phillip l. polakoff, md,mph,menv.sc. january, 2015
TRANSCRIPT
Health Transformation
ALL for ONE!
Phillip L. Polakoff, MD,MPH,MEnv.Sc.
January, 2015
“Health is a state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity.”
2
In Our Nation: A Tale of Healthcare
“It is the best of times…Unprecedented advances in medical technology, treatments,
and pharmaceuticals can improve population health
“It is the worst of times…”The state of public health, unsustainable health care costs, the quality of medical care delivered and access to services challenge clinical care
and overall health
Sources: Sam Nussbaum, MD, “Advancing Health Care Quality, Access, and Affordability Through Innovation”; Charles Dickens “A Tale of Two Cities”. 3
“Affordable Care Act has ‘Sovietized’ the American Health Care System.”
“If all we are doing is adding more people to a broken system than costs will continue to skyrocket.”
4
Key Challenges in U.S. Health Care System
Source: Sam Nussbaum, MD, “Advancing Health Care Quality, Access, and Affordability Through Innovation”
UNSUSTAINABLE COST
VARIATION IN
QUALITY
LACK OF COORDINA
TION
20%OF GDP BY 2021
$700BWASTE ACROSS U.S.
SYSTEM
2XCOST PER CAPITA
VERSUS OECD NATIONS
45%CARE INCONSISTENT WITH RECOMMENDED
GUIDELINES
$210BUNNECCESARY SERVICES
3XVARIATION IN HOSPITAL DAYS IN LAST 6 MONTHS
OF LIFE
19.6%MEDICARE HOSPITAL
READMISSIONS
$45BANNUAL COSTS FOR
AVOIDABLE COMPLICATIONS$91B
REDUNDANT ADMINISTRATIVE
PRACTICES
5
Source: Centers for Disease Control and Prevention
Smallest Impact
Largest Impact
Examples
Counseling &
Education
Clinical Interventio
ns
Long-lasting Protective
Interventions
Changing the Contextto make individuals’ default decisions
healthy
Socioeconomic Factors
Eat healthy, be physically active
Rx for high blood pressure, high cholesterol, diabetes
Immunizations, brief intervention, cessation treatment, colonoscopy
Fluoridation, trans fat, smoke-free laws, tobacco tax
Poverty, education, housing, inequality
Health Impact Pyramid Factors that Affect Health
6
What’s the Return on $2.9 Trillion?
Source: The Way to Wellville Challenge; www.HICCup.co7
The Triple Aim
U.S. health care system is the most costly in the world
Yet, we get the worst outcomes of nearly any industrialized country, even when adjusting for age and income
The Institute for Healthcare Improvementhttp://www.ihi.org/Engage/Initiatives/TripleAim/pages/default.aspx
Population Health
Per Capita Cost
Experience of Care
8
Provider
Network
Home
Self-care
Technology
Information
9
Sick-Care Healthcare Health
An Epidemic Explosion of Lifestyle Related Chronic Conditions
70%of US deaths are
tied to cardiovascular
condition, cancer and
diabetes
75%of healthcare expenditures
are tied to cardiovascular
condition, cancer and
diabetes
>50%of Americans
are likely to be obese by 2030 costing $66B in
treatment
10
D.O.D.
Our Nation:Nutrition, Physical Activity, and Obesity
11
Our Nation:Tobacco Use
12
We Need a New Model
13Source: The Way to Wellville Challenge; www.HICCup.co
Macro Challenges
14
Consumer Directed Healthcare
Affordable Care Act
Physician Shortages
Regulation
Role of the Physician
Lifestyle Factors
Patient Dynamics
Social Media
The Healthcare LandscapeThe Market Is Complex And Evolving . . .
The U.S. health market requires greater flexibility and insight than ever before. Leaders increasingly need expert advise to make sound
decisions in today’s climate.
Regulatory
Environment
Aging Populati
on
Evolving Payment Models
State Budget Crises
Unprecedented
Environmental Change
Consumerism
Comparative
Transparency
Workforce
Challenges
Emerging Technologi
esQuest for Value
15
Demographics Healthcare Reform
Population GrowthPopulation AgeingChronic Conditions
Economic Pressure
GovernmentsEmployersMarket Competition
PPACA (US)Other global reform (e.g., GER)ARRA, HITECH for EHR
Aggregation, Storage and AnalyticsPooling/Open DataData Center Capacity
TelemedicineWireless SensorsRemote Patient MonitoringApps/Social Media
GenomicsTargeted TherapeuticsPersonalized TreatmentsPharma Firms Competing to ‘Own The Disease’
Payer-Provider Integration Incentive AlignmentRisk Shifting
Consumer EngagementValue Based Benefits Wellness/Preventative Programs
Population Models (e.g., PCMHs, ACOs)Condition Oriented Models (COEs, DM programs)
Key Drivers
Business Model
Enablers
Convergence Care Model RedesignConsumerism
Technological
Enablers
‘Big Data’Personalized
MedicineMobility
Various economic, technological, regulatory and social factors are pushing the industry in new directions, creating problems that never before existed.
The Healthcare LandscapeDrivers and Enablers of Change
16
The Past
Employers, payersRisk
Reimbursement
Service/volume-based
2000 2010 2015 2020
Delivery Hospital-based, expert/specialist driven
Community/retail-based, team driven
Information
Siloed, static, paper-based
Treatment One-size-fits-all, volume-based
2005
Personalized, value-based
Networked, dynamic, digitally-based
Performance/value-based
Providers, patients
The Future
Physicians are in the unique position to help shape the industry’s future
Healthcare transformation has afforded physicians unprecedented opportunities to shop their medical degrees to firms tasked with solving today’s issues.
The Healthcare LandscapeWhere is the Industry Going?
17
In 5 Years, Overall Forecast …
Source: Rich Umbdenstock, President of the American Hospital Association, “Transforming Healthcare Delivery”
Nationally
Your Market &
Organization
More hospitals in health systems More physician affiliation with hospitals More providers owning health plans
More value based payments More fixed/capitated payments
Decreasing total revenue Increasing outpatient revenue Split view on costs increasing or decreasing Providing more primary care, urgent, health/wellness and home health services; less so in nursing home, and social/human services Same or fewer inpatient beds Half planning to repurpose inpatient beds or inpatient space to outpatient/ambulatory, rehab, observation, psych, hospice Most patients will have primarily electronic healthcare interactions
More retail clinic visits through mostly independent clinics Significantly fewer use of medical resources Implementing multidisciplinary teams Conducting telephonic outreach of discharged patients Half are implementing predictive analytics to identify high risk patients in some areas Primary talent gaps are population health management, data analytics, change management and non traditional health partnerships Many organizations are seeking Partner or Experiment path, but varies by hospital type
18
The goal of population health management is to keep a patient population as healthy as possible, minimizing the need for expensive
interventions.
Proactive preventive and chronic care to all of a patients during and between encounters
Manage high-risk patients to prevent them from becoming unhealthier and developing complications
Use of evidence-based protocols to diagnose and treat in a consistent, cost-effective manner
Population
Health
Accountable Care
Patient Registrie
s
Care Teams
Disease Mgmt
Patient-Centered Medical Home
Coordinated Care
19
Population HealthThe First Line of Defense
CURRENT VIEW:30 Patients per Day14 have Chronic ConditionsUnknown Health RisksOffice Visits too short for coaching
NEW POPULATION VIEW:2500 Patient Population900 have Chronic Conditions1100-1250 have Moderate/High Health RiskCare Teams leveraged by HIT
Volume-Based/Episodic Care Value-Based/Continuous Care
20
Population HealthTransitioning to Value Is a Huge Change
21
Population HealthA Model
Functional
Status
Morbidity
Rate
Mortality
Rate
Clinical Quality ImprovementThree Core Metric Objectives
22
Designing Triple Aim Solutions
Characteristics of a System:
Process for Design:
Source: Georgia Department of Public Health
Identification of target
populations
Definition of system aims
and measures
Development of a portfolio of
project work that is
sufficiently strong to move system-level
results
Rapid testing and scale up
that is adapted to local needs and conditions
Focus on individuals and
families
Redesign of primary care services and structures
Population health management
Cost control platform
System integration and
execution
23
Community
Health
ChronicDiseas
e
Payment
Rewards
Behavioral
Health
Health vs.
Care
PublicHealth
PublicSafety
K-12Educati
on
Community
Investment
Source: Truman Medical Centers24
Population HealthDynamics
PolicyMakers
/ Advoca
tes
Patients/Community
Politicians Clinical
Providers Pharma
/Medica
l Device
s/Vendor
sPatient/Commun
ityAdvocat
es
Public HealthAgenci
es
Educational
Systems
Purchasers
Payers
HealthSystem
s
25
Population HealthInteractive Stakeholders
26
Micro Challenges
26
Local Politics
Transitions
Payer Mix
Local Workforce Issues
Competitive Environment
Geography
Access to Care
Seven Core Health Transformation Principles to Achieve Success
27
Doing Care Differently:Journey to a Healthier Nation
Logic will get you fromA to B
Imagination will take you everywhere
- Albert Einstein
28
Discussion
29
Contact Information:
Phillip L. Polakoff, MD,MPH, MEnv.Sc. Health Transformation Leader
510-508-9216
30