21st Princeton Conference 2014, SESSION I: Forces Driving Innova on in the Delivery System
THE COMMONWEALTH FUND
Health Care in Ten Years
David Blumenthal, MD, MPP President, The Commonwealth Fund
21st Princeton Conference The Changing Health Care Landscape Princeton, NJ May 14, 2014
2 Health Spending as a Function of Gross Domestic Product, 1960 to 2012
Ln(health spending/capita) 10
9 2012
2000 8 1990
7 1980
6
1970
5 1960
4 7.5 8.5 9.5 10.5 Ln(GDP/capita)
Source: Woodward RS, Wang L, “The Oh-So Straight and Narrow Path: Can the Health Care Expenditure Curve Be Bent?” Health Economics, 2011. Updated with data from the OECD and National Health Expenditure Accounts.
David Blumenthal, MD, MPP 1 21st Princeton Conference 2014, SESSION I: Forces Driving Innova on in the Delivery System
Excess Health Spending Growth in the US and Other 3 Industrialized Countries "Excess" = %∆ Health Spending ― %∆ GDP
10.0%
8.0%
6.0%
United States 4.0% OECD Median*
2.0% Median of Countries with 2012 Data**
0.0% 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
-2.0%
-4.0%
Source: 2013 OECD Health Data. US health spending data are from National Health Expenditure Accounts, adjusted to meet OECD definitions. Note: Periods when the US economy was in recession are shaded. * The OECD median includes only the 23 OECD countries with 25+ years of data between 1980 to 2012. ** In 2012, data was only available for 12 OECD countries, including the US.
4 Healthcare Associated Infections Declining
Standardized Infection Rate [2008 set to 1.0]
1 20% drop
0.8 44% drop
0.6 2008
0.4 2012
0.2
0 Central Line-associated Surgical-site Infections for 10 Bloodstream Infections Common Procedures
Source: “National and State Healthcare Associated Infections: Progress Report,” Centers for Disease Control and Prevention, March 2014.
David Blumenthal, MD, MPP 2 21st Princeton Conference 2014, SESSION I: Forces Driving Innova on in the Delivery System
5 Diabetes-Related Complications Declining
Source: US Centers for Disease Control and Prevention, April 2014.
6 ACO Distribution to Date, by Hospital Referral Region
Total of 601 accountable care entities in the U.S. • 366 Medicare ACOs • 235 Non-Medicare ACOs
Note: Data for Medicare ACOs as of January 2014; data for non-Medicare ACOs and in map as of July 2013. Source: Petersen M, Muhlestein D, Gardner P, “Growth and Dispersion of Accountable Care Organizations: August 2013 Update,” Leavitt Partners; Centers for Medicare and Medicaid Services.
David Blumenthal, MD, MPP 3 21st Princeton Conference 2014, SESSION I: Forces Driving Innova on in the Delivery System
7 U.S. Physicians’ Practice Size and Ownership, 1983-2012
Percentage of physicians Has ownership stake in practice 80% In solo practice In hospital-owned practice/hospital employee 76% 72% 60% 61% 61% 58% 53% 40% 41% 29% 29% 20% 23% 25% 16% 18%
0% 1983 1988 1994 2001 2008 2012
Source: Kane CK, Emmons DW, “New Data On Physician Practice Arrangements: Private Practice Remains Strong Despite Shifts Toward Hospital Employment,” American Medical Association, May 2013. Data from 2008 may undercount physicians in practices that are fully or partly owned by hospitals.
8 EHR Adoption Among Hospitals, 2008-12
50% 44.0% At Least Basic 45% EHR 40% 35% 30% 26.6% Basic EHR 25% 27.3% 20% 15.1% Comprehensive 15% 11.9% EHR 18.0% 16.7% 10% 8.8% 11.5% 5% 7.2% 9.2% 8.7% 0% 1.5% 2.7% 3.6% 2008 2009 2010 2011 2012
Source: DesRoches CM, et al. Adoption Of Electronic Health Records Grows Rapidly, But Fewer Than Half Of US Hospitals Had At Least A Basic System In 2012. Health Affairs, July 2013.
David Blumenthal, MD, MPP 4 21st Princeton Conference 2014, SESSION I: Forces Driving Innova on in the Delivery System
9 When it Comes to Health Care, There are Two Americas
Source: D. Blumenthal, Two Americas, (New York: The Commonwealth Fund, August 2013).
David Blumenthal, MD, MPP 5