Healthcare X PRIZE - Executive Summary
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Transcript of Healthcare X PRIZE - Executive Summary
Healthcare X PRIZEInitial Design and Prize Guidelines Summary
for Public CommentV1.0 Published 4/14/09
Join the discussion at: www.xprize.org/wellpoint
Initial prize design—for public comment: www.xprize.org/wellpoint 1
Introduction to effortIntroduction to effort
Initial prize design—for public comment: www.xprize.org/wellpoint 2
INTRODUCTION TO X PRIZE APPROACH
• Vision: “Bring about radical breakthroughs for the benefit of humanity through the power of incentivised competitions to stimulate innovation”
• Mission:We design and conduct X PRIZE competitions to address the grand challenges of our times.
• Attributes: Highly leveraged investments, efficient by only paying the winner, and sparks a new industry as a by product of the competition
- Target market failures; Define the problem, let teams compete to create the solution g ; p , p
- Clear, objective & simple rules in a hard but attainable grand challenge (3‐8 year horizon)
- Assure that a “back end business” is viable and an industry can be created
- Global competition that yields a telegenic finishGlobal competition that yields a telegenic finish
• Example: Ansari X PRIZE
- $2.5M startup, $10M prize purse, $100M invested, and $1B industry created
Initial prize design—for public comment: www.xprize.org/wellpoint 3
- 26 teams, 7 nations, and global interest generating 5B media impressions
INTERVIEWS WITH EXPERTS HIGHLIGHTED IMPLICATIONS FOR A HEALTH PRIZE
Problem Statement: Expected Breakthroughs:Problem Statement:
• Financial incentives not aligned with doingthe right things
Expected Breakthroughs:
• Payment needs to re‐align to desired outcome
• We don't know holistically what works relativeto other things
• Fragmented system with substandard
• Outcome tracking needs to occur holistically
• Solutions need to be holistic and steer consumers to best performers
/• Fragmented system with substandard distribution of best practice
• Need to move to "health" system vs. sick system
• Focus on engagement / behavior modification
• Need to focus both on public health and a more efficient system
• We have a very short term focus in terms of addressing future needs
• Consumer not engaged in care even if theywant to be
• Consumer need choices that are engaging (pull)
• Providers accountable for autonomous approaches via transparency of outcome
Initial prize design—for public comment: www.xprize.org/wellpoint 4
want to be
• Best providers not rewarded for better performance
approaches via transparency of outcome
Healthcare Prize Development TimelineWHERE WE ARE IN THE EFFORT
Healthcare Prize Development Timeline
Ideation Phase Design Phase Planning Phase
Nov 08 Dec Jan 09 Feb Mar Apr May Jun Jul Aug Sep
Initial Design Announcement
April 14th
Next steps in the design phase:Next steps in the design phase:1. Announcement of initial prize design to engage interested parties and gain access to more
experts/ ideas2. Public comment utilized to test and refine goals and initial design
Initial prize design—for public comment: www.xprize.org/wellpoint 5
3. Experts engaged for deep dives in areas critical to prize development effort4. Validated prize design moves into planning phase
The Initial Prize DesignThe Initial Prize Design
Initial prize design—for public comment: www.xprize.org/wellpoint 6
HEALTHCARE X PRIZE DEVELOPMENT OBJECTIVES
W k t i th l f th t h lth t bWe seek to improve the value of the current health system by:• Rewarding entities who optimize health value
• Reinvesting resources to enhance individual vitality by encouraging activation and• Reinvesting resources to enhance individual vitality by encouraging activation and personal responsibility for health
• By increasing the vitality of individuals, we seek to advance the health of community lloverall
Initial prize design—for public comment: www.xprize.org/wellpoint 7
GOAL OF HEALTHCARE X PRIZE:
To create an optimal health paradigm thatTo create an optimal health paradigm that empowers and engages individuals and
communities in a way that will dramatically improve health valueimprove health value
Initial prize design—for public comment: www.xprize.org/wellpoint 8
PROPOSED COMPETITION:
Goal:50 %↑ in Community health
Total cost
Draft Guidelines:•Health value = Improvements in Community Health Index and Total Cost
•Teams create mechanisms to engage, coordinate, advise, evaluate, and influence individuals and relevant care providers in their assigned test community in ways that generate health value
•Each finalist competes in a pre‐selected community/ employer test community of ~10K individuals; results compared against an equivalent control group in a similar/adjacent communityresults compared against an equivalent control group in a similar/adjacent community
•Aggregate results over 3 year contest determine winner. 50% threshold required to win purse. Competition and results audited by independent panel of judges
Initial prize design—for public comment: www.xprize.org/wellpoint 9
1 Focus on health outcomes and value at community level:
DIFFERENCE FROM OTHER EFFORTS:
1. Focus on health outcomes and value at community level: Community Health Index tracks outcomes across a community; Total Cost tracks expenditure across all parties
2 Consumer Engagement:2. Consumer Engagement:
Consumer engagement required to generate results
3. Payment Incentives:
Teams may create payment innovations to improve incentives for consumers, providers, vendors to demonstrate desirable behaviors/ outcomes
4. Comprehensive and Proactive Outlook:pTeams responsible for health across all care settings and multi‐year time horizon. Increased focus and investment in proactive, longer‐term health improvement programs
5. Local partnerships:
Initial prize design—for public comment: www.xprize.org/wellpoint 10
Teams must develop relationships with at least some local health care providers and/ or community organizations
IMPACT POTENTIAL
Successful implementation of the Healthcare X PRIZE could create within 10 yrs:
1. A new model and system of health that demonstrates a >50% improvement in healthcare value (HCV).( )
2. A measurable and globally accepted population health metric, tentatively called the “Community Health Index” (CHI), which becomes a benchmark for measuring future improvements in health at a population levelp p
3. An individual health metric, tentatively called the “Individual Vitality Score”, which can helps individuals (and providers helping them) understand and benchmark their current health status and potential for improvement
4. A personalized “Vitality Dashboard” where consumers will be able to understand current health status, “portfolio” of improvement options, projected return from health improvement efforts
5 A new Optimal Health paradigm that helps consumers optimize their health and rewards providers
Initial prize design—for public comment: www.xprize.org/wellpoint 11
5. A new Optimal Health paradigm that helps consumers optimize their health and rewards providers that can demonstrably create improved health value
WE LOOK FORWARD TO YOUR INPUT AND PARTICIPATION
Visit our website: www.xprize.org/wellpoint
• Add your comments to the proposed approach/ guidelines
• Add yourself to the mailing list for updates
• Follow the conversation on our blog, twitter, facebook, etc.
• Let us know if you’d be interested in creating a team as the effort moves forwardLet us know if you d be interested in creating a team as the effort moves forward
Initial prize design—for public comment: www.xprize.org/wellpoint 12
Details in developmentDetails in development
Initial prize design—for public comment: www.xprize.org/wellpoint 13
PHILOSOPHY FOR MEASUREMENT• Measures will contain desired outcomes only (no intermediate or process metrics)
– Status improvements we want to happen
– Clinical events that we want to remove from the human experience
• Where possible, measures tracked will be objective and come from established collection tools
• Measures will be at the community/population level
• Measures will be actionable. There are case examples available that suggest teams can influence outcomes in a significant way
• Costs will be captured across as many payment alternatives as possible and reflect the payment owed at time services rendered
• “Test‐group” communities will be actuarially equivalent across demographics, socio‐economics, and health status We will divide similar or adjacent communities into 2 equivalent groups with the team selectingstatus. We will divide similar or adjacent communities into 2 equivalent groups, with the team selecting control vs risk groups
• Data will not be projected. Specific sub‐populations may be oversampled to make absolute results comparable
Initial prize design—for public comment: www.xprize.org/wellpoint
• Weighting will place functional improvement at equal stature with sick care
COMMUNITY HEALTH INDEX ‐ DEFINITION
Draft category Draft metric• Days hospitalized• Number ER visits• CDC surveillance report of prevalence
Draft category• Hospitalization/ Rehospitalization• ER visits• Communicable disease
Draft metric
Eliminate acute exacerbation
• Incidence• Prevalence of LT Disability• Prevalence LTC usage• Incidence by age
• Major morbidity• Disability (Long Term)• Long term care• Mortality
Preventlong term impairment Incidence by age
• Total days unplanned absence (school, work)• Total days ST Disability
Mortality• Sick days• Disability (Short Term)
p
Reduceshort term impairment
• TBD• SF‐12
p
Optimize Individual Vitality
• Functional Fitness• Self Reported
Initial prize design—for public comment: www.xprize.org/wellpoint 15
Vitality
TOTAL COST – DEFINITION
$ h h l h d b lDirect • $ through existing claim system, or otherwise processed by claims• $ assigned to medical care (HSA codes) going through debit card• $ submitted for reimbursement on other OOP spend• $ spent on communication / coordination with individuals • $ spent on consumer or provider activation (e.g., lottery, rewards, incentives)• Sick and disability pay added to total cost
Indirect • Not counted in cost, many improvements included in vitality index, y p y
• Costs are all direct and accounted forNo projections
Phase in /out • Team gets operating budget for first 6 months “dry run” which doesn't countagainst total cost
p j
Initial prize design—for public comment: www.xprize.org/wellpoint 16
INDIVIDUAL VITALITY SCORE– DEFINITION
• Scoring system to help consumer summarize current health status
• Approach developed by each team to best engage consumers; team pp p y g g ;innovation
• Individual vitality score used to engage individuals in their health and health actions
Initial prize design—for public comment: www.xprize.org/wellpoint 17
WHAT IS THE PHILOSOPHY BEHIND THE PRIZE DESIGN GUIDELINES?
Transparent and Objective
• Tracking of Community Health Index and Total Cost audited by trusted third party
• Open sharing of results and implementation experiences by sponsor
• Regular and detailed public updates on team progress
d d d d l f lj
• Independent judges oversee team down‐selection to finalists
Open contest;
• Teams may enter from anywhere as long as able to compete in test beds
• All funding sources are ok for development of team platformOpen contest;global idea recruitment
g p p
• “Salary cap” on operating expenses to ensure equal playing field between finalists in test beds• Limited use of existing, controlled facilities within a test bed to maximize potential entrants
Demonstrableimpact w/in3 year window
• Broad population health spectrum to maximize relevant approaches, and limit non‐systemic solutions
• High target: need to generate radical change• Large enough / long enough to demonstrate real sustainable value
Initial prize design—for public comment: www.xprize.org/wellpoint 18
3 year window Large enough / long enough to demonstrate real sustainable value
• Teams need to prove consumer and/or provider engagement
WHAT ARE THE PHASES OF THE COMPETITION?
Entry Concept Pilot Finalist
Requirements • Registration document– Concept
• Intervention model– Targets
• Demonstration successful pilot of key
• Intervention model and pilot exceed targetsp
– People– Resources / Assets– $10k
g– Interventions– Engagement– Modeled impact• Execution strategy /
p yassumptions (50‐100 pts network test)
• Alpha product• Business plan, modeled
p g• Team in place• Beta product / interface
high‐level plan • Concept sketch
financials
Proof • Concept that’s reasonable
• Model showing target impact
• Pilots exceeding requirements
• Matching / selection into test‐beds
• Likely mergers between complementary concepts
• Testable key assumptions
• Evidence of consumer and provider engagement
• Actual progress in test‐beds (live competition, reported monthly, detailed quarterly
t )
Initial prize design—for public comment: www.xprize.org/wellpoint 19
reports)
Timing • Fall 2009 • Summer 2010 • Spring 2011 • Early 2015
WHAT CAPABILITIES MIGHT TEAMS DEPLOY?
• Financing/ Payment: • Incentives that promote optimal outcomes/ desired behavior/ allocation to optimal treatmentsg/ y
• Behavior modification:
• Outcomes/ ComparativeEffectiveness:
p p / / p
• Programs that successfully change behavior
• Population‐level record of outcomes vs. treatment and understanding which approaches deliver better outcomes
• Personalized decisionsupport:
• Measurement/ tracking/feedback:
• Decision support helping consumers compare different treatments and select best for them (outcomes, risk, $)
• Database/ records captured over time, allowing for feedback loops and suggestions/ remindersfeedback:
• Coordination of care:
• E‐Health:
• Programs that create oversight/ handoffs that ensure a holistic view of consumer across providers
• Communication tools allowing for an extended interaction/ conversation (e.g., email, chat, video, home monitoring)
• Information and programs that create leverage of provider expertise (e g teleconsult physician extender home monitor)
• Convenience:
Information and programs that create leverage of provider expertise (e.g., teleconsult, physician extender, home monitor)
• Removing the barriers to seeing a provider (e.g., convenient location, extended schedule, home visit)
• Changes to the type of care offered (e.g., 60 minute visit, prescription for exercise, reduced use of referrals/ tests)• Care Experience:
Initial prize design—for public comment: www.xprize.org/wellpoint 20
• Others???
WHICH POPULATIONS WILL BE INCLUDED?
Comment
End of life • Ethical considerations
Recommended
Acutely ill • Coordination and best practices through acute illness will prevent error. Use ofhome health / remote monitoring likely to reduce “fragmentation”.
End of life Ethical considerations
Severity
At‐risk /lif t l
• Behavioral / lifestyle foundational to avoiding preventable illness (e.g., smoking, obesity, fitness, etc.) but poorly executed today
Chronicallyill
• Coordination puts “care” back in healthcare and saves lives
Disease lifestyley, , ) p y y
• No scaled, proven solutions today
Early healthrisks
• Similar goals to at‐risk, but costs likely to be additive in short‐term
Initial prize design—for public comment: www.xprize.org/wellpoint 21
No risks • All costs additive