J.D. Kleinke

Like it or not, health reform is now. Or is it? What does the actual plan look like—and what does it mean for your organization? Recent election results have put health reform legislation into a state of suspended animation, and forced all organizations to re-think how they should or should not ready themselves for major systemic changes that may or may not come. This is precisely what happened in the 1990s under the promise of broadbrush change from managed care—much of which never came to pass. Many of the strategic responses for healthcare organizations today should follow the same path that Klenke recommended in his first book, Bleeding Edge, back in 1998: hedge your bets; understand the basics of the reform plan and be prepared to adapt to those most likely to be implemented but do not re-architect your organization around them; prepare for real change that the market (rather than the government) is demanding; stick to your competitive advantages as an organization; and, most importantly, do not overreact to predictions of revolutionary change—because the American electorate has proven over two short election cycles that it does not want nor trust a radical reforming of the healthcare system. It simply wants the healthcare system to work better, and that goes for every individual healthcare organization.

This session examines the concurrent effects of government reform, increasing patient economic empowerment, and emerging patient information technologies on today's healthcare 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 healthcare system confronting the greatest changes in its bizarre, hundred-year history.

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 copayments 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 - a decline which will accelerate to full collapse with the next downturn in the health insurance underwriting cycle.

How will those patients 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 key moments in the healthcare system’s history and policy for clues as to what the future will hold for all of us, not just as patients, but as real healthcare consumers.

A new generation of health information technology is emerging – and this one may finally be ready for primetime thanks to $17.2 billion in stimulus funding! Beyond the government's sudden willingness to fund the computerization of healthcare, there has been explosive growth in e-prescribing and other electronic medical tools. As a new generation of providers comes online - and as online patient communities emerge - patients are increasingly able share exquisite details about their medical conditions and experiences.

To attract and retain the most lucrative (i.e., well-off, well-insured and webenabled) 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 are emerging in parallel with these technologies, all while 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 healthcare, and the "liquification" of patient data from paper charts and institutional silos will have far-reaching strategic consequences for every organization in healthcare.

Managed care has been like chemotherapy for a sick healthcare system – harsh medicine for the 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 shook up our entire medical financing and delivery system. But, like many chemotherapies, did the cure prove worse than the disease? Or are certain aspects of healthcare's cost and quality problems simply incurable? How can provider organizations cope with a system that, as payers attempt to re-engineer it around reimbursement, seems to yield only more chaos? This presentation provides a broad and often humorous overview of business and leadership strategies providers are using to position themselves to survive and thrive in a world of intense financial and organizational pressure.

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 healthcare 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 healthcare 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.

It finally happened. Decades of a hybrid private market and government healthcare system have resulted in one of the most costly and least efficient systems in the world. Combined with a renewed belief that government may be able to fix what deregulated markets cannot, and serious health reform has been signed into federal law. What does the plan look like? Will it work? What does it mean for you and your family? And how will broader market forces toward ever more patient cost-sharing enhance, hamper or complicate the reform plan? Everything we think we know about how our healthcare system will look in the very near future is completely speculative. And that is before factoring in the wave of new medical information, data access and patient communities coming online and into their prime right now. This session examines the combined effects of government reform, increasing patient power (and financial responsibility) and emerging information technologies on you and your family.

In his new book, Catching Babies, J.D. Kleinke uses a new literary form – fiction – to analyze and discuss the medical culture and politics of childbirth. In this talk, he takes a hard look behind the medical curtain into the practice, politics, and often-bizarre culture of American teaching hospitals, while also exploring the broader social and emotional landscape surrounding obstetric medicine and women's health.