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You get what you pay for: A global look at balancing demand, quality, and efficiency in healthcare payment reform
As the pressure to control health spending increases, payers, governments, and providers are compelled to scrutinize the quality and amount of care they'll be able to deliver in the future. Health leaders around the world see the health payment system as one of the best tools in managing this challenge and achieving sustainability. However, with less than 40% of those same leaders ranking their existing payment system as good, every country has room to improve and can benefit from shared best practices. See
You get what you pay for: A global look at balancing demand, quality, and efficiency in healthcare payment reform.
Behind the numbers: Medical cost trends for 2009
From one year to the next, healthcare costs for employers and their workers always go up. Yet, for the past five years there's been some positive news. The growth rate has been dropping. However, that trend will level off in 2009, according to employers and health plans. The new Health Research Institute (HRI) report, "Behind the numbers: Medical cost trends for 2009", addresses the cyclical nature of the healthcare industry and provides insights into the conflicting factors that are contributing to both cost increases and savings. See
Behind the numbers: Medical cost trends for 2009.
PricewaterhouseCoopers answers five top questions on Form 990
While the debate continues to evolve regarding the lengths hospitals and not for profits must go to justify their tax exempt status — one thing is clear — the deadline looms.
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The price of excess: Identifying waste in healthcare spending
More than half of the $2.2 trillion spent annually on healthcare in the U.S. could be considered wasteful, according to an analysis published by PricewaterhouseCoopers’ Health Research Institute. Defensive medicine, such as redundant, inappropriate or unnecessary tests and procedures, was identified as the biggest area of excess, followed by inefficient healthcare administration and the cost of care necessitated by conditions such as obesity, which can be considered preventable by lifestyle changes.
Straight Talk: Looking at Health System Disaster Preparedness
When — not if — a large-scale disaster hits, Americans expect a carefully orchestrated and sequenced response from hospitals, emergency workers and public health officials. In their greatest time of need, the system may fail them unless disaster preparedness becomes a greater priority. In this StraightTalk roundtable, health industry leaders discuss the steps health executives should take to ensure an effective response to a disaster.
Working towards wellness: The business rationale
Written in collaboration with the World Economic Forum PricewaterhouseCoopers outlines how chronic diseases risk the economic sustainability of an interdependent global economy. Through examples, we demonstrate how effective workplace wellness efforts can lead to solid returns on organizational investments and can be used to attract, retain and motivate employees.
Paying for performance: Incentives and the English health system
Many countries are looking at ways to reform their healthcare payment systems around performance. The English system for paying primary care physicians is the only one in the world that bases a significant portion of physicians’ pay on quality metrics. For that reason, this “pay for performance” (P4P) system is worthy of study, and the PricewaterhouseCoopers Health Research Institute (HRI) report shows what is working well, what needs further refinement and what should be considered when implementing pay for performance methodologies. The learnings from this go far beyond the English system
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Research rewired: Merging care and research information to improve knowledge discoveryToday's ad hoc methods of managing research information are beginning to strain under increasing demands for new drugs, more personalized medicine, better diagnostic tools, and post-market safety monitoring. This report investigates the benefits, barriers, and emerging approaches to creating an integrated information environment that will help to shape scientific diagnostic, drug, and device discovery in the future.
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Top eight health industry issues in 2008
Health organizations face a pivotal year in 2008 as they anticipate the wildcard outcome of the presidential election. Meanwhile, they must prepare for impending changes — pharmaceutical and life sciences companies are adapting to a new safety agenda from the FDA including the agency's expanded authority over post-market drug safety.
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Beyond the sound bite: November 2007 review of presidential candidates' proposals for health reform
Healthcare is one of the top domestic concerns in the upcoming presidential election. The current health care system is not built to last, and the 2008 presidential election is poised to see a significant push for major health reform. The direction it goes depends largely on the next President.
PwC Straight Talk on creating a climate of innovation: Healthcare industry leaders discuss what they're doing to nurture innovation
The United States faces another political season, and, likely, a volatile debate about what can be done to improve the current health system. Everyone agrees that the current path is not sustainable, and is fracturing around access, affordability and quality. Failure is not inevitable; in our global research report, HealthCast 2020: Creating a sustainable health system, PricewaterhouseCoopers’ Health Research Institute identified "Climate of Innovation" as one of the key features needed for sustainability.
Closing the seams: Developing an integrated approach to health system disaster preparedness
A disaster occurs every week in the US, and the numbers are increasing. Yet despite increased federal and state funding since 2001 and lessons learned following 9/11 and natural disasters like large-scale hurricanes and floods, disaster planning in the healthcare arena remains sporadic, disconnected and under-funded. PricewaterhouseCoopers Health Research Institute's (HRI's) "Closing the Seams" analyzes preparedness throughout every key element of our healthcare system, identifies gaps, and highlights emerging solutions and innovative best practices that can be leveraged to make the most of our resources and help those in the emergency response and healthcare communities deliver the best healthcare possible in the face of unknown disasters.
Creating a climate of innovation: the health industry's most challenging paradox
Innovation is one paradox of healthcare - tremendous strides forward within a system that overall doesn't work well. Can innovation transform healthcare? The annoyingly complex answer is that it does and it doesn't. Effective incremental, sector and local innovations are everywhere, but the breakthroughs that would make the entire health system workable remain elusive
What works: Healing the healthcare staffing shortage
The federal government predicts that by 2020, nurse and physician retirements will contribute to a shortage of approximately 24,000 doctors and nearly 1 million nurses. Health industry leaders are faced with the challenge of orchestrating care in an increasingly complex and converging healthcare labor market. Seeking solutions means understanding that while the challenges confronting nurse and physician shortages are very different, their roles and futures are starting to converge.
Behind the numbers: Healthcare cost trends for 2008
The nation's employers can expect a return to single-digit increases in health benefit expenses in the year ahead. Unlike health plan premium forecasts, medical cost trends reflect the underlying numbers for actual medical costs by plan design. They are used by private insurers and employers to compare health plan costs year over year, ultimately to set premium levels and design the benefit packages that will be offered to employees in the fall.
Pharmacy benefit management savings in medicare and the commercial marketplace
The Pharmaceutical Care Management Association (PCMA) retained PwC to estimate the value of pharmacy benefit management as well as the potential impact of enactment of proposed legislation that would restrict pharmacy benefit management (PBM) activities for consumers, private employers, health plans, unions, and state and federal governments> download report.
Collaboration fosters connected health
The system of caring for people.the chronically ill, the elderly or even the fitness buff.is reactive, expensive and cumbersome. But a new paradigm of care, called connected health, promises to reduce costs and improve quality by working with patients proactively.
Super cluster: Ideas, perspectives and updates from the Massachusetts life sciences industry
Massachusetts is a leader in the life sciences on many measures. This report provides economic analysis on provides trends related to employment, wages, and public funding. It also draws on information from the 2007 PwC Massachusetts Life Sciences Cluster Survey, which provides insight on future opportunities and threats from over 100 executives in all sectors of the life sciences in Massachusetts. Woven into the report are the perspectives of key leaders in life sciences in Massachusetts, who focus on the groundbreaking work being performed in the Commonwealth and its global implications.
Tailoring the approach: Employer attitudes and healthcare strategies address distinct issues
Employers are still debating how to stave off future healthcare cost increases and incent employees to take on more responsibility for their health. In describing emerging employer attitudes and healthcare strategies, a tailoring of approaches can be observed, in which distinct issues, such as chronically ill employees, are being addressed through specific tools, incentives and disease management programs. The newest results released by the Health Research Institute of PricewaterhouseCoopers and Management Barometer demonstrate the evolution of employer attitudes on benefit design, consumers and quality.
A sustainable framework for achieving transparency in the health industries
Transparency is having a transformative effect on the health industry. The following report: Seeing is believing: A sustainable framework for achieving transparency in the health industries, looks at transparency from three separate viewpoints: the health industry, government and non-health sectors, such as transportation and financial services. Understanding the power of transparency from these different viewpoints will be important as organizations traverse the future.
TGen: Translational Genomics Research Institute
Translational research generates tremendous benefits. The nexus between basic research and its commercial applications is too often neglected yet it can attract players on both sides, creating a true hub of scientific and business activity.
Top seven health industry trends in '07: A PwC perspective
We all know that our health system is ailing. Health industry leaders widely acknowledge that rising costs and unequal access threaten system sustainability, and they point to fixes such as increased transparency of quality and pricing information and health information technology. Consumers have slightly different thoughts about what's driving the system to the brink of sustainability: greed. Perhaps consumers are angry and frustrated. Perhaps they do not appreciate the complexity of healthcare as a business -- facing issues of administrative paperwork, medical malpractice, and the uninsured, to name a few. PwC's Health Research Institute has identified Top Seven Health Industry Trends in '07: A PwC Perspective for health executives and policymakers in the coming year as they move their organizations forward and tackle problems facing the industry.
The economics of IT and hospital performance
More than 60 percent of hospitals in the U.S. have made significant enough investments in information technology to begin seeing reductions in operating costs, according to a report on the relationship between health IT investment and hospital operating performance. The report, the culmination of two-years of research, provides the most comprehensive evidence that investment in information technology will improve hospital business performance and that IT capital investment can eventually pay for itself in the healthcare environment.
New Federal Leadership on Healthcare Transparency: What Will It Mean for Patients, Payers and Providers
On August 22, 2006, President Bush signed an executive order mandating that four federal agencies that administer or sponsor several of the largest federal healthcare programs compile information about the quality and price of the healthcare services they pay for and communicate that information to their consumers and each other. The executive order builds on previous administration efforts to expand the transparency of pricing in support of consumer-directed healthcare, an innovative approach to controlling healthcare costs by empowering patients as the consumers of healthcare. This PricewaterhouseCoopers report reviews the president’s executive order and its implications for patients, payers and providers.
The Healthcare Quality Equation
Though various health organizations may define and approach quality differently, the common denominator is the patient’s perspective, experience and outcome. Quality issues should be an important part of health system executives’ agenda. Successful quality programs have a number of key ingredients, including decision-reporting tools and business analytics information - which depend on robust information reporting and a system-wide electronic medical record - as well as highly motivated employees and physicians.
Behind the Numbers: 2007 Medical cost trends for employers
Healthcare spending in the U.S. is expected to increase by double digits in the year ahead, according to PricewaterhouseCoopers which released the first reported projections of medical cost trends for 2007.Frequently a source of debate and finger-pointing, increases in health spending have become an irresistible force.
Healthy choices: The changing role of the health insurer
Health insurance is pivotal to healthcare financing. In most parts of the world, governments are looking to enlarge, or at least to encourage, the contribution of private sources of healthcare funding.
My brother's keeper: Growing expectations confront hospitals on community benefits and charity care
PwC interviewed healthcare executives across the country and convened a roundtable of hospital leaders to get behind the headlines of these issues in order to reveal solutions and leading practices around reporting, pricing, and business relationships.
Consumerism in Healthcare: An Initiative of the HFMA Patient Friendly Billing Project
PricewaterhouseCoopers provided the research for this report, published in July 2006. It is is designed to help all of the stakeholders understand the goals, roles, and responsibilities inherent with consumerism, with an emphasis on the effect on revenue cycle activities of providers. The report lays out the strategies that must be considered, adapted, and implemented for the healthcare industry to take advantage of the opportunities and challenges consumerism offers.
Louisiana Recovery Authority Endorses PwC Healthcare Report
The Louisiana Recovery Authority Board of Directors endorsed a sweeping health care report on June 15 as a blueprint for health care reform in Louisiana. It urged health care reform leaders to use the reportīs findings in effectively rebuilding and redesigning the vast health care systems crippled by last yearīs hurricanes and created a subcommittee of board members to help guide the progress. The report, by PricewaterhouseCoopers LLP, was sponsored with private funds by the LRA Support Foundation, on behalf of the LRA. It includes recommendations addressing both the immediate and long-term recovery of the health care systems in the hurricane-affected areas, as well as the redesign of health care systems in all regions of Louisiana.
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Rebuilding Healthcare In Louisiana - A Blueprint for the Nation
Rebuilding Healthcare In Louisiana - A Blueprint for the Nation
Executives from Franciscan Missionaries Of Our Lady Health System, Baton Rouge, and Ochsner Health System, New Orleans, discuss the present and future state of healthcare in Louisiana and how they have struggled to cope with day-to-day challenges while also preparing for the future.
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Louisiana Recovery Authority Endorses PwC Healthcare Report.
Factors Fueling Rising Healthcare Costs 2006
The Factors Fueling Rising Healthcare Costs 2006 examines the causes of rising health care costs and analyzes how health insurance premium dollars are being spent. Health insurance premiums are growing at a reduced rate, despite increased utilization and higher costs, while health insurance plans' efforts are easing drug cost increases.
The study which was prepared by PricewaterhouseCoopers (PwC) on behalf of America's Health Insurance Plans (AHIP), " found that premiums increased 8.8 percent between 2004 and 2005, which is 36 percent lower than the 13.7 percent increase a similar report found in 2002.
Higher utilization of services accounted for 43% of the increase, fueled by factors such as increased consumer demand, new and more intensive medical treatments and defensive medicine, as well as aging and unhealthy lifestyles. Price increases in excess of inflation accounted for 30% of the increase and were impacted by movement among purchasers to broader-access health plans, provider consolidation, increased costs of labor and higher priced technologies.
The report found that 86 cents out of every premium dollar go directly towards paying for medical services. Embedded within the 86 cents are the costs of medical liability and defensive medicine, which are estimated to be ten cents of the premium dollar. The report also breaks down the extent to which each major utilization service is being affected by medical liability and defensive medicine.
HealthCast 2020: Creating a Sustainable Future
In this groundbreaking report, HealthCast 2020, PricewaterhouseCoopers looks at solutions and responses from around the world to the globalization and industrywide convergence of healthcare. What insights, best practices and policy lessons can be learned from experiences in various countries to create a globally sustainable health system? Who, or what, is driving the solutions?
The Trends and Benefits of Providing Healthcare Quality Data
In this latest HealthBrief, PwC discusses the results of a recent survey of top executives at large U.S.-based multinational companies. The focus of the HealthBrief is on healthcare quality data that firms provide to their employees as a way to influence the utilization of healthcare through better education of their employees on cost and quality issues and improvement of their own health behaviors.
Employers Embrace Consumerism to Control Healthcare Costs: New PwC White Paper
With double digit health insurance cost increases affecting the business bottom line, employers are turning to consumerism and consumer directed healthcare to provide a solution. HRI's latest research gets behind this trend to find out how employers are coping with rising healthcare costs and the promise that consumerism may bring.
Recapturing the vision: Integrity driven performance in the pharmaceutical industry
Pharmaceutical companies face increasingly regulatory scrutiny and highly critical media coverage of the industry's R&D, marketing and manufacturing practices. This report explores the reputation issues and compliance challenges facing the industry.
Acts of Charity: Charity Care Strategies for Hospitals in a Changing Landscape
Hospital charity care provides millions of the uninsured with free care but courts, government regulators, and community leaders are now questioning the value that society derives from this community benefit. This comprehensive report by PwC's Health Research Institute examines the developing charity care issue, discusses key findings and recommendations and provides strategies for succeeding in this evolving environment.
State Estimates of the Medicare Prescription Drug Benefit on Catastrophic Spending
Under the new Medicare prescription drug benefit the risk of catastrophic out-of-pocket expenses in all 50 states and the District of Columbia is reduced. The details and a state-by-state analyses were prepared by PricewaterhouseCoopers for Medicare Today, a partnership of more than 200 organizations committed to informing consumers about the new drug coverage.
The Digital Hospital: Opportunities and Challenges
Organizations building a new hospital have a one-time opportunity to completely rethink how care is delivered and dramatically enhance quality while concurrently reducing costs. Emerging technologies present the opportunity to automate the entire clinical continuum.
The Road To A Digital Healthcare Community
Straight Talk: New approaches in Healthcare
Personalized Medicine: The Emerging Pharmacogenomics Revolution
The latest report from PricewaterhouseCoopers' Global Technology Centre and Health Research Institute provides insights into the challenges and opportunities afforded by pharmacogenomics.
Personalized Medicine The Emerging Pharmacogenomics Revolution
Each revolutionary change in human medicine, from antibiotics to painkillers to vaccines, has moved the practice of healthcare toward improved patient treatment. Pharmacogenomics, the next fundamental development in this area, promises to usher in an era of individualized patient care or personalized medicine.
Pharmacogenomics uses markers in individuals' genetic code to pinpoint the underlying causes of disease. The science is enabling researchers to better identify drug targets and the mechanisms of action of investigational new drug candidates. Genomics-related technology facilitates the elimination of unfavorable products at earlier stages of development than is currently possible. It also could guide companies
in designing clinical trials that would more definitively prove drug efficacy, in turn decreasing the time, costs, and risks of drug development. In the clinical setting, pharmacogenomics will help physicians better define long-term health risks patients face, more precisely diagnose the stage of patients' diseases, and more accurately predict their responsiveness to specific drugs or the likelihood for adverse events.
Year in Review : Straight Talk Roundtables
Together, these Modern Healthcare roundtables provide a blueprint of the issues involved in improving performance both through process redesign and the identification and capture of lost revenues.
President Bush's Second Term: Prescribing Private Solutions for the Nation's Healthcare Problems
PwC's Health Research Institute (HRI) developed a comprehensive 360 degree view of President Bush's health plan, the challenges and opportunities for industry, and an analysis on the likelihood of implementation.
How are hospitals financing the future (vol. 6): Where the industry will go from here
It has become clear that a capital gap exists between U.S. hospitals that have capital to invest strategically and those that no longer produce operating margins sufficient to support their capital needs. Without access to capital, these "have-not" hospitals are falling behind in the market and may never be able to improve their financial performance. This report culminates our Financing the Future research by exploring where the industry will go from here.
How are hospitals financing the future (vol. 5): Core competencies in capital planning
Financing the Future has focused on the numbers behind capital access and planning. It's shown the tremendous need for capital, particularly in some geographic areas, and it's shown the ways to fund capital projects. It's demonstrated the lack of capital funding in recent years and the anxiety about future capital access. Building on that research, this fifth Financing the Future report will focus on the how-to of capital planning and access. Capital planning and access is a complex process involving a number of intertwined and ongoing activities.
How are hospitals financing the future (vol. 4): The future of capital access
Hospitals will have an insatiable need for capital in the decade ahead. The 1990s were times of underinvestment in plants as hospitals adjusted to managed care’s hand in cutting inpatient stays and shifting treatment to outpatient settings. The current decade is already distinguished by rising investments in hospital plants, technology, and equipment.
Thoughts for Payors and Providers on Denial Management
There are many protocols that must be developed and agreed to by providers and payors in order improve timely filing and management of denials.
How are hospitals financing the future (vol. 3): The future of capital spending
The future need for capital is largely influenced by projected demand for services and past capital investments. Simply put, sharply growing demand and lack of past capital investment are a recipe for high capital spending in the future. This section assesses how our nation's hospitals will be affected by the key factors influencing capital need:
- Condition of infrastructure
- Future population growth rate
- Future health status
- Physician demand growth rate
- Historical capital spending
A look at each of these factors, and how each is likely to change over the next five years, reveals that hospitals' capital needs are likely to increase dramatically, with certain regions most commonly affected by certain factors.
How are hospitals financing the future (vol. 2): Capital spending in healthcare today
Findings from this second Financing the Future report suggest that the gap between the "have" and "have not" hospitals, when it comes to capital spending, is significant. Hospitals with a successful strategic capital planning process and an attractive enough balance sheet to make significant capital spending possible apparently are at least investing enough to keep ahead of depreciation. However, hospitals with a more challenging financial situation are not keeping up with the need to invest in the future. This report answers key questions about the level and effect of capital spending.
Implications of the Medicare Modernization Act: Pharmaceutical
New white papers from PricewaterhouseCoopers explain the implications and opportunities of the new Medicare reform law for each of the largest sectors of the healthcare industry.
Impact of the Medicare Prescription Drug Benefit
Three new reports from PricewaterhouseCoopers show how the new drug benefit will affect low-income seniors and catastrophic spending by all seniors.
How are hospitals financing the future (vol. 1): Access to capital in healthcare today
This report, the first in a series of six, focuses on access to capital: what are the sources, who has access, how do you get access, and steps for the future. Included are such helpful tools as a matrix of various capital sources and their uses, an explanation of a bond deal, and financial and other criteria for capital access. The report also features new research findings that illuminate the challenge of accessing capital in a period of intense financial pressure, as well as factors within hospital leaders' control to make their organizations more attractive to capital sources.
Trends in IT Spending Among Hospitals
This year's Modern Healthcare/PricewaterhouseCoopers IT Survey included responses from 394 hospital CEOs and CFOs revealing how IT spending patterns are changing.
HealthCast Tactics: A Blueprint for the Future
This report suggests tactics for the healthcare industry to employ over the next three to five years. According to HealthCast Tactics, there are significant gaps between what healthcare executives, policy makers and employers rate as important and what is being implemented performance-based reimbursement, privacy, and clinical excellence. The report draws on a survey of more than 650 top executives of hospital systems, payors, governments, medical supply vendors, physician groups and employers.
HealthCast 2010: Smaller World, Bigger Expectations
Our survey group included a mix of policy makers, health system executives, employers, physicians, insurers and medical supply vendors. In addition, PwC practice leaders interviewed more than 50 thought leaders from seven countries at length about future trends and their implications for the industry's stakeholders.
Implications of the Medicare Modernization Act: Providers
New white papers from PricewaterhouseCoopers explain the implications and opportunities of the new Medicare reform law for each of the largest sectors of the healthcare industry.
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