Healthcare Innovations: Trends, Transitions, Technology, and Talent Ricardo Martinez, MD, FACEP...
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Transcript of Healthcare Innovations: Trends, Transitions, Technology, and Talent Ricardo Martinez, MD, FACEP...
Healthcare Innovations: Trends, Transitions, Technology, and Talent
Ricardo Martinez, MD, FACEPChief Medical OfficerNorth Highland Company, North Highland Worldwide
It Starts…
• Care given at home• People paid out of their pockets directly• Hospitals largely for poor or travelers without a home
-run by charities and religious orders.• Physicians started many of today’s hospitals to deliver
advances in medicine.• In the 1920-30’s, health insurance started by hospitals
and doctors to help people pay for hospital and physician care.
• Then…
2
...it went nuts.
Putting the “Fun” in Dysfunction….
Common Characteristics of Current Healthcare System
• Expensive, with hidden prices• Activity-based rather than performance• Fragmented and uncoordinated• Insular• Difficult to access and to use. Not user-friendly• Inefficient• Ineffective• Highly variable• Autonomous and insular thinking• Slow to adopt and change
3
Market Failure – Widespread Demand For Improvement
What is Innovation?Innovare; "to renew or change”
Steps to Innovation• Curiosity• Discovery • Invention• Innovation
The Nature of Innovation• Unique, not just new.• Must be definably
valuable• Must be worthy of
exchange – of time, money or effort
Four Types of Innovation
• Transformational– A paradigm shift that changes
society
• Category– Building new industry within
transformation
• Marketplace– Builds or expands markets, reach
new customers
• Operational– Redesign to improve business
processes and customer experience
The Innovators Dilemma
• Great companies fail for doing the right things.
• Too much emphasis on current customer needs and fail to adopt new technology or business models
• Stuck in a value network• Examples: computers,
steel minimills• Healthcare?
The Big Trends
• Financial• Social• Technological• Political
8
Market drivers toward Value Based Care = Quality/Costs
• Responds when patient need arises
• Centered around provider practice and schedules
• Independent practices• Highly variable practice• Systems designed for
commercial rates to be profitable
• Large administrative burden• Volume-based• High utilization = revenue• Margins dependent upon
reimbursement• Patients finds access points
and navigates fragmented system
• Identifies unmet needs and responds proactively
• Centered around patient needs and schedules
• Integrated network
• Highly repeatable practice
• Systems designed for Medicaid rates to be profitable
• Frictionless healthcare
• Value-based
• Utilization = costs
• Margins dependent upon costs
• Patients ushered to appropriate access point and navigated thru integrated health system
Drivers of HealthCare Trends
Activity-Based Care Fading Away
Future
Value-Based Care Rapidly Emerging
Positioning Enterprises for Success.
Social
Financial
Technology
• Consumerism• Aging population• Chronic Disease• Shortage of staff
• Limited Reimbursement• Financial Risk Sharing• Consumer as payment
source
• Rapid growth health IT• Mobile devices• Telehealth• Cloud and exchanges
Healthcare enterprises must change or die.
Health Reform• Increased Medicaid• Insurance and Data
Exchanges• Payment reform
Current
Financial Crest
• Reimbursement peaking• Move toward “Pay for Value” – Quality/$$• Shift away from high fixed costs• Move toward risk sharing models• Greater scrutiny from payers and public• Growth of defined contribution benefits• Increasing patient co-pays makes them a
payer source• Value-based insurance design
10
Building capability requires a phased approach
Fee for Service Discounted Bundling / Episodes Capitation Scheme
Pro
vid
er
Re
imb
urs
em
en
ts
Reimbursement Model
Decrease Costs Decrease
Costs Decrease
Costs
Current State
Phase 2: Enhanced
Phase 3: Advanced
Phase 1: Foundational
12
Road Map of Future Shifts in Reimbursement Models
Just cut the fat out and you’ll be fine…
Social Waves
• Aging of population • Growth of chronic diseases• Shortage of physician and healthcare
workers• Increasing consumerism• Shift from Independence to
Interdependence [Systems Thinking]
14
16
Source: The Economist: Into the Unknown. November, 2011http://www.economist.com/node/17492860
I think I’m going Japanese…
http://socioecohistory.wordpress.com/2010/05/18/japan-the-sleeping-sovereign-debt-crisis-giant/
Growth of Chronic Disease
• 5% of population accounts for ~ 50% of total health expenditures
• The 15 most expensive health conditions account for 44%• 25% of US have one or more of 5 major chronic conditions
– Mood disorder, diabetes, heart disease, asthma, hypertension
• Rise in population treated with 7 of top 15 conditions, rather than rising treatment costs per case, accounted for greatest part of spending growth.
• And obesity continues to climb – which causes
hypertension, diabetes, heart disease and hyperlipemia.
19
Shortage of Physicians and Health workers
• US has 3 specialists for each generalists, the inverse of other countries.
• Geographic maldistribution of healthcare resources
• Leads to difficulties and delays in access to care • Each state has different laws on scope of
practice of various• Will only get worse
• Started in the US in the 1960’s • Systems Thinking accelerated with The 5th
Discipline, 1990’s• Most other industries adopted and
“reengineered”• Relatively new concept to Healthcare• Physicians taught autonomy often without
skills needed for success in systems.
Shift From Independence to Interdependence
Increasing Consumerism
• Want more control and choice in health relationship
• Desire more convenient access to care• Think they own their medical information• Increasingly cost conscious• Can collaborate with others with the same
disease• Want access to medical information• Desire personalized experience
24
Technological Waves
• Rapid growth and implementation of Health IT across healthcare allows capture and exchange of clinical data.
• Expansion of wireless broadband increase flow of information
• Rise of digital sensors and imaging that can provide information and be shared
• Boom of mobile devices for collaboration and information retrieval, including consumers.
25
https://www.ecri.org/Documents/Secure/Health_Devices_Top_10_Hazards_2013.pdf
What is the “Road Ahead” ?
28
Patient-centered, physician-directed teams
Value-driven: high quality at lowest cost
Connected and integrated – culturally and digitally
Delivers measurable quality health care (meaningful metrics, dashboards)
Data-driven performance, with Business Intelligence – constantly learning
Opportunity Knocks.
Maintaining Margin Depends on Lowering Costs
Decrease Costs Decrease
Costs Decrease
Costs
Road Map of Future Shifts in Reimbursement Models
Current State
Phase 2: Enhanced
Phase 3: Advanced
Phase 1: Foundational
36
The Medicaid Paradox
$1.14
$0.89
$0.60
$-
$0.20
$0.40
$0.60
$0.80
$1.00
$1.20
Commercial Medicare Medicaid
Re
lati
ve
Re
imb
urs
emen
t Ra
tes
37
Decrease Costs
Recalibrating the system for Medicaid rates will increase margins for other payers.
Source: Hospital and Physician Cost Shift: Payment Level Comparison of Medicare, Medicaid, and Commercial Payers. Milliman. December 2008.
Controlling Cost Per Unit Service
Ways to decrease costs of care delivery:• Provider substitution• Diagnostic/treatment substitution• Setting Substitution• Process redesign:
• Eliminate steps and processes• Add missing steps and processes• Re-engineer process
• Offload costs to patient and family
38
Cost Per Unit Service Concept
Progressive strategies build in a cost-effective manner
41
“Value” requires matching patient need with the lowest cost access point…
Care Continuum
Consistent Quality and Connectivity / Culture
Self Care Call CenterWellness
and Fitness Center
Retail Clinics and Pharmacies
/ Urgent Care Clinic
Primary Care
Physician
Diagnostic / Imaging
CenterHospital Inpatient
RehabSNF
Ambulatory Surgery Center
Cost of CareEase of Access
…while maintaining consistent quality
Hiring the Patient
• Patient Empowerment and Activation– Self-monitoring and feedback “self
quantification” – Nike?– Patient health portals, shared with caregivers– Healthcare Gamification– Home testing and diagnostics– Disease-specific communities of care– Decision support– Informed Consent
Redesigning the ProcessAnd Patient Experience
• Delivery process re-engineering– RFID, Real-time Locations Systems, Kiosks
• Care Coordination across spectrum• Care Navigators and health coaches• Focused factories and value streams• Health malls• Cost transparency• Patient compliance tracking
Setting substitution
• Home diagnostics, with wireless connectivity
• Retail clinics, expanding into chronic care• Urgent care, tightly affiliated with networks• Telemedicine/teleheath• Hospital At Home programs for >100 DRGs• Home-based chronic care• Online/email consultations
Diagnostics/therapeutics substitution
• Utilization management programs• Consumer decision-support and Intelligent
Virtual Assistants• Online/telemedicine
– Behavioral health, neurology, wound care, cardiology, chronic care, EM
• Decentralized lab and testing - POC• Computer-guided diagnostics• Sleep testing and therapy
Provider Substitution
• Generalist over Specialist – Medical Home• MLP or Associate Provider over MD• Nurse over Associate Provider• LPN over Nurse• Tech over LPN• Community Worker over Tech• Do it yourself
Emerging
• Big Data – drowning in it– “Money Ball” Analytics– Predictive Modeling– Integrated dashboards
• Cloud-based solutions• Crowd sourced solutions and epi• Computer-assisted diagnostics
These interconnected competencies drive successful transformation.
What “talent” attributes are needed now?
• Leadership• Teamwork• Systems thinking
Three Generations of Reform