Calculating Value in Healthcare:

The Importance of theConsumer Experience

Raki K. Pai, MD, MBAChief Population Health Officer &

President of Metro Health Medical Group

Healthcare Buzz

PopulationHealth

Quadruple Aim

TransformationGenomicsRevolution

Volume to Value Personalized

Medicine

Trends in HealthcareVolume to Value Regional Genomics Revolution

Technologies

Population Health Personalized Medicine

New Wearable Wrist Patch Could End Painful Fingersticks To Measure Blood Sugar

Fitbit Strikes Deal With Google

That Could Lead to Wearables

Collaboration

Dermatologist-level

classification of skin cancer

with deep neural networks

Color Announces Population

Health Initiative With Academic

Medical Centers

BCBSA Value-Based

Plan Outperforms in

Key Health Metrics

CMS launches new voluntary

bundled-payment model

Startup and researchers get

$3.1M grant to bring personalized,

cancer-fighting tech to patients

FDA Approves First Gene Therapy

For Leukemia

Cx Value = Quality + Experience

CostCx = Consumer

Value: relative worth, utility, or importance

The Healthcare Value Equation

• Depression Screening 54%

• STEMI Door to Balloon Time 52 mins

• STEMI Mortality Rate 1.6%

• ACS Door to EKG < 10 mins in 81.1%

• Stroke Door to Needle 29 mins

Quality:

Improving Health for Our Communities

Cost: Total Cost of Care PMPM Over Time

Metro Health Does Well with Costs

Other Health Plan Providers

Metro Health Integrated Network

PMPM = Per Member Per Month

Health Consumption Expenditures Per Capita, U.S. Dollars, PPP Adjusted, 2017

The US value was obtained from the 2017 National Health Expenditure data

Source: KFF analysis of data from National Health Expenditure Accounts

and OECD • Get the data • PNG

$5,280

Studies point to a simple reason, the prices, not to the amount of care.

And lowering prices would upset a lot of people in the health industry.

Austin Frakt & Aaron Carroll, MD

January 2018

Healthcare $$$ Not Utilization

Medical Device

Payers

Pharmaceutical

Employers

(Self-funded)

Providers & Hospital/Clinic

Delivery Systems

Medicare & Medicaid

Patients, Families & Consumers

Complex Healthcare Ecosystem

Pre Care

Care Post Care

ExperienceExperience Experience

Consumer experience is fragmented & confusing

Experience:

The Healthcare Journey

Financial$$$$$$$$Harm to Patients

Experience

Post Care

The Post Care Healthcare Experience

Care DeliveryModel

PaymentReformModel

GR

OW

TH

TIME

INNOVATION

0

Disruption = Innovation

Linear vs Exponential Disruption

Healthcare Disruptors?

What Will Amazon Do = WWAD?