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Report* on thecreateAworld of Healthcare

16 August 2014@

The Brandery, Cincinnati, Ohio

The report is meant to be augmented with missing information and to grow with new ideas.

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AttendeesLast First GroupAtkinson Pam

X Bowman JimCampbell Karen

X Deal Steven FacilitatorErasala NaveenFarmer Daneika

X Finney Betty Mind, Body, SpiritFlaspohler LouFord Daniel

X Girvin SarahIngmire SusanJackson Cole

X Koehler AdamX Komarek Paul Mind, Body, Spirit?

Lewis CarlX Matthey HarrietX Mazur Robert

X indicates the person signed in

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AttendeesLast First GroupMechley Amy

X Metharu Mandeep Evidence-Based Medicine – Data

X Murray-Davidson James Mind, Body, SpiritX Nelson AdamX Paige Cathy AdvocacyX Patel MayuriX Paul Susan

Porter BrandonRudolph PaulSchmidt Michael

X Short ScottX Southern Sunnie FacilitatorX Thompson Hillary AdvocacyX Tschopp Rondi AdvocacyX Willmot JackieX Wood Frank

Zhang YifanX Last name? Jon

X indicates the person signed in

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Process

• A seven-step process was planned for the day.• The third step was not implemented. It involved removing the organizing around which the

groups’ ideas were centered. Because of the way the group titles evolved, step three was not appropriate.

• The seven steps, with the third one crossed out, are depicted on the following two pages.

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AffinityDiagram

Story of how your ideas, products and technologies are experienced by stakeholders.

Use CaseCreation

How do we break down our creation to make it manageable?

1 2 3 4

Change theWorld

What happens if you magically take away concept around which your idea is centered?

X

Interfaces w/ Other Groups

What are the goes into’s and goes outta’s at the boundary of your part?

??

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DepictYourPart

We put all the pictures together and walk through the world we created.

Put theWorld

Together

Make a graphic.

5 6 7

DescribeThe

World

Pick a partner with a smartphone and describe your view of our new world in a video.

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Ideas for Step 1, Affinity DiagrammingNot all the idea cards were saved at the end of the idea. If your idea is missing, please add it.

1. School-Based Health Coordination – Paul Rudolph– Create a network of community workers that operate out of community learning center

schools.2. Global Social Services Network for Case Managers -- ??– Provide a global network for health and social services for case managers of

developmentally disabled adults and children to share best practices using live-chat IT platform.

3. Reduce Provider Administration Time – Scott Short– Find ways to reduce the time providers spend communicating to outside entities (so

providers have more time with patient)– Opinionxpress.com, injury opinion.com

4. Thriving With Stress – Frank Wood– Enabling individuals and teams to communicate clearly despite differing agendas

5. Getting Unstuck – Jim Bowman– Most of us are stuck in our judgments, believes and opinions. Getting unstuck is our

access to innovation, creativity and change.7. Multi-faceted Wellness Center with Meditation Tank Spa and Holistic Care – James

Murray-Davidson– A wellness center similar to a medical arts building with multiple disciplines available such

as chiropractic, physical therapy, massage, naturopath, acupuncture, open class space and meditation tank spa.

8. Holistic Health Coach -- Jon– An individual (or vehicle or resource) available to discuss full implications of a person’s

illness (physical and emotional) and linkages to related illnesses that can direct the person to comprehensive help.

9. Keepers – Paul Komarek– A drug treatment program that retains people who relapse.

10. Moving mental Health into the Mainstream – Hillary Thompson– Stress and its affects are often times unknown and unidentified. There is a need to move

stress and positive mental health understanding via education or devices.

11. Insurance System to Reward Alternative Health -- ??– Develop ways that insurance companies will pay for healthy alternative practitioners.

12. iPillbox – ??– Medicine reminder pillbox that provides real time data monitoring and is simple and easy

to use.13. Rx DogGone Opener – Bob Mazur– Tool to open medicine bottles. Hangs on fridge with a magnet.

14. PurrFect Jar and Bottle Opener – Bob Mazur– Flexible, magnetic, easy to open.

15. Identify User Needs – Jim Bowman– 1. Who is the user? 2. What is the job to be done? 3. What are the unmet needs?

16. Get Products Through Research/FDA Faster –Hillary Thompson– Don’t delay research for devices, product testing and approval through FDA.

17. Thrive 365 –– A handy way, available wherever you are, to search foods and log meals. You can scan the

UPC code to look up a food score, review scores for many local restaurant menu items, get delicious recipes – to help you keep track.

18. Missing Idea – Contributor Name– Description.

19. Missing Idea – Contributor Name– Description.

20. Missing Idea – Contributor Name– Description.

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Group Titles

1. Team Building2. Mind, Body Spirit (Mental Health was original)3. Diabetes, Nutrition4. Advocacy (Doctor-Patient Information)5. Evidence-Based Medicine (Info to Doctors)6. Healthcare Logistics (Connection to Care)7. Devices

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Team Building

• Empty– No one elected to work on these ideas

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Mind-Body-Spirit

Group Members• Betty Finney• Paul Komarek• Harriet Matthey• James Murray-Davidson

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Mind, Body, Spirit Product 1

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Mind, Body, Spirit Product 2

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Mind, Body, Spirit Product 3

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Mind, Body, Spirit Product 4

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Mind, Body, Spirit Product 5

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Mind, Body, Spirit Product 6

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Mind, Body, Spirit Summary

• Concepts– Goal is to make people happy or happiness is the objective of health and wellness, feels good is positive– Health and wellness opportunities need to be located in places that people habitually visit– Proactive vs reactive-preventative

• Themes– Journey – Need to create a pathway, healing versus curing, treatable vs undiagnosed, behavioral changes as problem and healing path,

catalytic “nudges,” levels of choice– Advocacy -- Broker role for small-scale communities, bridges for patients between holistic, therapeutic providers and primary care providers,

churches, marketing health and wellness, peer pressure– Access – Wellness can be achieved dojos, fitness centers, massage studios, bars, bowling alleys, dancing, stores , health products stores,

grocery stores (for nutrition) (Kroger), farmers markets, community gardens; peace space, churches• Caresource, Homes• “Health Hub,” “Wellness Center”• Data and dollars used as filters to happy health hub

– Roles – Practitioners (western, alternative, complementary), 2nd tier providers, volunteers, part-time staff– Connectivity – Networks of information, between practitioners, community (“togetherness club”), free interchange, community bridges,

regional associations, word of mouth, advocates, activism, institutions, community health (targeted social influencing), phones, email– Economics – receive negotiable credit (Money? Insurance credit? Points? Stipend?) for actions taken that make one happy and healthy

• Institutions – Affordable Care Act, Medicare, Medicaid, MCOs, the “normal” world community, Unilever• Linkage with job creation for healthcare positions• Investors

• Objections– People don’t want to live in a world in which healthcare is always in their face

• Connections– Advocacy– Education– Data – simple, low-level, non-intrusive, data gathering– Economics– Devices – bringing products to market, show promise and payoff

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Diabetes-Nutrition

Group Members• Sarah Girvin• Bob Saunders• Jackie Willmot

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Diabetes-Nutrition Product 1

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Diabetes-Nutrition Product 2

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Diabetes and Nutrition Summary

• Concepts– Healthcare as an ecology

• Themes– Nutrition cycle – production (farm) to purveyors (grocers, restaurants, fast food, schools)– Activities – tracking– Proactivity – Propensity for disease, phenotype, biomarkers to identify problem before diagnosis,

system triggers according to biometric feedback– Public health – Food pyramid definition, product marking– Users – Discover user needs by talking with those with diabetes nutrition challenges– Connectivity – patient to provider and to cloud database

• Objections

• Connections– Devices– Monitoring, supplies, wearable devices, – Data – Cloud-based, patient healthcare database, – Logistics – Food delivery; data collection, processing, dissemination use; healthcare supplies (drugs,

syringes)– Providers – Diagnoses, response to system triggers– Economics – Payors– Genetics– Government – Department of Agriculture, 911 services

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Advocacy

Group Members• Sue Ingmire• Harriet Matthey• Cathy Paige• Hillary Thompson• Rondi Tschopp• Jamie __________

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Advocacy Product 1

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Advocacy Summary

• Concepts– Life Context – “Everyone has a story,” what you do, how you feel, what you think– Patient Education – Shift from reactive to proactive healthcare, maintaining health is up to the

patient– Advocates – Family, friends, faith-based communities, professional support, health coach,

empower, compassion, understanding, empathy,• Themes

– Data – About patient, information about nutrition; enabler for patient engagement– Patient Engagement – Unique, individualized approach; customized approach, participatory

process– Integration of entire healthcare community – Patient, doctor, therapist, practitioner, patient+doctor

(providers) together, resources, data, friends, family, faith-based communities– Access – connected and integrated, patient access to western, complementary, alternative,

• Objections

• Connections– Nutrition – Food as medicine– Data– Devices– Mind, Body, Spirit– Healthcare logistics

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Evidence-Based Medicine, Data

Group Members• Carl Lewis • Mandeep Metharu• Amy Mechley • Mayuri Patel • Scott Short • Frank Wood

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Evidence-Based Medicine, Data Product 1

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Evidence-Based Medicine, Data Product 2

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Evidence-Based Medicine, Data Summary

• Concepts– Uncouple insurance purposes – preventive vs. catastrophic– Global data – patient data in health information exchanges (HIE) integrated into populations

database; clinical, research, and genomic data integrated into population database ; care episode outcomes metrics

– Support to care episodes• Themes

– Data Properties – Standardization, collection, real time data exchange– Outputs – Patient and provider education (outreach, engagement), evidence based medicine,

comparisons of care episode symptoms with global data– Patient medical histories – Electronic Medical Record (EMR) (EPIC as an example or

standard?)– Standardization – data exchange, practice implementations

• Objections

• Connections– Advocacy– Devices– Healthcare logistics– Mind, body spirit

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Healthcare Logistics – Connections to Care

Group Members• Joseph MacDonald• Paul Ruldoph

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Healthcare Logistics Product 1

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Healthcare Logistics Summary• Concepts

– Pathways Community HUB Model: a structured process that uses community care coordinators to identify, define, and resolve a health or social service problem. Each pathway represents one issue that is tracked through to completion and a measurable outcome. For example, the Pregnancy Pathway ends with a normal birth weight infant, and the Social Service Referral Pathway ends with a confirmed appointment with a social service provider.

– Process1. Two-dimensional population representation

• Age vs Need• Special populations -- underserved

2. Networks of brokers addressing two-dimensional population broken into sub-groups• Department of Defense for veterans• Centers for Health and Wellness for students and parents• Retains centering on personhood• Incentives tailored to population (Insurance refunds,etc.)

3. QoL and cost tradeoffs of care models (e.g., Medicaid treatment of Intellectual Development Disabilities vs institutionalization)4. Healthcare providers

• Create plans of care based on best practices– Inputs about quality drivers, which data is relevant, best practices, minimum data sets

• Doctors, Dentists , Dietician, Pharmacists5. Data used to support patient risk strategies predictive analytics6. Patient Engagement

• Portal• Profile• Shared Knowledge• Live Chat

– Pathways Community HUB Model: a structured process that uses community care coordinators to identify, define, and resolve a health or social service problem. Each pathway represents one issue that is tracked through to completion and a measurable outcome. For example, the Pregnancy Pathway ends with a normal birth weight infant, and the Social Service Referral Pathway ends with a confirmed appointment with a social service provider.

• Themes– Centers for Medicare and Medicaid Services (CMS) drivers of logistics engine

• Social Security broker the logistics network.– Phased approach – Phase I National, Phase II Global

• Shared best practices• National Information Exchange• Registry for patients used to align logistics data underpinning -> initial assessments, outcomes, profile

– Measured outcomes aligned with patient incentives• Play book for “Pay for Performance”

• Objections– None presented

• Connections– Evidence-Based Medicine, Advocacy, Diabetes Nutrition, Mind Body Spirit

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Devices

Group Members• First Session

– Jim Bowman– Robert Mazur

• Second Session– Racquel Redwood– Gentleman with Racquel (would love to know his name)

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Devices Product 0

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Devices Product 1

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Devices Product 2

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Devices Product 3

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Devices Product 4

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Devices Summary

• Concepts– Market Divides into 1) Market (consumer) and 2) surgeon/care provider/Accountable Care Organizations/general practitioner– Device Classes

• Wearables, Personal Health Records, Electronic Health Records, Plastic Optical Fiber-based, Data Info Systems– Device Categories

• Human I/O, Data Info Sys, Point-of-Care systems, “Force Multipliers”• Themes

– Prioritization of which devices to bring to market– Stakeholder definition (who, when, where, customers vs users) and prioritization– What are the needs? (the pains?)– Making device is easy, communication/selling is hard

• Purpose driven, fluid message– Evaluations

• Foundational: Low cost , efficiency • Primary: Optimal outcome• User: improved experience (e.g., time, access)

• Objections– None presented

• Connections– Device-to-patient, device-to-device, device-to-generator, patient-centered devices, analytics engines, observation systems,

operating room cameras scopes, device to internet-of-things, device-to-mobile, design ergonomics– Government: HIPPA compliance, FDA, patent (intellectual property)– Healthcare Logistics– Evidence-Based Medicine / Data

• Right diagnoses, right treatment,, data transfer, good treatment, good value

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Aggregate Summary

• Health and Wellness Pursuit: A fundamental right if it equates with happiness– Objective vs Subjective metrics

• “Feeling good” is a an acceptable measure of success• Phased paradigm shift

– Reactive Medicine Preventive Medicine Proactive Health and Wellness• Proactive Health and Wellness is centered on “personhood” and Quality of Life• Proactivity

– Propensity for disease, phenotype, biomarkers– System “triggers” to engage proactively and incrementally as required

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Aggregate Summary - Process

• Health and Wellness is comprised of parallel processes– Life journey: birth to death

• There is the general story we all experience.• There are the stories of each individual (what a person does, what a person feels,

what a person thinks)– Includes individual health histories

• There are the common stories of people with similar traits or propensities– Includes special populations

– Situational behavior modification processes: debilitation, chronic disease, undiagnosed unwellness, treatable, untreatable, end-game

– Treatment pathways (e.g., pregnancy, heart, stroke, etc.)– Health and Wellness delivery logistics– The Nutrition cycle– Public health processes– Personal health data to public health data cycle– Research processes– Product-to-market process

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Aggregate Summary - Process

• Processes have partners– Person/Patient– Family– Advocates (brokers, care coordinators, faith-based communities, friends)– Wellness and care providers– Suppliers– Device makers

• Processes have enablers– Third party-payers (insurance, government, employers)– First party payers– Information technology– Education

• Proactive processes are tailorable to individual/situational needs• Processes can scale (local, regional, national, global)

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Aggregate Summary - Ecology

• Proactive Health and Wellness can be thought of as an ecology– Access Points

• Information• Health and Wellness Experiences

– A person’s Social Fabric– Social Norms– Employment– Nutrition sources– Health and Wellness providers– Education– Compensation and incentivization– Information network – Governance – FDA, HIPPA, Dept of Agriculture, Intellectual Property, Standards

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Aggregate Summary - Ecology

• The set of potential proactive Health and Wellness locations is larger than and subsumes the set of locations where reactive and preventative health and wellness can take place– For example, Nutrition point of service is wherever food and beverages are sold

• Connectivity, collection, storage, analytics and communication are enablers of proactive health and wellness– Degree of participation must be at the discretion of the individual– Continuum from no interaction through low-level to constant monitoring– Devices are instruments supporting the enablers

• Marketing is an instrument of communication– These are also enablers of unique, individualized approach; customized process;

participatory process.• Proactive Health and Wellness connection with Education is larger than and subsumes the set

of reactive connections (includes patient education in addition to provider and supplier training)

• Proactive Health and Wellness access includes that to western, complementary and alternative methods– Results research and data gathering must be fairly undertaken and applied

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Aggregate Summary - Economics

• Economics of proactive health and wellness differ from reactive and preventative health and wellness– Incentives for proactive stance– Decoupling of insurance purposes

• [Proactive] and Preventivediffers from

• Catastrophic

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Ideas

• Pay for results: Employers no longer pay for insurance; pay for productivity. Lost time decreases payment into health and wellness system

• Healthcare is not an enterprise one can “win at all costs”. The reality is we all die.

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Operational View 1 (OV-1)

• Insert link to OV-1