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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.
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.
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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Keeping score: A comparison of pay-for-performance programs among health plans
In order for providers to improve quality and make sustainable changes in the delivery of care, they must have specific incentives to do so. Pay-for-performance programs are an important tool to link financial payment with quality improvement. If P4P is to succeed in significantly moving the needle on quality, we ultimately need an all-payer approach, wherein providers face the same metrics and incentives for all their patients, regardless of their insurance coverage.
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.
Tailoring the approach: Employer attitudes and healthcare strategies address distinct issues
Employers must increasingly customize their approaches to providing health benefits to the unique health needs and behaviors of their workforce. Fortunately, a growing number of tools are available to activate employees. Tailoring the right approach may be challenging but not impossible. The results released by PwC's Health Research Institute (HRI) 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.
The quality conundrum: Practical approaches for enhancing patient care
More than a year in development, "The Quality Conundrum" is a compilation of essays by PwC subject matter experts, discussions with selected clients and insights from our interviews with health industry leaders in the United States and around the world. It explores the barriers that have made healthcare quality improvements difficult to achieve, and outlines a clear path to progress. It includes a discussion of quality from the patient's perspective, in the journey across the health care system.
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.
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.
Louisiana Recovery Authority endorses PricewaterhouseCoopers (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.
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.
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?
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.
Improving patient flow dramatically decreases wait in emergency and inpatient admitting
Recognizing that backups in the emergency department are a result of broken processes throughout the hospital, Provena Saint Joseph Medical Center in Joliet, Ill. redesigned workflow in many areas. In May, the 517-bed hospital eliminated the emergency department's waiting room and triage procedures and dramatically reduced the time that patients wait before being transferred to an inpatient bed.
In this installment of Modern Healthcare's Straight Talk, we look at the patient throughput initiative at Saint Joseph -- one of six hospitals owned by Provena Health in Mokena, Ill. The session on patient throughput was held on August 4, 2005 at Modern Healthcare's Chicago headquarters. Fawn Lopez, publisher of Modern Healthcare, was the moderator. PricewaterhouseCoopers presents Straight Talk.
Pay-for-performance
Commercial and government payers are taking parallel paths, some of which intersect, in developing metrics and reward systems. The lack of consensus, however, is creating confusion.
The best starting point for performance improvement: A healthy bottom line
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.
Outsourcing in the business office increases cash
Straight Talk: New approaches in Healthcare
Identifying savings from pharmacy management
A new study from PricewaterhouseCoopers finds that pharmacy management techniques are expected to save $1.3 trillion in drug cost over the coming decade.
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.
Physician practice turnaround in an integrated delivery system
Straight Talk: New approaches in Healthcare
An Employer's guide to consumer-directed health benefits
This comprehensive report explores the legal, regulatory, financial and actuarial issues that employers must consider when empowering their employees to make more decisions about their healthcare and healthcare benefits. The report comes from the Wye River Group, an informal policy consortium that includes PricewaterhouseCoopers.Download an Employer's Guide to Consumer-Directed Health Benefits (3020K).
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.
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