill? Everything we think we know about how consumers will behave when purchasing routine care from these new cash accounts - and about how desperately ill patients will behave when confronted with draining those same accounts when fighting a life-threatening illness - is completely speculative. This keynote session examines keys moments in health care system history and policy for clues as to what the future will hold for all of us, not just as patients, but as real health care consumers.

The High Price of Progress: Who Pays for Medicine's Good Bad Luck?
The majority of medical research compels the utilization of ever newer and ever more expensive drugs and other medical technologies. At the same time, the majority of actions by private and public health plans seek to constrain their use. The result is an emerging collision course - between the march of medical science and the countermarch of medical policy - arising from often bitterly divided views about the optimal use of expensive medical resources.

Pharmacy costs in particular are rising in excess of general and medical cost inflation, leading to calls for price and utilization controls by public and private payers. Such controls would be ineffective and counterproductive because they would attempt to reverse two profound, historic phenomena at work in the US health care system: the added costs associated with breakthrough medicines represent a major structural shift from the provision of traditional medical services to the consumption of medical products; they also represent the creation of economic, social, and public health utility that we value as a society.

Nonetheless, the turmoil in the private health care system's approach to managing health benefits and costs - currently undergoing replication for Medicaid and the new Medicare drug benefit - can be remedied through adoption of a value-based (rather than price-based) approach to pharmaceutical spending - and all stakeholders in the system have the opportunity to enable, rather than resist, the hard economic news associated with all of our good clinical luck.