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introduces a range of new incentives/penalties that force market participants to address major cost, efficiency, and quality issues within the healthcare system.

The ACA and other healthcare reform initiatives are challenged by dual and somewhat conflicting objectives. They are focused on reducing costs and slowing growth rates in spending, but at the same time expand the size of the population that has access to healthcare covered by third party payment mechanisms. In order to cover the increased costs of the expanded coverage, reform initiatives attempt to radically improve the efficiency of healthcare delivery as a way of freeing up resources that can be redirected to providing care to populations that had previously not been covered. Some of the lowest hanging fruit that is being targeted in early reform initiatives is eliminating waste from the healthcare system. There are enormous resources that can be freed up by eliminating expenditures that are unnecessary or duplicative. In the U.S. healthcare system alone, there is an estimated $765 billion that is wasted annually. More than half of that total ($415 billion) is the result of fraud, unnecessary services, and inefficiently or mistakenly delivered care. Another 25%+ of the total ($190 billion) is the result of excess administrative costs (e.g., inefficiencies associated with paperwork and documentation)27. Finding ways to reduce waste in the system offers the opportunity to create significant value, but requires the adoption of entirely new tools and technologies by payers, providers, and patients. Developing these tools, applications, and systems is an area of significant opportunity for innovative technology focused companies.

A major part of eliminating waste in healthcare will be accomplished by driving efficiency and deriving maximum benefit from the enormous levels of current expenditures. Achieving this goal will have to include a fundamental change in focus to the principles of value-based medicine across all levels of the healthcare system. This is a radical change in objectives that is already happening, and it is leading to entirely new reimbursement models built around paying for technologies and treatments that provide care efficiently and at a cost proportional to the health benefit they deliver. Value-based medicine focuses on outcomes from healthcare services, which more closely aligns the interests of the payers with the healthcare providers and product companies whose services and products are the major cost elements in the delivery of healthcare. Although simple conceptually, this is a fundamental change in how healthcare is paid for from the historical reimbursement models that have focused on fixed payments for delivery of discrete procedures, with no corresponding emphasis on quality of the care delivered or on the resulting patient outcomes.

Refocusing treatment objectives within the healthcare system towards high quality outcomes over numbers of procedures will require many healthcare companies to reengineer aspects of their business models, but it will also provide them with new opportunity. In a system that rewards outcomes, companies and organizations that run with the highest quality and most efficiently will have significant opportunity to expand their own returns by taking on risk in the treatment of patients. Opening the market to this dynamic, where there is opportunity to earn a return on cost-effective, high quality patient management and outcomes, will stimulate the development and adoption of an entirely new set of enabling technologies and business models, which represent opportunity for innovative, technology-based, development and growth stage companies.

27 National Academy of Sciences, “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America”

26 CONTROL NUMBER 257 - CONFIDENTIAL

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