Post on 07-May-2015
Matthew Holt
Forecasting the future is really hard
2010 Reality?52 million uninsuredPer capita spending only $8,300Share of GDP 17.3%
Guess ONE:65m uninsured; 19% of GDP
& $10,000 per capita
…leads to…Reform after 2010
Guess TWO:47m uninsured; 16% of
GDP & $8,600 per capita
…leads to…No Reform after 2010
Who do Americans Believe
Can Predict the Future?
05
101520
253035404550
Biblical Prophecy
Farmer's Alm
anac
Astrologers
Psychics
Pollsters
Ouija Board
Magic 8 Ball
Source: Peter D. Hart Research Associates, for the Shell Poll 1998
Percentage who
believe
Unemployment:
The hours are great, but…
Founded 2003
First month’s visits
73
Media sources people trust
Health Care Costs Too Much
0
1000
2000
3000
4000
5000
6000
7000
1980 1984 1988 1992 1996 2000 2004
Canada
France
Germany
United Kingdom
United States
Dollars spent per capita
Average
spending on
health
per capita
($US PPP)
Source: Gerard F.
Anderson, Ph.D.,
and Patricia
Markovich,
Data: OECD Health
Data 2008 (June
2008)
Commonwealth
Fund 2008
Us
Them
Average
spending on
health
per capita
($US PPP)
Source: Gerard F.
Anderson, Ph.D.,
and Patricia
Markovich,
Data: OECD Health
Data 2008 (June
2008)
Commonwealth
Fund 2008
4
6
8
10
12
14
16
1980 1984 1988 1992 1996 2000 2004
Canada
France
Germany
Switzerland
United Kingdom
United States
Health spending as share of GDP
Us
Them
I = f(PDI) = f(M5B + MBZ)
Where:
• I is increase in health care costs• PDI is physicians’ desired
income• M5B is mortgage payment on a 5
bedroom house with a pool• MBZ is monthly lease on
a new 300 series Mercedes
Source: Analysis of the March 1988–2004 Current Population Surveys by Danielle Ferry, Columbia University, for The Commonwealth Fund
Rapid Increase in Uninsurance; in the MiddleWorking adults in US who were uninsured for at least 3 months in a 2 year period
20% 21%24%
4% 5% 6% 6% 5%
51%50%48%
52%48%
44%41%
39%37%35%
18%25%
8% 10% 10% 11% 11%
0%
20%
40%
60%
1999* 2000 2001 2002 2003
Lowest
quintile
Second
Third
Fourth
Highest
quintile
And it got much worse (2010)
Adults in
families with a
job loss in past
2 years
= 24% or
43 million
Percentage of
those who had
insurance
= 47%
Percentage of
those who lost
insurance
= 57% or 9mSource: The Commonwealth Fund Biennial Health Insurance Survey (2010).
But in health care:
the future is like the present,
only longer
We do a shitty job with
chronically ill patients
Views of the Health Care System from those with chronic illness
Percent AUS CAN FR GER NETH NZ UK US
Only minor changes
needed 22 32 41 21 42 29 38 20
Fundamental
changes needed 57 50 33 51 46 48 48 46
Rebuild completely 20 16 23 26 9 21 12 33
Data collection: Harris Interactive, Inc.
Source: 2008 Commonwealth Fund International Health
Policy Survey of Sicker Adults.
Base: Adults with any chronic condition
Who can’t do chronic care?
Disease managed? Maybe not…
39
31
40
59
67
43
0
20
40
60
80
CAN FR GER NETH UK US
% of diabetics who received four key preventative services*
Data collection: Harris Interactive, Inc.
Source: 2008 Commonwealth Fund International Health Policy
Survey of Sicker Adults.
* Hemoglobin A1c checked in past six months; feet examined for sores or irritations in
past year; eye exam for diabetes in past year; and cholesterol checked in past year.
Did Not Get a Recommended Test, Treatment
or Follow-up Due to Cost, by Income
17%
9%
18%
4%
36%
14%
4%
11%
2%
14%
0%
25%
50%
AUS CAN NZ UK US
Below average income Above average income
2001Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
37
28
60 5955
52
21
29
41
31
63 66
0
25
50
75
Total Insured all year Insured now, time
uninsured in past
year
Uninsured now
2001 2005 2010
Adults Uninsured for Any Time Had Highest Rates
of Cost-Related Problems Getting Needed CarePercent of adults ages 19–64 who had any of four access problems*in past year because of cost
*Did not fill a prescription; did not see a specialist when needed; skipped recommended medical test, treatment, or follow-up; had a medical problem but did not visit doctor or clinic.Source: The Commonwealth Fund Biennial Health Insurance Surveys (2001, 2005, and 2010).
We do different things to the same
people in different places
Health Affairs
April 7, 2004
Cost & Quality in Healthcare
Quality
Cost
Motel 6
Ritz-Carlton
More spending
≠ better
outcomes
Portland 22.7%
Eugene 18.4%
Salem 16.9%
Bend 23%
Medford 16.4%
Our primary care system is broken
New physicians follow the
money
Data: MGMA
This is America:
There’s always a “new” technology
IT History Quiz, Part 1
• 1947 Christmas Eve– Shockley & pals invent the transistor
• 1959– Noyce (Intel) & Kilby (the other guy from TI) invent the integrated
circuit (separately)
• 1981– IBM introduces the PC (Bonus Question--Why did they give it
away?)– Expected to sell 295,000 in first ten years!
• 1986– Microsoft and Oracle go public
IT History Quiz, Part 2
• 1991 & 1993– WWW & Mosaic Browser
• 1998– Google founded
• 2004– Google goes public (Bonus Question--Why didn’t Matthew buy the
stock?)– Thought it was overvalued at $80 a share!
• 2004– Facebook (but for students only for 3 years)
• 2007– Apple releases iPhone
• 2010– Apple releases iPad
Source: Harris Interactive
2007
160 million adults
84% of those online
The Rise of the CyberChondriacs
The ever-so-slow EMR uptake
Source: CDC
Source: Harris Interactive 2002
EMR Use: The N
factor
Netherlands 88%
Norway 90%
NZ 80%
10 years ago!
EMRs: Yes We Can!
EMR Evolution
$34 BillionHITECH
1. Denial2. Anger3. Bargaining4. Depression5. Acceptance
This is America:
There’s always a “new” generation
Matthew’s wifeAmanda
Matthew’s business partner, Indu
Matthew’s Screwed!
Regina HollidayPatient EMR/DataAdvocate/Artist
Ted Eytan MDKaiser Premanente EMR Evangelist
Technology + people
= massive potential for change
Web 2.0 Ecosystem (circa 2005)
What is “Health 2.0”
Holt’s best guess at the constituent parts
• Personalized search that looks into the long tail, and
cares about the user experience
• Communities that capture the accumulated
knowledge of patients and caregivers – and explain it to
the world
• Intelligent tools for content delivery -- and transactions
• Better integration of data with content
And not just a maybe….
Technologies fusing as patients increasingly guide their
own care
Social
Networks
Tools
Search
Transaction
Data
Health 2.0: User-Generated Healthcare
Content
Search & Online Communities
+
Emergence of Consumer-Focused Tools
1. Personalized
2. Analytical
3. SupportingDecisions
4. Enabling Transactions
EMRBiological/ClinicalClaims
INDIVIDUAL
User-generated
POPULATION
Government DataPrivate Data
REFERENCE
WeatherMapping/GPSFood DatabasesDrug Databases
QuickTime™ and aGIF decompressor
are needed to see this picture.
Permissions Identity
Unplatforms
This is America:
There’s always a “new” idea
In the end. It’s the human touch
engagewithgrace.org The One Slide Project
1.On a scale of 1 to 5, where do you fall on this continuum?
2.If there were a choice, would you prefer to die at home, or in a hospital?
3.Could a loved one correctly describe how you’d like to be treated in the case of a terminal illness?
4.Is there someone you trust that you’ve appointed to advocate on your behalf when the time is near?
5.Have you completed any of the following: written a living will, appointed a healthcare power of attorney, or completed an advanced directive?
Can You and Your Loved Ones Answer These Questions?
1 2 3 4 5
Don't give up on me no matter what, try any proven and unproven intervention possible
Let me die in my own bed, without any medical intervention