the patient to consumer revolution - abms.org© oliver wyman | chi-hlc05601-037 . 2 . what will...

0 0 HEALTH & LIFE SCIENCES

Health Market 2.0

The patient to consumer

revolution

Quantified self

Transparent consumer markets

Smart care teams

1 1

CHANGING THE CONVERSATION

2 © Oliver Wyman | CHI-HLC05601-037 2

WHAT WILL CONSUMERS EXPECT?

Personalized Health & Lifestyle Convenience and Simplicity

Baseline quality standards Relevant Partnered Engagement

Prediction & Prevention

Value Transparency - Shopping

CONSUMERS WANT – BETTER VALUE AND WAY LESS HASSLE

THE NEW BASICS CONSUMER MARKET BETTER LIVING


THE TRILLION DOLLAR GROWTH RUNWAY

Consumer Skin in the Game

Retail Exchanges

Health Apps & Communities

Consumer Tech Players Create Transparent Health

Market

Retailers Monetize Health & Lifestyle

Market Relevant Quantified-Self

Consumer Engagement Ecosystems Redefine

Chronic Care

WHY NOW? OPPORTUNITY IS JUST TOO COMPELLING

CONSUMER MOTIVATION

CONSUMER POWER

DISRUPTIVE ALTERNATIVES

A BETTER LIVING MARKETPLACE

Precision Science Pioneers Open New Markets

4 4

Consumers Suppliers

MARKET STRUCTURES

ORGANIZED ECOSYSTEMS

Social networks

Navigators and mobile apps

• Tele-health

• Specialty care

• Hospitals

• ASCs/DxCs

• Assisted living

• Skilled nursing

• Rehab

• Hospice EOL

• Primary care

• Smart care teams

• Convenient care

Gramps

LEADING TO HEALTH MARKET 2.0

Fred

Sally

HEALTH MARKET 2.0 ATTRIBUTES • Price/value transparency

• Crowd sourcing

• Sensible consumer economic units

• Balanced marketplace competition

• Open market borders

• Efficient substitute economics

• Significant value innovation curve

5 5 © Oliver Wyman | CHI-HLC05601-037

ENGAGED

PERSONALIZED LIVING BETTER

CONNECTED

MORE GOOD YEARS

Meet FRED 2.0

$10k

LIFESTYLE MEDICINE HYPERTENSIVE

NON-COMPLIANT DIABETIC

OBESE

ADULT

HONDA

Meet FRED 1.0

$25k

Health Market 2.0

The patient to consumer revolution

HOW ARE YOU THINKING ABOUT FRED?


POPULATION AND CONSUMERS End of life • Palliative care experts • Support for caregivers • Hospice centers • Legal/financial advisers

for family • Etc.

Poly-chronic/complex • Dedicated “Extensivists” • Remote monitoring • Specialty clinics • Integrated behavioral health • Etc.

Severe behavioral • Dedicated psychiatric

NPs/MDs • Bio-monitoring of

Rx adherence • Dedicated social worker

and PCP • Etc.

Chronic with social needs • Case worker embedded

in care team • Dedicated coach focused

on nutritional and mental health needs

• Etc.

Early chronic/at-risk • Dedicated health coach

focused on fitness, nutrition • Attention to behavioral health • Rewards for meeting

health goals • Etc.

Generally healthy • Affordable acute

care options • Rewards and incentives • Social/mobile health

tracking tools • Etc.

Potential Care Model Components

Specialized care models for population segments with distinct needs

Presenter

Presentation Notes

Organizations will apply and customize the patient centered care design principles for specific population segments based on the unique needs of the segment – frail elder, people with chronic disease and mental illness, terminally ill, and so on. Applying this powerful shift to patient centered care – new teams, new technology, new engagement, broader focus, personalized and real time – to unique population segments leads to resetting the value bar on cost, access, quality, outcomes, and patient experience.


Consumer engagement

Lifestyle medicine

Big data, EBM and

personalized health

Magnitudes illustrative

A NEW INDUSTRY PROFIT MODEL

THE NEW PROFIT LEVERS

Passive monitoring & prevention

Health Market 1.0

Hea

lth v

alue

impa

ct o

ppor

tuni

ty

Potential profit

10%

10%

10% 5%

Complex adaptive

ecosystems

5%

Health Market 2.0

Better consumer pricing

The new profit drivers

40%

HEALTH AND LIFESTYLE

Presenter

Presentation Notes

In the new full budget world PHMs will have new profit levers – all of which relate to improving total value. 1. acuity rating the population is the starting line for creating the appropriate full budget. Under rating drives losses and over rating drives profits. 2. managing the care across the population and delivering the care more cost effectively with better value drives profit. 3. Using information analytics to predict/prevent and having early interventions (avoiding acute events) drives profit. 4. Changing consumer engagement or behavior – medication compliance, lower stress, daily activity, better diet, more social connection leads to better health and drives profit. The new profit levers are completely different than the existing ones.


WHAT WILL IT TAKE TO WIN

40% BETTER OVERALL VALUE GUARANTEED

TEN—X BETTER CONSUMER EXPERIENCE

SHOPPABLE AND IN CONSUMER TERMS

ALWAYS AVAILABLE AND INTEGRATED

HEALTH AND LIFESTYLE – PERSONALIZED

REAL TIME, PREDICTIVE AND PREVENTITIVE

ALMOST NO UNWARRANTED VARIATION

NEW INTEGRATED ECOSYSTEMS

9 9

THE CONSUMER TECH ATTACK CHANGES

EVERYTHING


No Coordination

of Care

Hard to fit patients in schedule

Lack resources to manage chronic

illnesses

Doctors Wait weeks

to see doctor

Too many patients, too little

time

No time or $ to talk end of life

Emotionally attached

Byzantine billing

More billing staff than nurses

Hard to be ideal doc

Professional frustration

Miss Appointments

Problems go unnoticed

Can’t Drive

Complicated referrals

15-20 medications

Patient

Expensive hospitalization

Multiple specialists

Conflicting treatments

No holistic care

Emergency? Call 911

Expensive co-pays

No end-of-life plan

Health Plan

Redundant treatment

Hard to find quality docs

Costly senior care

Risk of adverse selection

death spiral

Need to minimize

costs Staff focused on costs, not prevention Small

margin for Medicare patients Denial of

coverage

UNLOCKING CONSUMER VALUE


IT IS ALREADY UNDERWAY

• MyFitnessPal • Jawbone • Zipongo • Livongo

• Google • IBM Watson • Apple • Microsoft

• Theranos • NantHealth • Illumina - HL • 23andMe • Samsung

• Castlight • WebMD • Zest • ZocDoc

• HealthSparq • Amazon

• Liazon • Bloom • Mercer Market

• Towers

• Welltok • Audax • Rally

• Teladoc • MDLive • HealthSpot

• HealthCare Partners

• Iora • Qliance • CareMore

• Evolent • xG Health • Optum • Healthagen • Alignment

• Weight Watchers

• Whole Foods • GNC

• Walgreens • Walmart • CVS • Rite Aid • Target

Health Market

1.0

Advanced diagnostics

Health shopping

Exchanges

Engagement platforms

Mobile health/ home hubs

Smart care teams PHM

PHM enablement

Food and grocery

Retail

Mobile and monitoring Tech – Big data TECHNOLOGY

ATTACK

CONSUMER MARKETS

HEALTH ECOSYSTEMS

RISE OF RETAIL



• Google • IBM Watson • Apple • Microsoft

• Theranos • NantHealth • Illumina - HL • 23andMe • Samsung

• Castlight • WebMD • Zest • ZocDoc

• HealthSparq • Amazon

• Liazon • Bloom • Mercer Market

• Towers

• Welltok • Audax • Rally

• Teladoc • MDLive • HealthSpot



• Evolent • xG Health • Optum • Healthagen • Alignment

• Weight Watchers

• Whole Foods • GNC

• Walgreens • Walmart • CVS • Rite Aid • Target

Health Market

1.0


Health shopping

Exchanges


Mobile health/ home hubs


PHM enablement

Food and grocery

Retail

Mobile and monitoring Tech – Big data TECHNOLOGY

ATTACK

CONSUMER MARKETS

HEALTH ECOSYSTEMS

RISE OF RETAIL

REDRAWING THE MARKET MAP

Health Market

1.0

Benefits coverage and risk

Healthcare delivery

Healthy living &

wellness

Long-term life/health planning

Health Market

2.0


RISE OF RETAIL C

ONSUMER MARKETS

TECHNOLOGY ATTACK

EXCHANGES

ENGAGEMENT PLATFORMS

HEALTH SHOPPING

TELEHEALTH

ADVANCED DIAGNOSTICS

SMART CARE TEAMS PHM

RETAIL

FOOD AND GROCERY

MOBILE AND MONITORING MyFitnessPal Jawbone Zipongo Livongo

TECH – BIG DATA

PHM ENABLEMENT

Google IBM Watson Apple

Theranos Hudson Alpha Illumina 23andMe

Castlight

WebMD

DocSpot

Amazon

Liazon Bloom

Welltok

Audax

Teladoc MDLive HealthCare Partners Iora Qliance CareMore

Evolent xG Health Optum Healthagen

Weight Watchers

Whole Foods

McDonalds

GNC

Walgreens

Walmart

CVS

Rite Aid

HEALTH AND WELLNESS ECOSYSTEM

$10bn from strategic(s)

1600 clinics

200m consumers 100k apps

100 biomarkers

now

1000 biomarkers coming

4m daily downloads

WITH ACCELERATING

VELOCITY

Next gen disruptors

getting to scale


DESIGNING AROUND THE CONSUMER

Single sick care business unit

Clinically integrated sick care networks

Population based health ecosystem

Population based health and wellness ecosystem

Consumer better living ecosystem

Transactional finance

Transactional clinical

Basic reporting

Complex adaptive workflow

Population analytics

Social networks and mobile apps

INFO

RM

ATIO

N V

ALU

E LA

DD

ER

BUSINESS DESIGN AND ORGANIZATIONAL SCOPE

Big data -- personalization

Actionable insights

Predict/prevent modeling

15 15

Crowd Sourcing & Social Networks

Cloud Platform Technology & Big

Data Mobile Smart

Platforms

Biometric Monitoring & Wearable Sensors

RETHINKING WHAT IS POSSIBLE

Next Generation Diagnostics

Low Cost Sequencing & Biomarkers

WiFi Implantable Nanotechnology

Gigabit Fiber Networks

16 16


FRED THE HONDA

$25k

17 17



Data

Mobile Smart Platforms




Low Cost Sequencing &

Biomarkers



FRED THE HONDA

$25k

Always Available

18 18



Data






Biomarkers



FRED THE HONDA

$25k

Location Independent

19 19



Data






Biomarkers



FRED THE HONDA

$25k

Transparent , Crowd Sourced & Social

20 20



Data






Biomarkers



FRED THE HONDA

$25k

Personalized, Relevant & Adaptive

21 21



Data






Biomarkers



FRED THE HONDA

$25k

Predictive & Preventative

22 22



Data






Biomarkers



FRED THE HONDA

$25k

Limited Practice Variation

23 23



Data






Biomarkers



FRED THE HONDA

$25k

Predictive & Preventative

Limited Practice Variation

Location Independent

Always Available

Transparent , Crowd Sourced & Social

Personalized, Relevant & Adaptive

24 24

THE TRILLION DOLLAR RACE

The worry – search – shop – buy – schedule loop •Best total value – price, convenience, quality transparency • Integrated rewards changing the insurance risk paradigm •Adaptive personalized experience

1

25 25

THE TRILLION DOLLAR RACE The new front door

•$25 visit and $5 script •Clinic or virtual •Mobile or retail diagnostics •Never leave home, or •Perfect visit and chicken soup

2

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=http://www.healthspot.net/&ei=sPv1VMOPH4X3UJrWgNgB&bvm=bv.87269000,d.cWc&psig=AFQjCNHu7a-9idmrRljcHfAtQAbUcnRYjQ&ust=1425493291831246

26 26


Consumer engagement ecosystems (at-risk, chronic) •Predictive and preventative •Personalized and real time •Connected and relevant •Health and lifestyle

3

27 27

Path to zero practice variation •Longitudinal PHR and big data •Highly accurate retail diagnostics •Personalized EBM treatment plan


4

28 28


Higher value acute care for complex chronic patients •Patient centered health ecosystem •Connected care team, shared PHR • Insights engine – treatment plan •Patient centered smart workflow •Applied precision medicine

5

29 29

Path to zero practice variation • Longitudinal PHR and big data • Highly accurate retail diagnostics • Personalized EBM treatment plans • Big data, biomarkers, tissue banks


The new front door • $25 visit and $5 script • Clinic or virtual • Mobile or retail diagnostics • Never leave home, or • Perfect visit and chicken soup

Consumer engagement ecosystems (at-risk, chronic)

• Predictive and preventative • Personalized and real time • Connected and relevant • Health and lifestyle

The worry – search – shop – buy – schedule loop

• Best total value – price, convenience, quality transparency

• Integrated rewards changing the insurance risk paradigm

• Adaptive personalized experience

Higher value acute care for complex chronic patients

• Patient centered health ecosystem • Connected care team, shared PHR • Insights engine – treatment plan • Patient centered smart workflow • Applied precision medicine

1

2

3

4

5

Five Massive New Market Spaces


Undiagnosed depression;

pre-hypertensive

Poly-chronic, severe mobility impairment, depression, in skilled

nursing facility

Overweight, diabetic, high blood pressure,

undiagnosed depression

Hea

lth s

tatu

s m

igra

tion

Lifetime

Psychologist catches early depression,

addresses it Nutritionist helps craft better diet to promote

good weight PCP addresses high cholesterol

with an Rx

Occasional home care visits help maintain

independence

Over weight, diabetic, high blood pressure,

depression, CHF

Fully mobile

Care team prescribes coaching, diet,

exercise program

Biosensors, light weight training, strength and

stretch training Health Market 2.0

Health Market 1.0

GIVING US THE PROMISE OF TEN MORE GOOD YEARS

Physician Centered Sick Care

31 31

THREE CONVERGENT MOVEMENTS


ELEMENTS OF HEALTH MARKET 2.0


Quantified self

Healthy living values

Clinical and health condition values

Expense and budget values

Quantified self the bridge to a personalized health and wellness marketplace

Social and expert

communities

Health living rewards exchange

Exchanges and shopping market



Changing consumer’s health IQ and engagement level thru real time health/living feedback through a common sense mobile app

Healthy living values • Steps or activity • Sleep • Nutrition • Stress • Weight

Clinical and health condition values • Blood sugar • Weight changes • Blood pressure • Heart function • Blood oxygen

QUANTIFIED SELF

Expense and budget values • Premium share • Risk exposure • Co-pay/deductible • Rewards


Healthy living values • Steps or activity • Sleep • Nutrition • Stress • Weight

Clinical and health condition values • Blood sugar • Weight changes • Blood pressure • Heart function • Blood oxygen

Real time personalized preventive health


Exchanges and shopping

market

Smart personalized shopping

Smart care team a personalized ecosystem

Health living rewards

exchange

Increased relevance and engagement through social communities

Social and expert

communities

Expense and budget values • Affordability • Deductible status • Exposure • Pharmacy costs • Reward opportunities

QUANTIFIED SELF



Personalized Better Living

Itinerary

Crowd Sourced Recommendations

Retail Healthy Living Services

Personal Health Economy/Bank

Convenient Care

Major Diseases and Conditions

Surgical and Diagnostic Procedures

Acute and Complex Care

Services

Annual Decision Process

Plan Year Marketplace



Crowd sourced recommendations

Personal health economy/bank • Benefits • Reward • Flex dollars • Cash/debt

Insights engine

Annual decision process

TRANSPARENT CONSUMER MARKETS

Consumers with advanced decision tools building personalized configurable health solutions during annual enrollment

Personalized better living

itinerary

Smart care team


Retail healthy living

services

Acute and complex care

services

Surgical and diagnostic procedures

• Cancer care • Inflammatory disease • Vascular and cardiac • Renal care

Consumers and families working with their smart care team and

decision tools to make more

informed decisions on

acute and complex care

Convenient care

Real time shopping based on price location, waiting times and experience

Consumers making informed decisions about disease treatment with support tools and their smart care team

Bundled procedures with comparative price, value, experience and outcome information

Retail health and wellness shopping with integrated rewards

Annual decision process

Plan year online shopping

marketplace

Major diseases and

conditions

TRANSPARENT CONSUMER MARKETS

Crowd sourced recommendations

Personal health economy/bank • Benefits • Reward • Flex dollars • Cash/debt

Insights engine

Personalized better living

itinerary

Smart care team


Predictive, personalized, preventive health, wellness and engagement system

Smart Care Team

A Personalized Ecosystem

Communication platform

Biosensors and monitoring

Predictive insights engine

Weight management

Stress management

Nutrition management

Smart clinics

Retail pharmacy clinics

Coaching

Telehealth

Physical in the community

resources

Virtual health resource access

Better living programming

IT enablement engines

Complex Adaptive Workflow

Personalized Health Itinerary

Intuitive engagement model

Real time biometric and daily living information

Personalized connected relationship

Smart care teams



The smart care team building the foundation with full multi-skill team composition and a consumer better-living culture




Smart Care Team


Smart clinics Physical

in the community resources

SMART CARE TEAMS

Coaching

Telehealth

Virtual health

resource access



Diving into daily living relationships with the consumer through passive monitoring, real time feedback – prevention becomes expected


Complex Adaptive Workflow Personalized Health Itinerary Intuitive engagement model





Weight management

Stress management


Smart clinics

Coaching

Telehealth

Physical in the

community resources

Virtual health

resource access


IT enablement

engines


Smart Care Team


SMART CARE TEAMS



Building in near perfect diagnostics with personalized treatment plans, behavioral segmentation models and advanced predictive capabilities








Weight management

Stress management


Smart clinics

Coaching

Telehealth


IT enablement

engines

Genomics and advanced diagnostics


Virtual health

resource access

Physical in the

community resources

Smart Care Team


SMART CARE TEAMS







Value based acute and complex care services


Smart care teams partner with consumers to navigate and coordinate acute and complex care

Smart Care Team





Weight management

Stress management


Smart clinics


Coaching

Telehealth


resources



IT enablement

engines

Genomics and advanced diagnostics

Shared longitudinal and collaborative health record

SMART CARE TEAMS


HEALTH MARKET 2.0

Quantified self

Healthy living values

Clinical and health condition values

Expense and budget values


Social and expert communities

Health living rewards exchange

Exchanges and shopping market


Personalized Better Living Itinerary

Crowd Sourced Recommendations

Retail Healthy Living Services

Personal Health Economy/Bank

Convenient Care

Major Diseases and Conditions

Surgical and Diagnostic Procedures

Acute and Complex Care Services

Annual Decision Process

Plan Year Marketplace


Smart Care Team





Weight management

Stress management


Smart clinics


Coaching

Telehealth


resources









Smart care teams

45 45

UNLOCKING THE INCUMBENT’S DILEMMA


The biggest problem in business … is staying with your previously successful business model two to three years too long.


The trillion dollar question… how can you change the mental model and thrive in Health Market 2.0?


1. CHANGE YOUR FRAME OF REFERENCE


• Google • IBM Watson • Apple

• Theranos • Hudson Alpha • Illumina • 23andMe

• Castlight • WebMD • DocSpot • Amazon

• Liazon • Bloom

• Welltok • Audax

• Teladoc • MDLive



• Evolent • xG Health • Optum • Healthagen

• Weight Watchers

• Whole Foods • McDonald's • GNC

• Walgreens • Walmart • CVS • Rite Aid

TECHNOLOGY ATTACK

CONSUMER MARKETS

HEALTH ECOSYSTEMS

RISE OF RETAIL

Health Market

2.0


Health shopping

Exchanges


Telehealth


PHM enablement

Food and grocery

Retail

Mobile and monitoring Tech – Big data


Network advantage

Value chain control

New industry standard

Product leadership

True commodity Price position

Price advantaged

Above market

Market position

Multi-year lead Laggard

Ecosystem

Highly coordinated

Consumer beware

Point of design

Consumer - health

Physician - disease

Transformative value

Become magnetic

Delight consumers

A new consumer economy with redefined value

Priced based Competition and substitute economics

2. DON’T GET BLIND SIDED BY THE SPEED OF CHANGE


3. KNOW THAT IT IS NOT A LEVEL PLAYING FIELD

Asset intensity

Return on capital

Access to capital

WALL ST

Market value

Speed

Information Intensity

Regulation

Geographic scope

New Players

Adjacencies

1 new operating theatre a decade

1 dollar of capital for a dollar of

revenue

25 new product releases a year

5 cents of capital for a dollar of

revenue

Incumbents

AGILITY WEIGHT GLUE FUEL

A capital markets perspective


Protect the fort

Reinvent &

Innovate

Consumer configurable health plans

Population based smart care team ecosystems

4. SHIFT YOUR STRATEGIC FORMULA TO 70% OFFENSE

Protect the fort

Reinvent &

Innovate

Provider

Payer


? Health Market 1.0 Incumbent

PASSIVE MONITORING

BIG DATA AND PREDICITVE MODELING

MOBILE APPS

RETAIL PHARMACIES

5. DON’T GO IT ALONE – PARTNER

Health Market 2.0 New Players

Selecting Strategic Partners from the

Health and Wellness Jungle

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=p0URnalUj-iRZM&tbnid=4sJyjF4DCnfFOM:&ved=0CAUQjRw&url=http://sketchup.google.com/3dwarehouse/details?mid=d58ef2d21b126ea87827edf8f3dcefd5&ei=vzdvUf2rHbHI4APjsoEg&bvm=bv.45368065,d.dmg&psig=AFQjCNGTIKTj0speaXpCeVYCkXu1SSi1cg&ust=1366329658582252


Hospital system

Clinically integrated network

Patient center care model

1

2

3

Smart care team ecosystem


Smart Care Team





Weight management

Stress management


Smart clinics


Coaching

Telehealth


resources









4

6. RUN SKIP-GENERATION PLAYS

Population based smart care team

Provider


Population health management businesses

Convenience care service models

Value based episodic and chronic care models

7. BUILD BUSINESSES LEVERAGE THE ROADMAP

Low High Required Investment

Moderate

Prof

it M

argi

n High

The Portfolio Approach to Transformation

Full risk Medicare

Advantage

Employer Carve-outs for

consumers with chronic disease

Managed Medicaid Programs

Disease Centers of Excellence

Consumer packaged

procedures

Access Channels: Clinics & Kiosks

Ambulatory Surgery

Urgent Care

Virtual Care

New high growth risk based PHM business models

No-regret FFS extensions

Home Health

Hospice & End of Life

Care Consumer

centered value based health

services

55 55 © Oliver Wyman | CHI-HLC05601-037 Personalized better

Health and w

ellness

Popu

latio

n ba

sed

smar

t Transparent consumer

Healthy living community stores +

care team ecosystems

consumer banking

shopping markets

livin

g ec

osys

tem

s

Consumer configurable health plans

The Scarcest Commodity

LEADERSHIP

56 56

VIVA LA CONSUMER REVOLUTION!!

the patient to consumer revolution - abms.org© oliver wyman | chi-hlc05601-037 . 2 . what will...

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