Transcript Innovation for HIT

From AM Radio to Pandora:
The Health Care Innovator’s
Next Frontier
PrimeHealth
September 19, 2012
Today’s Agenda
• Why we have to fix the system now
• The tsunamis that are forcing change
• What we are being asked to do to create a sustainable
system
• How entrepreneurial innovation can be part of the
solution
Medicare+Medicaid is Largest
Driver of Future Federal Spending
Projected Increases in Federal Spending, 2010-2021
$2,500
Nondefense Discretionary Spending
$2,250
Defense
$2,000
Other Mandatory
Spending
Federal Spending in Billions
$1,750
Social Security
$1,500
$1,250
$1,000
Net Interest
$750
$500
$250
$0
Medicare +
Medicaid
Offsetting Receipts
-$250
© 2009-2012 Center for Healthcare Quality and Payment Reform, Network for Regional Healthcare Improvement
3
Huge Increases in Costs for
Both Employers & Workers
$14,000
Average Annual Contributions to Health Insurance Premiums
1999-2010
Employer Contribution
$12,000
Worker Contribution
Employer Contribution
More Than Doubled
$10,000
$9,773
$8,000
$6,000
$4,000
$4,150
$2,000
$1,878
$0
$318
$899
Single Coverage
1999
Single Coverage
2010
$4,247
Employee
Contribution
Nearly
$1,543
Tripled
$3,997
Family Coverage Family Coverage
1999
2010
© 2009-2012 Center for Healthcare Quality and Payment Reform, Network for Regional Healthcare Improvement
4
Health Care Costs Have
Wiped Out Real Income Gains
Monthly Income for Typical U.S. Family of Four
$9,000
$8,000
$7,000
$ 870 for inflation
$6,000
$ 945 for health care
$5,000
$
$4,000
$1910 more income
$3,000
95 for spending
Inflation on NonHealth Care Goods
Health Care Taxes,
Premiums, Expenses
Net Available Income
$2,000
$1,000
$0
1999
2009
Source: "A Decade of Heallth Care Cost
Growth Has Wiped Out Real Income Gains
For an Average US Family," Health Affairs,
September 20011
© 2009-2012 Center for Healthcare Quality and Payment Reform, Network for Regional Healthcare Improvement
5
The Second Tsunami: Information
• Moore’s law: number of transistors on a chip doubles
every 18 mos. (trend true for >50 years)
• Corollary: Information is increasing at an exponential
rate
• Conclusion: The tools and methods we used twenty
years ago are obsolete, and are being replaced
The Third Tsunami: Consumerism
• Customer expectations are rising exponentially as
well
• Other industries have taught Americans to expect
their experiences to be individualized and automated:
mass customization
• Disruptive innovation: minute clinics, other
professionals, telemedicine, remote monitoring,
personal health records, communities of care;
geography increasingly irrelevant
Old Chinese curse: “May you live in
interesting times.”
Federal deficit over next decade will be driven largely
by growth in HC spending.
Employer contributions have doubled over the last
decade; employee contributions have tripled.
We owe the Chinese $1.2 trillion; I think they’re on to
us.
Being out of money has an amazing clarifying effect
on people’s thinking.
The challenge of doing the opposite of
what you’ve been doing
•
•
•
•
•
Old Game
Maximize billable activity
Biggest network of
unconnected providers
Value based on
credentials
Patients as passive
recipients
Care centered on
providers
•
•
•
•
•
New Game
Maximize health
outcomes for least price
Providers who produce
best outcomes together
Value based on
outcomes
Patients as activated
partners
Care centered on
patients
Integrated
system global
payments
Global DRG
fee: hosp & MD
inpatient
Outcome
measures; large
% of total
payment
Less Feasible
Global DRG
fee: hosp only
Episode of
care fees
Global
ambulatory
care fees
More Feasible
Care
coordination and
intermediate
outcome
measures;
moderate % of
total payment
Global primary
care fees
Simple process and
structure measures;
small % of total
payment
Blended FFS &
med home fees
FFS and DRGs
Small practices;
unrelated hospitals
Medical
Homes
Independent Practice
Assns; MD-Hosp Orgs
Continuum of Organization
Source: Modified version of slide from Shih et al, The Commonwealth Fund, August 2008.
Fully integrated
delivery system
Continuum of Performance- Based Pay Design
Continuum of Payment Bundling
Transformation of Payment and Delivery
Big Data +
Empowered, Demanding Consumers =
Mongo Opportunity for Innovations
That Inform and Empower
Berwick: Kano Model of Innovation
• Kano I: reduction in defects
(Dissatisfiers)
• Kano II: reduction in cost while
maintaining or improving customer
experience (Satisfiers)
• Kano III: new service or product that
costs more money (Delighters)
Transformation Opportunity
Less of:
More of:
Moving beyond Kano III to offer solutions to enhance health
care experiences, contain costs, and improve the health of
Coloradans.
Opportunities for Innovation
Coverage + Coordination + Collaboration
Clinica Family Health Services | Access
1. Providing high-quality treatment in small
groups, plus:
• Education
• Screening
• Answers
• Support
2. 90-minute session with coordinated team
of caregivers
3. Improved outcomes, better adherence
+ Connection?
What would it take to offer a new level of interactions and support
to patients using the channels they’re already using?
Opportunities for Innovation
Connection + Performance Improvement
Adherence
is a $290
Billion/year
problem*
1. Interventions impact
adherence
2. Medication
adherence leads to
lower health care
costs
* New England Healthcare Institute. Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication
Adherence for Chronic Disease, 2009.
Opportunities for Innovation
Data on Outcomes, Cost and Quality
Society of Thoracic Surgeons and
Consumer Reports:
1. Data to report on:
• complication and survival rates
• whether groups used the best
surgical technique
• whether patients were sent
home with certain medicines
2. Examining whether giving patients
access to this kind of information
could improve heart surgery
outcomes
Thank you!
Jay Want, MD
Chief Medical Officer
CIVHC | Center for Improving Value in Health Care
Phone: 720-583-2095
e-mail: [email protected]
Web site: www.civhc.org