Integrated Care

© 2014 IBM Corporation 1© 2015 IBM Corporation

Abha KeshavaDirector, Product Management, IBM Smarter Care

© 2014 IBM Corporation 2© 2015 IBM Corporation © 2014 IBM Corporation

IBM’s point of view: Integrated careAbha Keshava

28 May 2015


Global trends are forcing the need for change

2 million aged over 65 in UK will lack informal care

from adult offspring by 2030…a 66% increase from 1.2 million in 2012

1 out of 466% $7 trillion+

Aging Population

The cost for health and social programs

worldwide, and it is rising

Increasing Costs

1 in 4 Americans - 2 of 3 overage 65 –have multiple

chronic conditions, accounting for 93 percent of

Medicare expenditures

Chronic Disease


Sources: 1 World Bank 2014, 2 World Health Stats 2014 (WHO), 3 WHO / by country, 4 World Economic Forum, 5 IDF, 6 Whitehouse.gov

Health care consumes 15% of global government budgets, up from 13% a decade ago 2

Rising costs: the global health care model is not sustainable

• Global economic growth is in a moderate 3% range1

• Global Financial Crisis in 2008 drove spending cuts and coverage restrictions in many countries. With additional spotlight on efficiency, significant policy reforms are beginning today1

• Health care costs are rising at a higher rate of over 8% 2

• 75-80% due to increased spending on prescription drugs, hospital and physician spending3

• 20-25% due to longer life expectancy, aging populations: care costs increase as we age3

• Chronic diseases threaten global economy, as #1 cause of death by 2020. Costs 400% more in productivity loss than the cost of treating the disease 4

• One in 10 adults will have diabetes by 2030 5

• 30% of health care costs are due to inefficiency in current systems6


A global issue: legislation creates new incentives to meet these challenges

Germany increases benefits for care needs, including relatives, in January 2015 and combines management of public health and social well being

Ireland launches new funding model: “Money Follows the Patient, to manage care across settings with stakeholder engagement. National Dementia Strategy in progress …

United States Medicaid funding for chronic care management (CCM) came into effect January 2015

UK launches a $5.3B Better Care Fund to help join up local health and care services

China NHFPC launches new rural health care initiative and “will speed up population health informatization”


Integrated care is a global strategy to reduce inefficiency across health and social welfare systems and improve patient-centered care

Source: World Health Organization Global Burden of Disease (GBD) 2013

Types of Integrated Care:

During 2014 and 2015, WHO will develop a Global Strategy to achieve universal health coverage with more people-centred and integrated health services

Horizontal: single patient co-ordination across health, social and

other care providers

Vertical: managed care in

a network of primary, hospital, community and

tertiary care

Holistic: population health

model; health care, social care and wellness.

Sectoral: multiple providers in a single sector e.g. mental health


“Towards people-centred health services delivery: a Framework for Action for the World Health Organisation” (WHO) European Region. Int J Integr Care 2013; Oct–Dec

“Integration of health and social care would better safeguard adults from harm” BMJ 2013; 346:f3266

China – “Healthy China 2020”: radical social health insurance reformsThe Economist

New accountable care

organizations save

Medicare $372 million The Buffalo News

Integrated information is transforming health and social services South Wales Guardian

“Understanding integrated

care: a comprehensive

conceptual framework based

on the integrative functions

of primary care.”

Int J Integr Care 2013; Jan–Mar

Healthcare and social care are merging – and rightly so…


Counseling and education

Clinical interventions

Long-lasting protective interventions

Changing the context to make healthy decisions

Socioeconomic factors

This is further proven - socio-economic factors have the highest impact on health

CDC Health Impact Pyramid

Environmental & social factors account for approximately 55% of health status

Smallest impact

Largest impact

G

enet

ics:

5%

Medical care:

20%

Environmental and social factors:

55%

Behavioral factors:

20%


End-of-lifeConsiderations

and care

Care and case management

Follow-up engagements after treatment

WellnessPrevention, education, nutrition and fitness

Episodic careInfrequent treatment for specific ailments

Chronic careFor ongoing conditions like diabetes and cancer

Supporting health and care systems across the continuum


Turnkey solutions

Healthy behavior

Proactive early

detection

Best practice care

protocols

Outpatient support

Care coordination

- Incentives

- Early detection

- Regular exams

- Warning of disease

- Prescriptive care

- Alerts of non conformance

- Additional clinical insights based on literature

- Prevent readmissions

- Management outside the hospital

- Across providers

- Care plans for multidisciplinary teams

- Leverage of new models (PCMH)

Starting point for IBM solution

WellnessDiagnosis and

early interventionDisease maintenance

Late stage/co-morbidity mgmt.

There are different needs for Health solutions across the care continuum


Educators

Providers, hospitals

Pharmaceuticals, life sciences and health

retailers

Human services

Payers

Researchers

Empowering a spectrum of stakeholders


EMR adoption reaches $22.3B adoption in 2015HOWEVER

they do not support the aspirations or the workflow of integrated care,rather they are a complementary enabler for integrated care solutions

Sources: EMR Adoption statistics Accenture 20141 Rudin, Bates 2014, 2 Bates 2010, 3 O’Malley et al 2010, 4 Graetz 2009, 5 Rudin 2014, 6 PWC 7 Cipriano et al

Improved outcomes

Efficiency

Integrated Care

+ Multiple provider+ Patient engagement

+ Personalized care plans+ Workflow & Collaboration

Electronic Medical Records (EMR)

Provider-centricBilling oriented

Mature reporting

EMRs

Single EMR

Structured

Provider-centric

Predefined terms

System of record

Uniform care

Care Pathways

Multi-EMR integration

Dynamic, ad-hoc

Patient-centric

Non-standard terms

Support for future goals

Personalized plans

Group decision making

Integrated Care


Integrated care approaches improve health, reduce costs

Unchecked, costs increase across the continuum of care

Promote healthy behaviors

Proactive early

detection

Best practice

care protocols

Outpatient support

Care management for complex conditions

Costs increase due to:

•Aging populations

•Chronic disease

•Complexconditions

Proactive, evidence-based approaches

Late Stage/Co-Morbidity Mgmt.

Diagnosis and Early Intervention

Disease MaintenanceLate Stage,

Co-morbidityWellness

Diagnosis and Early Intervention

Disease Maintenance

Address the whole patient with proactive approaches across the continuum of care

Co

sts


Personal data is exploding


Integrated approaches need new insights and engagement

© 2015 International Business Machines Corporation 15

Late Stage/Co-Morbidity Mgmt.


Early InterventionDisease Maintenance

Late StageCo-Morbidity


Early InterventionDisease Maintenance

Insights• Real-world evidence improves care pathways and service delivery• Combine personal and population health data with new sources• Apply advanced analytics and cognitive computing for transformational

insights

Engagement• Enable providers to act on meaningful insights• Drive to outcomes: monitor results and payment flows,

benchmark performance

Data• Structured and unstructured


Announced April 13, 2015: IBM Watson HealthIBM and Partners to Transform Personal Health with Watson Open Cloud

Systems ofRecord

Systems ofInsight

Systems ofEngagement

EnterpriseInnovation

Enabled by Cloud

Pervasive SecurityIntelligence

IBM Watson Health

1.Watson Health Cloud

2.Insights as a Service

3.Health solutions

Enabling ecosystems: data, insights, solutions

InsightsCognitive &

Advanced Analytics

DataStructured & Unstructured

SolutionsIBM & Ecosystem

Solutions

Individuals Researchers Gov’t Payers ProvidersHuman

ServicesPharma

IBM Watson Health CloudHIPAA-enabled, standards-based, scalable

Integrated Care

Documents

Transcript of Integrated Care