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Healthcare 101 & HLS Symposium Preparation. September 15,2013. Why Healthcare?. H ealthcare spending is exploding. U.S. Healthcare Spending. National Health Expenditures (Billions USD). National Health Expenditures as % of GDP.
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Healthcare 101 & HLS Symposium Preparation September 15,2013
Healthcare spending is exploding U.S. Healthcare Spending National Health Expenditures (Billions USD) National Health Expenditures as % of GDP Source: http://www.cms.hhs.gov/NationalHealthExpendData/downloads/proj2005.pdf
Retail: Who buys? Who pays? Who chooses? Pretty simple to follow the money Amazon.com Consumer Places Order using Visa Ships Order Pay $ Pay $ Bill Cardholder Check card; bill Credit Card (Bank)
Healthcare: Who buys? Who pays? Who chooses? Provider(Physician, Hospital, or Pharmacy) Wholesaler/distributors Producer(Pharma/Device) Pay $ (AWP) Pay $ (WP) Ship Product Ship Product Payor(Gov’t, private insurance) Files “Claim” Pays $ (Reimbursement) Product or Service “Co-Pays” IT’S COMPLICATED Payment (“Premium”) Consumer (Patient)
Healthcare Landscape • Regulatory Uncertainty Industry
Pharma/Biotech Leading Corporations • Industry lives and dies by patents; patent life is 20 years from filing • “+10 years and +$1 billion dollars to bring a drug to market”
There are Many Types of Providers Health Systems/Hospitals/ACOs Outpatient Clinics Home Health Agencies Physician Offices Rehabilitation Centers Pharmacies Hospices Nursing Homes
Hospitals in the US Source: IBISWorld Industry Report “Hospitals in the US,” July 2013
Payors: The private market follows the public trends Source: IBISWorld Industry Report “Health & Medical Insurance in the US,” July 2013
Regulatory: ACA increases insurance coverage • Roughly 32 million Americans will gain coverage starting in 2014 • Medicaid expansion (~ 16 million) • Citizens with family incomes < 138% of the FPL will be eligible • Newly eligible will mainly be childless adults • Private coverage through Insurance Exchanges (~ 16 million) • Citizens with incomes between 100% and 400% of the FPL will be eligible for premium tax credits • Young adults can remain on their parents plan until age 26 • Has increased coverage by 2 million already
ACA also aims to reduce the growth in spending • Some use policy levers unique to the Federal government • Reductions in Medicare payments to private health plans • Reductions in the growth of Medicare reimbursement rates • Reform of the tax treatment of employer-sponsored insurance • Many build on private sector initiatives already underway • Integrated, accountable care • Bundled payments • Increased use of electronic health records • It is too early to judge ACA, but private sector developments may already be having an impact
Healthcare Recruiting at Ross Pharma / Biotech Medical Device Payer / Provider / Retail Consulting And many others….
HLS Symposium – BE PREPARED, BE PROFESSIONAL • Formal business attire (bring your name tags!) • Be on time • Come prepared with some questions • Know a little bit about the companies you’re interested in • Be nice, humble, and polite to recruiters and other students • Stay for the entire event • HAVE FUN!!