improving quality of care, using existing assets better and reducing medical costs, pop up uni, 1pm,...

Copyright © 2015 Healthways, Inc. All rights reserved.

Improving quality of patient care, using existing

NHS assets better, reducing medical costs

Dr Oliver Harrison

Senior Vice President Healthways International

Wednesday, 2 September 2015


Overview of presentation

• Our shared challenge

• Our approach to meeting this challenge

• Improving quality of patient care, using existing NHS assets better

• Reducing medical costs

• Opportunity for joint innovation

• Closing comments

2


Our challenge: NHS Five-Year Forward View

2

# Chapter Key points

1 Why will the NHS need to

change?

Core NHS principles work for future: Care free

at point of access, centrally funded from tax

revenues

£30bn projected annual funding gap by 2020

Need to drive 2-3% efficiency gains annually

(against historic <0.8%)

2 What will the future look

like? A new relationship

with patients and

communities

Getting serious about prevention

Empowering patients

Engaging communities

3 What will the future look

like? New models of

care

New models of care

Limited number of new service models will be

developed and implemented

Neither “one-size-fits-all,” nor “many flowers

bloom”

4 How can we get there? Co-design

Implementation driven locally

Strong emphasis on IT


Key area of focus: Long-term conditions

• Focus on prevention

• Address complex causes:

- Genetic: ±20%

- Environment: ±10%

- Behaviour: ±70%

• Need for radical service

innovation

4

“Life expectancy in the UK has improved over the last 20

years, but levels of ill health have not and the UK is now

below average compared with 18 other countries on many

important indicators.”

Newton J, Fenton K, et al. (2013). Special analysis of Global Burden of

Disease, 2010. The Lancet

“The UK has seen some success… However, the risk factors

continue to increase, which shows that this progress is

unsustainable, relying on increased use of drugs, surgery

and other procedures. There is much more that can be

done in delaying or preventing the diseases, before the

costs of treating complications threaten to overwhelm

health services”

C3 (2011). Non-communicable diseases in the UK A briefing paper

prepared for the UK Parliament (House of Lords)


Costs are dominated by long-term conditions

• Mortality

• Morbidity

• Acute events

• Health costs

• Productivity

• Performance

• Social impact

5

Effect


Tackling long-term conditions means addressing

their root causes

• Nutrition

• Activity

• Stress

• Sleep

• Mood

Cause • Finances

• Career

• Relations

• Purpose

6

Effect

• Mortality

• Morbidity

• Acute events

• Health costs

• Productivity

• Performance

• Social impact


Our contribution: the SIM Model

7

Demographic

Segmentation

Initial Participant

Characteristics • Modifiable

Behaviors • Conditions

• Participation

Modifiable

Behaviors

Chronic

Conditions

Value Creation • Baseline

• HWAY Impact

Medical Cost

Productivity

Intervention

Impact

Customizable

Inputs

Assumptions Based

Epidemiological Engine Assign Initial Member

Level Characteristics

Assign Cost to

Severity of Existing

Conditions

Managing principal, leading actuarial

and healthcare research company, Healthcare economic expert, Harvard

University

Epidemiologist, Harvard School of Public Health

Health Policy expert, Harvard Medical School Health management expert, Johns Hopkins Bloomberg

School of Public Health

Clinical and health psychologist, University of

Rhode Island CEO, leading behavior change company

Economist, Cornell University

Health policy expert, Harvard Medical School Productivity expert, Cornell University


Opportunity of taking action on long-term conditions: United Kingdom

Source Healthways, World Economic Forum Simulation Model (2012)

8

17

16

16

15

17

17

15

16

130

13

11

11

10

12

11

10

11

89

Inactivity Diet Smoking Alcohol Poor

Standard of

Care

Stress Sleep Screening All

Interventions

Annual

opportunity:

£22 billion

10-year cumulative savings from well-being improvement

£ Billion

Productivity savings

Medical savings

±60% ±£13bn p.a.

±40% ±£9bn p.a.









9


Introduction to Healthways • Well-established company

- Founded in 1981

- $742 million in FY14 revenue

- 2,500+ full-time colleagues

- Serving >70 Million people on 4

Continents

• Science-driven

- 100+ scientific publications backing

proven solutions

- Long-term exclusive partnership with

Gallup to measure well-being globally

• Diverse clients worldwide

- >80 health insurers and commissioners

(public and private)

- >1,000 employers (public and private)

- >100 hospital and health systems 10 Copyright © 2015 Healthways, Inc. All rights reserved.

Copyright © 2015 Healthways, Inc. All rights reserved. 11

In 2008 Gallup and Healthways initiated a 25-year partnership to define, measure and

better understand how to influence well-being – because health outcomes data doesn’t

tell the whole story

Purpose Social Financial Community Physical

Liking what you

do each day and

being motivated

to achieve your

goals

Having

supportive

relationships

and love in your

life

Managing your

economic life to

reduce stress

and increase

security

Having good

health and

enough energy

to get things

done daily

Liking where

you live, feeling

safe and having

pride in your

community

To address long-term conditions and their causes

Healthways has partnered with Gallup on Well-Being


Power of Well-Being measurement

12

Root causes

• Gaps in any Well-Being element lead to higher medical cost, and

lower productivity

Better

language

• Avoids medical jargon

• Enables better communication with the public

• “Health is a motivator, the future absence of disease is not” Public

Health focus group, Devon

Key levels

Individual Organisation Community Country* Global

* UK ranks #44 out of 145 countries in Global Well-Being (2014); Financial well-being high; Purpose well-being low


Productivity goes up

fewer unscheduled absences

Lower presenteeism

Higher reported job performance

More days of “best work”

in a 28-day period

5%

24%

5%

6%

On average, an individual with a 10%

higher well-being score will have:

Healthways cross-sectional analysis.

13

The Value of High Well-Being

less likely to have a hospital

admission

Less likely to have an ER visit

Less likely to incur healthcare

costs

Medical costs go down

Harrison PL et al., “Evaluation of the Relationship Between Individual Well-Being and Future

Health Care Utilization and Cost,” Population Health Management, 2012.

On average, for every point increase in

well-being, individuals were:

2.2%

1.7%

1%


Our approach to improving Well-Being

Report Impact

Establish Plan

Clinical (EHR), SUS, Rx, lab, device, well-being, social network

Analyze & Forecast Stratify population 1 Collect data

Proprietary

Analytics and

Predictive Models

Engage and Support

2 3

4

5

6

Healthy

At Risk

High Risk

Individualized well-being plan and guidance

Self-directed

Virtual coaching

Individual and Group

Live Coaching

Ongoing Treatment Plan

Support

High Risk and Episodic Care Transition

Management

Community / Social Determinants

Physician and individual directed well-being actions

All progress and outcomes communicated to PCP / Patient / Sponsor

14


Our approach to Population Health Management

Effective programmes identify individual needs and address them at each stage

along the spectrum from healthy to highest risk of hospitalisation

Keep Healthy

20%

Identify and

Reduce Risk

70%

Optimise Care

10%

Healthy with

Good Health

Habits

Healthy but

Poor Health

Habits

Health and

Lifestyle

Risk Factors

Well-Managed

Chronic

Condition

Poorly

Managed

Chronic

Condition

High Risk of

Hospitalization


Our proven solutions across the spectrum

• Hospitalisation

avoidance

• Discharge support,

re-hospitalisation

avoidance

• Assisted independent

living

Highest risk

±2% population

±20% costs

• Disease Management

(including Coaching)

• Tele-monitoring

• Tele-care

High risk

±13% population

±40% costs

• Healthy lifestyle

change

• Well-Being Coaching

Medium risk

±70% population

±30% costs

• Healthy lifestyle

change

• Digital well-being

improvement

solutions

Low risk

±15% population

±10% costs

Policy intervention

16


Mapping our services to Well-Being elements

Financial Well-Being (Dave Ramsey)

Well-Being ConnectTM & Well-BeingPlusTM

Groups & Challenges

On-site Coaching

SilverSneakers®

Blue Zones Project®

SilverSneakers

High Risk Cost

Avoidance

InnergyTM

QuitNet®

Prime® Network

Disease Management

Purpose Workshops

Leading for Well-Being

Well-Being Ambassador

SilverSneakers

WalkadooTM

Physician Directed

Population Health

Purpose

Social

Community

Physical

Physical Medicine

WholeHealth Networks

Dr. Dean Ornish

Program for Reversing

Heart Disease

Financial

17


World’s largest Well-Being database

Healthways approach

1. Collect real-world data on

a. Health-related behaviour, and

b. Behaviour change interventions

2. Analyse data to

a. Stratify population, and

b. Identify individual risks

3. Scale-up programmes to drive

population well-being improvement

4. Drive continuous improvement

18

±2 PB


Our unique focus on building scientific evidence

19

Science and Outcomes

• Foundation for the ongoing development and continuous

improvement of all our solutions

• Strong market differentiation for Healthways (many

competitors do not publish)

• Key tenet of our client value proposition

Resources

• 23-member team, including 11 doctoral degrees

• World’s largest health and well-being database ±2 petabytes

• >130 studies/articles

• Peer-reviewed literature available online at

www.healthways.com/science









20


New models of care

21

1. Increasingly we need to manage systems –

networks of care – not just organisations

2. Out-of-hospital care needs to become a larger

part of what the NHS does

3. Services need to be integrated around the

patient

4. We should learn much faster from the best

examples, not just from within the UK but

internationally


• Dave is a 70 year-old retired teacher living alone

• He has hypertension and type 2 diabetes managed by primary care

physician and smokes 20 cigarettes a day

• Last week he presented to A&E and was diagnosed with stroke

• He was an inpatient for five days

• The Occupational Therapist found that he is able to manage activities of

daily living but needs some support

• The hospital doctor discusses Dave with his GP and refers him for Hull

Integrated Health and Social Care

• Dave was discharged from hospital on Monday

22

Citizen experience: Meet Dave


• Dave is offered an appointment by his GP and receives an SMS

reminder on the day

• At the clinic he meets Daisy who explains there is a new service in Hull

that can help keep him well and support him at home where he needs it

• She explains that Dave can opt-in for support that’s designed exactly

for him

• He is offered a red-button he can wear around his neck in case he has a

problem at home, plus a couple of machines he can use to keep a close

eye on his blood pressure and his diabetes

• Dave is also offered support from a call-centre to manage his diet,

encourage gentle exercise designed around him, and help to quit

smoking

• Nurse Daisy is here to help along the way

• Dave accepts the offer…

23

New services are now available…


Discovery tools

Well-Being Assessment

Purpose Social Financial Community Physical

Liking what you

do each day and

being motivated

to achieve your

goals

• Seeing his

family,

especially his

grandchildren

are Dave’s

main

motivation

Having

supportive

relationships

and love in your

life

•Dave only sees

his family

every 3-4

weeks as they

live on the

other side of

Barcelona

Managing your

economic life to

reduce stress

and increase

security

•Dave has a

small pension

but no debts

and is able to

pay his bills

Having good

health and

enough energy

to get things

done daily

•Dave would

like help to

manage his

blood

pressure and

diabetes

•He would like

to stop

smoking

Liking where

you live, feeling

safe and having

pride in your

community

•Dave likes

where he lives

and volunteers

at a youth

centre

24

Nurse Daisy helps Dave complete a Well-Being

Assessment on a computer in the clinic


Call centre

• Dave can call if he has questions

• Rings him every week to help him

manage his blood pressure and

diabetes and check he’s OK

• A specialist tobacco counselor is

helping him quit smoking

Based on his Well-Being Assessment, Dave is

provided a range of services

Simple, clear mobile Apps and

portal

• Tracking for key health data (for

Dave, his doctor, and any family

and friends he wants to nominate)

• Access to library of simple

information to support self-care

GP data integration

• Limited data is shared with GP

according to his preferences

• Practice Nurse Daisy receives more

comprehensive regular data to help

Dave manage his conditions


• Dave’s son wants to help and offers to keep

a check on everything by computer

• Dave signs in and gives his son access

• Together they make a plan to walk together

in the evenings and keep an eye on Dave’s

blood pressure and diabetes

26

Dave provides his son access to his data to help

him manage his health


…from any healthcare provider

…and any mobile/personal health device

27

Dave checks his BP and diabetes at home every

day, sharing his data with his doctor and his son


28

28

Public Health Officer uses aggregate data to

prioritise interventions and track impact


Public Health

Officer New policies to

encourage

walking, enforce

tobacco rules in

Dave’s district

GP Uses data to

monitor and

modify Dave’s

treatment

Dave’s son Helping keep

track of Dave’s

blood pressure

and diabetes, and

encouraging him

to quit smoking

Nurse Daisy Helping

coordinate Dave’s

care

Call centre Helping Dave quit

smoking, manage

his blood

pressure and

diabetes and

improve his well-

being

29

Integrated health and social care • Improves Dave’s health and well-being • Provides targeted support based on his unique needs • Reduces risk of admission to hospital • Promotes independent living

Patient-centred, efficient care









30


• Hospital utilisation significantly reduced by

year one, and increased over the 4-years:

- 11.4% reduction in hospital admissions

- 36.7% reduction in readmissions

- 17.2% reduction in hospital bed days

• Average per-member savings across the 4-

year period totalled £1,636

• Participants were 27% and 45% less likely

to have any admission or readmission,

respectively, over the 4 year study period

Hamar, B, Coberley, CR, Pope, JE, Rula, EY (2015). Long-Term Impact of a Chronic Disease Management Program on Hospital Utilization And Cost in an Australian Population With Heart Disease or Diabetes. BMC Health Services Research; Available online at: http://www.biomedcentral.com/1472-6963/15/174/abstract (last accessed 27 August 2015)

Study 1: Long term impact on hospitalisation Australian chronic disease management programme

http://www.biomedcentral.com/1472-6963/15/174/abstract





-20%

-15%

-10%

-5%

0%

5%

10%

15%

20%

25%

30%

35%

Overall Low Severity

Med Severity

High Severity

Pe

rce

nt C

ha

ng

e in

Ad

mis

sio

n R

ate

Comparison

Intervention

Study 2: 12-month outcomes in German programme

32

Hamar, B, Wells, A, Gandy, W, Haaf, A, Coberley, C, Pope, JE, Rula EY (2010). The Impact of a Proactive Chronic Care Management Program on Hospital Admission Rates in a German Health Insurance Society. Population Health Management

• Admission rate in Intervention group decreased by 6.2%

compared with a 14.9% increase in the Comparison group

• Dose-response relationship with calls per participant

• Proactive care management effective helping German

members manage chronic conditions and avoid admission


Study 2: 12-month outcomes in German programme

Year 1 Year 2

Control group (N) 202,482 193,343

Participant group (N) 25,204 30,536

Participant months (n) 427,217 452,126

Savings (€ per patient

per month) 11.70 24.21

Total savings

(€ 000) 4,998 10,944

33


Design

• Randomized, placebo-controlled trial

• Email, web, and mobile-based

• Intervention: Daily Challenge (participants receive

daily suggestions of small health actions)

• Control: Traditional weekly health newsletter

Results

• Daily Challenge improved well-being significantly

more than control at 30, 90 days

• Well-being improvement was greater in

participants with than without social ties in the

program

Conclusions

• Multimodal online intervention leveraging social

network effects significantly improved well-being

over control Cobb NK, Poirier J (2013). Effectiveness of a Multimodal Online Well-Being Intervention: A Randomized Controlled Trial. AJPM, 2013; Available online at:

http://www.ajpmonline.org/webfiles/images/journals/amepre/AMEPRE_3923-stamped- 102913-2.pdf (last accessed 27 August 2015)

Study 3: Digital solutions alone can improve well-being US randomised controlled trial

http://www.ajpmonline.org/webfiles/images/journals/amepre/AMEPRE_3923-stamped-102913-2.pdf















35


Partnerships for impact

MeYou Health The development of products and solutions at the intersection of mobile technology, social network science, gaming, and Well-Being improvement

Navvis Health system strategy, leadership and performance to help healthcare leaders achieve success in a complex, ever-changing marketplace

Wholly-Owned Subsidiaries

Dean Ornish Science based models for lifestyle supported behavior change as treatment for coronary artery disease, diabetes and early stage prostate cancer

MIT AgeLab Working to advance health education and support for an aging population

Pro-Change Behavior Systems Jointly developing leading approaches to improved behavior modification

Johns Hopkins University Unique research and innovation relationship with the schools of medicine, nursing and public health

Gallup-Healthways Well-Being Index Creating definitive measure of well-being through the Gallup-Healthways Well-Being Index

Dave Ramsey’s Financial Wellness Program tools and proven expert-driven coaching to create a personalized financial plan

Blue Zones Joint venture to scale population longevity interventions of permanent and semi-permanent environmental changes

Hewlett-Packard Enhancing an already powerful platform with greater scalability and sustainable timely innovation at a lower cost

RoundArch Deliver a unique, total digital experience for our Well-Being Improvement Solution that drives sustained engagement through web, mobile and social media

Technology Partnerships

Academic Partnerships

Strategic Partnerships

36

http://navvisandcompany.com/









37


Why you, why now?

• Local leadership can create a ‘virtuous cycle’,

delivering the triple goal:

- Quality

- Access

- Cost

• Strong political and NHS England support for

radical innovation

• Strong grassroots belief in the need to innovate

• 2020 is coming quicker than we think!

38


Thank you!

eMail: [email protected]

Tel: +44 7447 186 580
