1. Great Plains Regional Medical Center Logo Refresh Exploration February 8, 2013 2013 NEBRASKA POLICY & ISSUES SUMMIT New Norms and Innovation in Health Care Delivery November 18, 2013 Gary A. Perkins, FACHE

2. Things Are Changing ACO’s Narrow networks are forming Exchange products are in place (public) Private Exchanges developing Fee-for-service volumes are declining Reimbursement/payment continue to decline Non-traditional providers The value proposition

3. Issues for Nebraska Access – Physicians limiting Medicare/Medicaid business – Narrow networks – Critical but unprofitable Continuing high quality – Recruiting best physicians, providers and staff – Less capital for replacement and new technology Implication: philanthropy Workforce – Aging/recruitment

4. Cautious Optimism Exchanges bring consumerism – Challenge for consumer: Poor information – Challenge for providers: High deductibles = higher charity care and bad debt Patient-centered medical homes Population health management IT systems are almost ready for prime time Providers working together with similar incentives Are consumers ready to change?

5. What Hospitals/Providers are Doing “The Value Proposition” – Accepting Risk – PCMH-Physicians and other Providers Developing IT Systems (EMR) – Care Coordination – Population Health Management – Quality-Evidence Based Care

6. What Hospitals/Providers are Doing New Tools to Drive Efficiency/Cost – Lean – Six Sigma “The Triple Aim” – Better Care – Better Health – Lower Cost