Video The Future of Prophylactic Mastectomies Under the ACA Play Pause Previous Next 1 of 200 slides Volume Quality 720P 540P 270P Fullscreen Captions Transcript Chapters Slides The Future of Prophylactic Mastectomies Under the ACA Overview [MUSIC PLAYING] DAVID SONG: So people always, at least in the plastic surgery circles, are not necessarily enthusiastic about hearing me speak because I often seem to be the bearer of bad news. And this is not all bad news, so please don't choke on your food. But here's recent stuff that's happening. I mean, hospitals are being squeezed as revenue growth slows to an all-time low. This is just a few weeks ago in Modern Healthcare. Nonprofits see their 2013 revenue-- because most hospital systems are on a July to July fiscal year, so that fiscal year just closed. And they're seeing the lowest revenue since the recession. And that's in the New York Times. Similarly in the Wall Street Journal, right around the same time-- and it's not a coincidence because this is where all the books are closed and the finance reports are shown in the 990s. And you can see the non-hospitals earnings fall as costs outrun revenue. I want to highlight that title-- as costs outrun revenue, "Prime Health Care Services Sues California Union Under Racketeering Statute" because of all these ways of developing revenue and controlling costs. And I can go into that in a little bit. And then a lot of these things are happening across the country. And probably in a home or hospital near you, there's lots of layoffs. So what does this really mean to us? This is just in the Chicago land area. Just as a show of hands, who is not in the Chicago land area, raise your hand. Who's not from the Chicago land area? So we've got a good maybe a quarter of the people. But let me tell you about what's happening in the Chicago land area. In 2011, Central DuPage Hospital in Delnor merged to create Cadence Health. At that same time, Provena and Resurrection merged to create Presence Health. Sherman Health Partners were acquired by Advocate in 2012. Edward hospital and Elmhurst in 2013 joined forces. And as many of you know, in 2014, Northwestern and Cadence merged and will probably become Northwestern. Basically it's a merger, but really an acquisition. And then just today, Advocate and NorthShore have merged. So why is this happening? This is happening on a massive scale. Not just in Chicago but across the country, you're seeing billion dollar corporate health care delivery systems merging with other good billion dollar health care corporate mergings because of the fact that revenues are decreasing and costs are having to be controlled. And the only way to make a margin is to gain scale. So this equals BMRP. Does anyone know what BMRP stands for? Anyone? No. This is a business school acronym for Buy, Merge and then Raise Prices. So this is what happens when big corporations get together. They buy, merge. And then they gain scale. They lay off a whole bunch of people, and then they raise their prices. And that's how corporate America has grown to this day and age. And then when they get really sophisticated, they buy a merger company offshore so that the tax basis stays away from the United States government. So this is what's happening in health care. We're no different. And I'm going to talk about how that affects the future of prophylactic mastectomies and all the great things that we talked about this morning. I'm not going to talk about what are the indications, the controversies related to patient decision making, because that's already been discussed. We can touch upon that. But I will talk about who pays for it and who's going to pay for it. These are my disclosures. And I want to make it very clear that these views are mine only and does not reflect that of the dean of University Chicago Medicine, our hospital president, our chair and so forth. These are my personal views. So I want to make that very clear. So I'm going to cover the current state of confusion and then what's happening in the coverage model, talk about price transparency, and the age of price transparency. Many of you who have heard me talk before, really I'm going to bang the gong again about cost control leading to better outcomes, and then really talk about disease-focused service lines. So the way medicine is going to be organized is changing as we speak. I'm part of early discussions on how that's going to be, what the governance is going to look like, how the funds flow are going to take place, and what it means for not just the providers, but also the patients. So where are we right now? Once again, this is not about who the right patient population is. This is just about the costs and who pays for CPM, which is contralateral prophylactic mastectomy. This is recently in the Annals of Surgical Oncology that CPM is a cost-saving measure for prevention of contralateral breast cancer in women younger than 50 with sporadic unilateral early stage cancer-- once again, just talking about costs here. CPM is also cost-effective over surveillance in patients less than 70. And that's in the Journal of Clinical Oncology. The most effective strategies for BRCA mutation carriers with and without quality adjustment were oophorectomy alone-- that was the most cost effective-- and oophorectomy plus mastectomy prospectively. This was a Markov model with Monte Carlo simulation. And that was in a 2006 article in the Annals of Internal Medicine with a large patient population basis. And then Esserman, it's interesting that she did this study. And note the date. It was in 2000 when she pooled third party payers across the country. She found that only 30% of payers had a policy for prophylactic mastectomy back in 2000. I'm going to show you some recent data that we dug up. Before, I forgot to list that I'm also, as a conflict of interest, I'm also on the medical advisory board for Cigna Health Care here in the Midwest. So then Monica Morrow did a discussion to Esserman's paper saying that a careful process that documents the level of risk and the patient's rationale for undergoing the procedure will help facilitate more appropriate insurance coverage. And we're going to really talk about that and hone in on that. And then once again, I'd like to make this into a robust discussion without anyone choking. So let me go to this. Here's a Cigna website. And if you go to Prophylactic Mastectomy, it's right here. And I'm not going to read this to you, but there are now coverage policies for CPM and PM. If you go to-- where are we here? If you go to Aetna, very similar. And I'm happy to provide this for you. These are the major carriers at least within the Chicago land area. These are the distinct policies for what's covered and what's not under this whole umbrella of prophylactic mastectomy oophorectomy. And then if you go to Blue Cross Blue Shield, well, they make it a little bit more confusing because you have to agree to something here. Click. Let's agree to this. And then you type in prophylactic mastectomy-- oops. And you go here. Here's PM. And here we go. Now interestingly in the fine print of all these major carriers, it says, pre-approval does not necessarily guarantee payment. So I want to make that very clear. Hold onto that thought and remember this slide because I'm going to come back to it. By the way, Eve, who's somewhere here hopefully, has really helped to get this data for me. So everyone knows about ObamaCare and about-- and I don't want this to be a political discussion. I want this to be as apolitical as possible. I'm here just to report the facts. Don't shoot me. Don't throw rotten food at me. Don't throw salad dressing at me, please. So I'm going to show both the good and the bad, OK? And this is my favorite slide. For those of you who can't see that, this is a caricature of a president of the United States saying, how can I put an end to all this confusion over my health care plan? And his secretary of human development or his secretary of health says, we can start by explaining it to you. And so it is very confusing. And right now, what happens is today in this day and age, we do more. We get paid more. The institution-- the University of Washington in Dr. Neligan's case, University of Chicago in my case, Cancer Treatment Center of America in Aaron's case-- gets the bulk of the remuneration for patient care in this fee for service model. And then there's pro fees. So what's happening now is the risk, as we all know-- and I've shown this slide multiple times. I showed this slide back when the Affordable Care Act, before it passed, and people-- I mean, I literally gave this talk at one of our major association meetings, and I could hear a pin drop. And there were no questions, and everyone's head was down like this. And I thought I had just shot my career amongst my peers. But I have to remind everyone, don't shoot the messenger. This is just facts that I'm reporting. So the risk is being shifted towards providers, the OTPT, the nurses, and most poignantly, the physicians in the room. So what does that mean? I've shown various iterations of this, but I found this to be intriguing and captures the point brilliantly. We were-- I used to say we are. We were over here where we practiced in this fee for service model. The more we do, the more we get paid. The more the hospital does, the more we get paid. And that is why, just for a moment, think about why contralateral prophylactic mastectomies and prophylactic mastectomies, the pendulum is so high. Because if you gave me a credit card and said, oh, go shopping at Whole Foods, well, I'm not really going to pay attention to the price. I'm going to start buying all the organic stuff and buying lots of it. Similarly with health care and elective procedures, when you're not paying for it, well, guess what happens? And by the way, your doctor is getting paid more for doing it, guess what happens? There's more contralateral prophylactic mastectomies. There's more prophylactic mastectomies. And I think couple that with Angelina Jolie factor and so forth and this whole move the world pink factor, you're starting to see an alignment of goals as to why I think we have enabled-- the society, the government, the payers, the doctors have enabled a greater ease of access and utilization for prophylactic mastectomy. So we're over here. Rather, we were over here. And we will be over here. I use this analogy as we're probably somewhere around here where we're going to be measured on value-based health care. We're going to be measured and paid on how our population does and a premium placed on quality, an incentive to decrease multiple episodes of care. And government payers will take a prominent role in doing so and has done so. So back to two or three slides ago when I showed you all these mergers, this is happening because the only way health systems can survive is to absorb and gain economies of scale for all their costing measures and also the revenue side. So this started to happen right after the passage of the Affordable Care Act. And you're going to start to see the velocity of mergers and acquisitions go up over time. I said this about three years ago. No one really sort of paid attention to it. But I showed you the data from 2011, 2012, 2013, and then most recently today, where the largest health care system will be Advocate/NorthShore. And they're doing that because bundled payments are right around the corner. I'm part of a committee that's looking at how we bundle care. So for those of you that don't know-- who has not heard of bundled payments, raise your hand. OK. So I'm going to explain it to you. Right now, when a patient comes to the University of Chicago or the University of Washington, he or she navigates through the myriad of touch points. And the payer gets-- Blue Cross Blue Shield, Cigna, Aetna, United, you take your pick-- gets paid on a episodic moment. So you access the plastic surgeon, well, we submit a bill. HCFA form goes in. And we get reimbursed. And depending on what your copay is, you're going to be asked to pay a copay. In the future, the very near future, this is sort of the distilled form of where bundled payments are going-- is that for PMPM, Per Member Per Month, payments are going to be accrued by third party payers. And they're going to come back to the providers within the conglomerate of this major health care system and say, OK, we have a PMPM member. She has a BRCG mutation, and we're going to give you x amount of money for that PMPM. So what that means is the University of Chicago will get a fixed amount of money before the encounter or during the encounter of patient-- Ms. Jones, let's say. And that's all we get. So that's where the dean, and the department chairs, and people like me have to decide how we allocate that pie, that fixed pie that we get, for the entire spectrum of care. What I mean by that is there's the geneticist, the psychoanalyst, the pyscho-oncologist, the oncologist, the radiologist, the patient care coordinator, the surgeon, the surgical suites, the whole nine yards, the pharmacy-- everything gets paid. You get big one lump sum. It's kind of like giving your child an allowance at the beginning of the month and say, Olivia-- that's my daughter-- that's all you get. You got to plan out for the rest of-- in fact, it's beyond that. It's like giving my three daughters an allowance, a fixed amount of money, at the beginning of month, and saying, that's it. You guys are on your own. And if you run out of that money after day two, well, tough. You're not going to be able to get anything, right? So that's where bundled payments are going, and I want you to hold onto that concept as we move along. This is just showing that all payers are now more interested in narrow networks. Cigna-- and I'm not revealing anything that is proprietary here. But this is all public information. All the major third party carriers are talking about narrow, narrow networks. As a point of reference, if you're not part of a network, you just won't get paid. So in Houston-- and this was in the Wall Street Journal-- places like MD Anderson are in a scramble mode because their cost structure is so high that 13 out of the 15 payers in the region are not including MD Anderson in their network. And so it's a big problem for where MD Anderson is going for their very near future. And I'm not just saying that because we hired someone from MD Anderson. That's just a-- [LAUGHTER] So what does price transparency mean? Right now, there's confusion. If you can't see that, it's an elderly woman pushing a walker. And it says, big sale. Your new hip, right now only 45,000. And this is just a wheel spinning this. And this is a cartoon, but this is reality as we speak. So this is an actual study. If you can't see it, on the low end, it's California study at appendix removal. So all in, what does it cost to get your appendix removed in the different hospitals in California? Well, the low range was $15,000. And the high range was $183,955. That's like if you went to Nordstrom and said-- like, let's say all of us went to Nordstrom. And I bought that same shirt for $15, and they charged Lori Ovitz $152. And they charged Peter Neligan $3,000. They should charge Peter Neligan $3,000-- but for the same exact shirt. It's absurd. The reason why that happens is because health care systems can do that. There's an obfuscation and a complete veil of how prices are adjudicated and sent to third party payers. And University of Chicago's different. Our chargemaster is different from Northwestern, which is different from Silver Cross, which is different from Cancer Treatment Centers of America. It's completely arbitrary based on the coverage of fixed costs. So part of what this appendix at 182,000 goes to pay for is most likely the third liver transplant of someone that failed. So that's how cross subsidization happens. And this is just another example of that. You have five different hospitals. And you have the cost of CABG is in red. These are the risk-adjusted CABGs risk-adjusted appendectomies. And you see the variability of the different hospitals. Just another study, this from 2005, just looking at charges and payments for heart bypass. You have UPMC way up here. These are case-mix adjusted, so all risk factors sort of blended in and adjusted. You see the variability in the different hospitals in the greater Pittsburgh area. So Castlight, which is a company-- has anyone heard of Castlight? They just went public about four months ago. This is a company that was born in northern California. And they have all these pricing data. And the whole goal is to show and unveil what things cost in health care across certain regions. And by doing that, it empowers the consumer, the patient, us, to choose the right pathway. So what happens is you go, type in your zip code. You're looking for a primary care doctor, a dermatologist, OB-GYN, you have an ear ache, you have pink eye or what have you, and you punch it in. And your deductible comes out and says, well, if you go here. You pay $1,830. But if you go there, you get $2,170. It doesn't have any quality data associated with it, but Castlight is now worth upwards of $2 billion looking at price transparency. As I mentioned in one of my disclosures, I'm the chief medical officer of a startup called HealthEngine. We're trying to do the same where we're bringing in price transparency with quality data and trying to get employers and providers together to cut out the insurance middle man. And we'll see where that happens. Let me go on to talk about cost confusion and cost control, because I think this is where providers, all of us, can really think about. Because you've got to understand that revenue, the money that we bring in as providers in hospitals, are going to stay the same at best, or decrease while the costs are going up. So our margin and what we get paid is going to be squeezed. So how can we control that? We can't necessarily control it by the revenue side because once again, the bundled payment era is upon us. What we can control as providers, both OTPT, radiologists, pathologists, surgeons, oncologists, we can control on the cost side so that our margins, for our hospitals and for our units, can maintain or potentially increase. So what do I mean by that? If you ever seen this show Price is Right, they have this Name that Price. And we're trying to make sure that what we charge for and what we collect, we can control the net income by really controlling how much we use and what we buy from our vendors and so forth. So I don't want to linger on this any further than saying that the break-even point is all about managing costs, and I'll show you what I mean by that. So I showed you this slide a few slides ago. It's all going to be in the bundled payment era institutional remuneration. And someone in the back office is going to say, OK, 12% is going to go to plastic surgery. 8.2% is going to go to environmental services. And 22% is going to go to genetics in this situation. And that's how it's going to be adjudicated, and there's no real formula here. But that's the era we're in. So what can we do? So I'm going to get into that in a second. This is depressing. But once again, in order to prevent this decline, as all providers and health care, we have to take control and we have to manage ourselves better. These are real slides. I've taken the names out of all the people here, but we have something called the OPEC committee, which many of our faculty members are familiar with. This is a very big, big committee for us because the cost savings that are implemented are at least in the six figures and beyond. So here's what we've done for orthopedics. And this is the estimated cost savings. And actually, the realized cost savings, for those of you who can't see that in the back, by changing vendors and consolidating what we do in a more efficient fashion for orthopedics, it was estimated to save 118,000. I think orthopedics saved about $280,000 just by consolidating vendors and getting the physicians in the room and saying, well, why are we using this knee? How come, Dr. Smith, every time you do a left knee, you're doing five different knee makers, and when you do it on a right knee, you're doing six? Can we pick one? And many times, surgeons will say, whoa, I didn't even realize that. And that opportunity is a the low-hanging fruit that we think about on a day to day basis. For us-- and I'm proud to just to share this with you, that our administration on the operative side and the perioperative service line really celebrates the fact that when we do a DIEP flap, we have really made everything efficient. And we've picked one vendor for certain things, and we've honed down to two vendors for other things. And that in and of itself has made dramatic shifts in what we can do on the cost side of when we do perforator flaps. This is another shot of-- I took all the names out of the company, but this is a real slide of what biologics cost. So imagine for a moment if per member per month, the University of St. Elsewhere gets $40,000, let's say, for a contralateral prophylactic mastectomy or bilateral mastectomy, let's say, for BCRG mutation. And we use a large pieces of ADM that cost upwards of $10,000. So immediately before we've even recouped anything back for the professional side of what we do, boy, now we're working with 30,000 to pay the general surgeon, the radiologist, the pathologist, the person that sweeps the floor-- oh, and by the way, also the plastic surgeon. So this is a big deal as we look at cost control and what happens with patients that come to us for prophylactic mastectomies and contralateral prophylactic mastectomies. So what will be the drivers of efficiency in the future? All of us have to understand cost data. I had a colleague of mine across the country, a very senior, well-respected household name in my field, say to me-- and this is a while back, said, you know, I'm a doctor. All that business stuff, I don't even want to here about it. I just want to take care of my patients. I don't even want to talk about business. I'm here to take care of Ms. Jones. That's a very noble and idealistic way of looking at it. And I wish that was the case. But because of that attitude, physicians and providers have relinquished the management of health care delivery to people that don't have any idea of the doctor/patient relationship. And this, is in my opinion, why we're here today, is because we have people running hospitals and major medical systems that has never seen a patient, that has never held the hand of someone that has cancer or is dying. And they're making decisions based on the bottom line. So suffice it to say, health care delivery of medicine is a business. It's a wonderful business, and we in this room have to control it, or else it's going to continue to be controlled for us. How do we do that? We have to understand what things cost. We have to manage variable costs. We have to partner with our hospitals. Because if we don't do that proactively, it's going to be done for us. And I've said this many times before. If you're not at the table eating, you're on the menu. And so you'll be eaten. [LAUGHTER] So we talked about work RVUs. I'm writing a paper on the concept of relative cost units for each position. What does that mean? So we have a study ongoing right now. This is the remains of the day, all the stuff that I've opened in surgery that I didn't touch. Well, in the United States, when you open something sterile and put it on the back table and you don't use it-- let alone that you don't touch it, let alone you don't use it, that gets thrown away or recycled and given to a foreign country. But that's a real cost. It's like opening up 20 $100 bills and giving it to someone in Dominican Republic. It's noble, but it affects what we do every day. So this is a study that's ongoing. And this is if you take a look at your practices-- and I encourage all of you to do this. At the end of the case before you go out-- we all have to do this debriefing now-- take a look at the back table of what the surgeon has opened but didn't touch. This gets thrown away. This here, I think it was close to like $1,350. And that's me, and I'm very-- I'm a pretty miserly guy. Talk to my wife. She'll tell you how miserly I am. And I was shocked to see this. So we're going ongoing study as to what we open and don't touch, and eventually what turns into waste. So my proposal is-- and don't freak out, Julia and David-- is that at the end of the case, we're going to have a debriefing. But as you walk out, the screen will either turn green, yellow, or red. Green meaning that your cost of doing that case is within a standard deviation of what you've done it, what your colleagues have done in the region. If it's yellow, it's a variability of, oh my gosh, why are so expensive on this particular case? And there may be a reason why. And then if it's red and if it's continuing to be red every case, well, then you get a talk with your section chief and people have to understand why you're costing so much for the same outcome or less. So this is down the corner. If we don't do in the University of Chicago, I'm sure it will be done. Because everything's RF coded now. You know what you opened. You know what it costs. And we have to be in front of this, or once again, it'll be in front of us. So let me switch gears to talk about disease-based service lines. Has anyone heard about this yet? Raise your hand if you've heard about the buzzword disease-based service lines. So we have a few people. So Cleveland Clinic has done this. This is really an effort to be forward thinking to our patients and not necessarily reactive to it. Because of price transparency and information velocity, there's just greater patient choice. And because of patient choice-- so if you're not an educated patient, which we're blessed because many of our patients in breast cancer, they have done all their homework. But if you have, let's say, pancreatic cancer or some other bad illness, well, you won't necessarily know that you have to go on the website to try to find an endocrinologist because maybe have an endocrine-based pancreatic cancer, and then find a surgeon in the department of surgery, and then find someone within the department of surgery that specializes in pancreaticobiliary. I mean, you have to do all that research. So what Cleveland Clinic and many of the Geisinger Health Care systems has done is outward-facing to patients become disease-based service lines. Well, that's all fine and dandy for marketing purposes, but what does it really mean? It's an opportunity for EMCs to reorganize. And actually, funds flow will organize around that. And I'll tell you what I think is going to happen. Right now, it's a silo. We have geneticists, radiologists, pathologists all working in silos, and it's up to the patient to figure out where he or she needs to go for their care and their prophylactic mastectomy. The patient has to understand that, well, there's navigators now, but if you don't have a navigator, you have to contact your surgeon. You have to first start with the geneticists, make sure that that surgeon wants you to get an MRI so that you have to be proactive about ordering that MRI and getting that. And then you probably have to have some sort of interview with an oncologist-- maybe, maybe not, depending on whether you have breast cancer or not, and seeking a CPM as opposed to a PM. And then roll back and schedule with the surgeon. And the onus is on the patient as we speak today. What I mean by patient care services is it's the patient's going to be front and center, and we come to the patient. A lot of places do that in an organized way, but I'm talking on a financial way. So we talked about bundled care. We're talking about PMPM payments by third party carriers and x amount of money. And that is going to be divvied up predicated on who touches the patient. And it's not going to be arbitrary. There's going to be work RVUs. And in my opinion, there's going to be cost RVUs that are associated with that. So imagine if all the-- let's say the University of Chicago decides that all the professional fees for a contralateral prophylactic mastectomy patient is $3,700. I just picked a number that's within the ballpark of what I think is going to happen. Well, that's going to be divvied up across the spectrum of providers-- pathologists, radiologists, plastic surgeon. I'm being hopeful here at $1,200. But that's what's going to happen, is that the cost structure is going to and the cost centers are going to be in alignment with patient-centered services. So this is just a hypothetical situation, once again, where for a breast cancer patient, we may get $33,000, all in for the global care of Ms. Jones who has breast cancer and needs a contralateral prophylactic mastectomy. So all the discussions that we discussed this morning are very germane. Dr. Tuttle, I don't know if he's in the room. There he is-- talking about survival, and that may be more important now more than ever. Because right now, the patient doesn't necessarily pay for her contralateral prophylactic mastectomy. In the future, depending on what she picks-- the bronze plan, the silver plan, or the gold plan-- that may not be included because there's no survival benefit. And that will be explicitly written in page 28 on the back of your Blue Cross Blue Shield manual. So when you go in for a contralateral prophylactic mastectomy, it's going to cite Tuttle et al where there's no survival benefit, and we won't cover it. But if you choose the gold plan, which the cost per month is $2,000 more, let's say, it may be covered. So these things are wonderful on the academic side, but I think the policymakers and the third party payers are going to make those decisions for us unless we get ahead of ourselves and be part of that discussion. So cost centers will be blended. Right now, a cost center is surgery, radiology, pathology, genetics, OTPC. Those will probably be all blended. There will be a bundled care team, which will be the norm. There will be a single payment model-- like an ACO to the hospital system; once again, PMPM. Remember that. You're going to be hearing a lot about PMPMs. The overall break-even or gain for the hospital is going to be predicated on how well we organize around it. And the lost revenue per patient may be made up by increased volume, efficiency, cost control, and so forth. Who pays for complications in this era? It'll be us. Because if you get a complication, once again, you've received a fixed amount of funds from third party carrier, and you'll have to pay for it. So what will the departments of the future look like? This is just made up. These, once again, are my thoughts. But it may be a Department of Breast Diseases. There's mastologists in Europe if we are going that way. But what I mean by that, it actually may be financially fixed around the disease process. So you have a chair who's your breast surgeon. I can see Dr. Jaskowiak here. Then you have the plastic surgeon, radiologist, pathologist, oncologist psychologist, geneticist within the Department of Breast Diseases holding joint appointments in medicine, surgery, and so forth. You have the Department of Heart and Vascular Disease. We're creating a Heart and Vascular Unit right now. Your chair may be the cardiologist, and the faculty members, once again, financially falling under the aegis of that cardiologist-- maybe the cardiac surgeon, the vascular surgeon, internist, radiologist, and so forth. On and on-- the Department of Trauma Extremity Care, the Department of Adult Head and Neck Disease, so on and so forth. This is, once again in my opinion, what's upon us. So what does it mean? Change is clearly inevitable. The current fog of confusion of coverage will continue. And seminal articles and outcome studies that show survival benefit or no survival benefit, recurrence rates or no recurrence rates, are going to be key. And this is what Cigna, Aetna, United, Blue Cross Blue Shield are going to really focus on and make policies around. So be careful-- it's not necessarily be careful. But when you publish those things and those articles, they will be incorporated into the manual of coverage and pre-authorization for all these insurance carriers. We are crossing the crevasse, as we speak to value-based health care. The risk is being shoved on us, and we have to own our complications more than ever before. And what I mean by owning them is financially. So that's happening as we speak. So what do have to do that? We have to help the cost-effectiveness of what we do and how we can control costs. And there's going to be more of an incentive to manage populations as opposed to fee for service. Price transparency will be the norm. They'll be a ton of tools out there. If you want your MRI, you'll have six different centers to choose from, and it'll be paired with some sort of quality measure. Patient-facing outcomes are going to be at front and center of what we do-- everyone sort of-- Yelp, Angie's List, Vitals, Healthgrades, and so forth. That will probably be paired with some sort of costing data. And then cost control on an individual level, and we can do is going to be accountable. And we have to be accountable for that. And that's how we're going to be able to show value in this era of value-based health care delivery. The opportunities are clearly-- I think this is the nexus of where a lot of these opportunities may come, from the discussions in this room and the collaborations with what we do across nontraditional collaborators. We're going to be partnering with patients. We're going to be partnering with employers. Imagine we're going to be the University of Chicago primary care provider for McDonald's, let's say, or [INAUDIBLE], and municipal governments. So the Kane County or the Cook County union will be provided for in their care by CTCA or some other provider group. So there is a new dawn upon us. And I think that it's exciting. It's scary. People call it-- at least my colleagues call it a crisis in health care. To me, I never let a crisis go to waste because I think there's tremendous opportunity in crises. And this is my final slide, and I'll read it to you if you can't see it in the back. It's a little goldfish jumping out of a pool. It says, if you want something in your life you've never had, you'll have to do something that you've never done. So thank you very much. Published May 13, 2015 Created by
