Game Changers in Health Care for 2014
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Transcript of Game Changers in Health Care for 2014
Game Changers in Health Care for 2014
Steven M. Berkowitz, MDSMB Health Consulting,
Austin, TX512-415-6095
2012- 2013 Clients- Two Lessons Learned
Every System is unique.But… Every System is dealing with the same issues.
So What’s New in Health Care Reform?Same old wine in a brand new bottle?
So What’s New in Health Care Reform?
You can always count on Americans to do the right thing… …after they’ve exhausted all the other possibilities !!” Winston Churchill
People do not change until the pain of staying the same… … exceeds the pain of changing. Anonymous
Medicine is a Team effort….
…..Why do we insist on playing Solo !
The Health Care Team
1990’s-- Market Correction
2013-- Market Reconfiguration
The Evolution of Health Care Reform
Remember, It’s Not Nice to Fool Mother Nature
Health care must follow the same market rules as all other industries
The event is surprise It has an extreme impact After the event occurs, it is rationalized by hindsight
What is a Black Swan?
The event is surprise It has an extreme impact After the event occurs, it is rationalized by hindsight
What is a Black Swan?
Examples:
The InternetPersonal computer going to the phone911
The event is surprise It has an extreme impact After the event occurs, it is rationalized by hindsight
What is a Black Swan?
Examples:
The InternetPersonal computer going to the phone911Maybe some day……. The Chicago Cubs
Management Goals: Cannot predict event Build robustness against negative events Acknowledge and exploit positive ones
What is a Black Swan?
The “Viral” Influence of Transparency The Increasing Trend of Higher Deductible Insurance The information technology system- EMR, ICD-10 New Technology- Personalized Medicine-Genomics
Game Changers for 2014
The “Viral” Influence of Transparency The Increasing Trend of Higher Deductible Insurance The information technology system- EMR, ICD-10 New Technology- Personalized Medicine-Genomics
Game Changers for 2014
The increasingly informed consumer will make health care decisions on the basis of VALUE
Value Based Purchasing
The increasingly informed consumer will make health care decisions on the basis of VALUE
The CONSUMER ultimately determines which of the above elements constitute VALUE
Value Based Purchasing
VALUE = Outcomes + Satisfaction Cost
Read all about it !! April 2005
Data Transparency
This is Your Life !!Data Transparency in Action
“What we concluded was that even when hospitals know their performance is not good, that's not sufficient motivation for them to do something. Making it public made a big difference in motivating them to improve.”
Judith Hibbard, Health Affairs 2003
Data Transparency
That which is measured, tends to improve.That which is measured publicly, tends to improve faster.
Core Measures: Heart Attack Heart Failure Pneumonia Surgical Care Improvement
HCAHPS
CMS Core Measures– the Top Decile
Core Measures: Heart Attack Heart Failure Pneumonia Surgical Care Improvement
HCAHPS
Transparency is the best thing that’s happened to quality since antibiotics...
…by decreasing variance and improving results
Data Transparency and Accountability
Percent Who Saw and Acted Upon the InformationChoice of Hospitals
Kaiser Family Foundation, October 2008
Exposure to and Use of Quality Information
If the other guy’s getting better, then you’d better be getting better faster than that other guy’s getting better…
…Or you’re getting worse. Tom Peters
Transparency is the best thing that’s happened to quality since antibiotics...
…by decreasing variance and improving results
As transparency matures, it will rewrite the book on:
Who is your competitor?
Data Transparency and Accountability
Price Transparency
QualityTransparency
The Role of Transparency
Price Transparency
QualityTransparency
The Role of Transparency
Stage IThe “other guy”
Stage IIIThe entire nation ?
Stage IVMedical tourism
Increasin
g Transpare
ncy
Stage IIAll hospitals in Oklahoma
System Strategic PlanningWho is Your Competitor…. The role of Transparency
The Continued Influence of Transparency The Increasing Trend of Higher Deductible Insurance The information technology system- EMR, ICD-10 New Technology- Personalized Medicine-Genomics
Game Changers for 2014
Total Health Care Spending
OECD, 2012
Distribution of Health Care Spending
Kaiser HRET, 2013
Distribution of Health Care Spending
Kaiser HRET, 2013
Distribution of Health Care Spending
Kaiser HRET, 2013
Total Premium and Percentage paid by Worker
Kaiser HRET, 2013
Kaiser HRET, 2013
Total Premium and Percentage paid by Worker
Kaiser HRET, 2013
Percentage of Plans with $1,000 or $2,000 Deductible
Kaiser HRET, 2013
Average Single Premium Deductible
QualityTransparency
The Role of Transparency
PriceTransparency
Price Transparency:??????
Steve has a URI symptoms and feels bad!Steve has great insurance but a $3,000 deductible
What does he do?
Treatment Options: Approximate*: Out of Pocket Wait Emergency Department $ 300 2-3 hrs Urgent Care 150 1 hr PCP visit 120 1 hr (if available)
Local Pharmacy 80 30 min Self Treat.. rest, OTC meds... 10 ? none
Reflections on Price Transparency
* The actual cost may not be known until the evaluation is completed
The physician’s reimbursement for the visit The nurses reimbursement for the visit The cost of his treatment to the institution Any other contractual relationships◦ Physicians◦ Vendors◦ Any other arrangements with the insurance company
Just tell me: How Much Do I Need to Pay !!
What Steve Does Not Need to Know
The Continued Influence of Transparency The Increasing Trend of Higher Deductible Insurance The information technology system- EMR, ICD-10 New Technology- Personalized Medicine-Genomics
Game Changers for 2014
Health Care Information Systems-- We are so far behind !!!
1 Zettabyte =
1,000,000,000,000,000,000,000 bytes
= 10007 bytes = 1021 bytes
The Role of Information Systems
More Than Meaningful Use
Health Care of the Future…..
…. We can’t get there from here
…. Without Information Systems !!
The Role of Information Systems
EMR and Evidence Based Order Sets are not just another IT initiative….
…. it is a Clinical Transformation to how we will be practicing better medicine in the future.
The Role of Information Systems
The EMR will do for health care What the assembly line did for manufacturing
The Role of Information Systems
More Than Meaningful Use
Health Care of the Future…..
…. We can’t get there from here
…. Without Information Systems !!
The Role of Information Systems
EMR and Evidence Based Order Sets are not just another IT initiative….
…. it is a Clinical Transformation to how we will be practicing better medicine in the future.
The Role of Information Systems
The Continued Influence of Transparency The Increasing Trend of Higher Deductible Insurance The information technology system- EMR, ICD-10 New Technology- Personalized Medicine-Genomics
Game Changers for 2014
For a Given Condition or Disease:
Identify the individual risk for the patient Identify patients most likely to respond beneficially Identify patients most likely to respond adversely– Minimize adverse
complications! Identify the optimal dosage Monitor the progress of the treatment
The Role of Personalized Medicine
Carrier Status◦ Cystic Fibrosis◦ Huntington’s Disease
Risk of Disease◦ Cardiovascular disease◦ Diabetes◦ Alzheimers◦ Breast/ ovarian cancer◦ Colon cancer
Response to Therapy/ Optimal Drug Treatment◦ Cancer◦ Heart Disease◦ Pain Management
Sample Capabilities of Genomic Testing
Original gene mapping-James Watson 2007: $ 1,000,000
Currently: $ 1,000 – 4,000
23 and Me…. 248 health conditions and traits: $99
The Price Barrier Starts to FallThe Race to the $100 Genome
Human genes that produce tumor suppressor proteins BRCA 1and 2 account for about 5-10 percent of all
breast cancers and 15% of ovarian cancers Mutation can be inherited from mother or father Each child has 50% chance if parent has defect
BRCA1 and BRCA 2
BRCA1 BRCA2 Normal
Breast CA 55-65% 45% 12%Ovarian CA 39% 15% 1.4%
Pancreatic CA increased riskProstate CA increased risk
BRCA1 and BRCA 2- Lifetime Cancer Risk
The major enzyme systems involved in drug metabolism-- about 75% of total metabolism
The cytochrome P450 system can either:◦ Metabolize a drug to make it inactive◦ Make a drug active by degrading its precursor
57 human genes code for this process
There are many differences in genetic makeup within the population that for a given drug may lead to:◦ High metabolizer◦ Normal metabolizer◦ Low metabolizer
Response to Drug TherapyThe Role Cytochrome P450
Examples of Drugs Metabolized by P450 System
Common medication widely used to thin blood◦ Treatment of blood clots◦ Stroke prevention in atrial fibrillation◦ Treatment of other hypercoagulable states
The most serious complication is bleeding◦Runs the spectrum from bruising ( usually benign) to
intracranial bleeds (life-threatening)
A Clinical Example- Coumadin
A Clinical Example- Coumadin
Identify the genetic status of the individual patient◦High metabolizer◦ Intermediate metabolizer◦ Poor metabolizer
Adjust the medication and dosage accordingly
A drug that inhibits platelets…. Decreasing the clotting mechanism Indications:
◦ Acute coronary syndrome◦ Stroke◦ Myocardial infarction◦ PCI◦ Peripheral artery disease◦ Post CABG
Not all patients taking plavix achieve the same level of platelet inhibition 20-50% of patients are poor metabolizers Variability in individual response is due to genetic factors, drug
interaction Heterogeneity of response could be due to non compliance
A Clinical Example- Plavix
A Clinical Example- Plavix
Personalized Medicine-- A Game Changer
Treatment based upon statistical evidence
Diagnosis of Established Disease
History Physical Exam Testing
Patient develops symptoms and accesses health care system
Traditional Model
Treatment based upon the individual needs
Likely Diseases Predicted
Testing is done upfront on patient’s DNA
Lifetime Risk of Specific Disease
Unique Response to Medications
Personalized Model
Increasing medical knowledge- research
Increasing speed and power of computers
Enhanced data capture - ICD 10
Unparalelled
Opportunity
to mine data
Increasing individual knowledge- cell phone
Increasing penetration of the Internet
Putting Together IT and GenomicsA Perfectly Perfect Storm
The Continued Influence of Transparency The Increasing Trend of Higher Deductible Insurance The information technology system- EMR, ICD-10 New Technology- Personalized Medicine-Genomics
Game Changers for 2014
To the world you may be just one person,But to one person you may just be the world.
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