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MobCon DH 2015 - Adam Darkins - transform healthcare delivery
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Transcript of MobCon DH 2015 - Adam Darkins - transform healthcare delivery
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USING INFORMATION AND TELECOMMUNICATION TECHNOLOGIES TO CHANGE THE LOCATION OF CARE AND TRANSFORM HEALTHCARE DELIVERY
1
MOBCONMinneapolis, MNApril 8th , 2015
Adam Darkins, MD, MPHM, FRCSVice President of Medical Affairs and Enterprise Technology SolutionsMedtronic, plc.
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Navigating Change
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• US healthcare spending hit $3 trillion, or 18% of GDP in 2013, and it has been growing consistently faster than the US economy
• Top 5% healthcare utilizers consumed 50% of healthcare cost, approximately $36,000 for each individual
• Chronic disease treatment accounts for 75% of total healthcare spending and 70% of the mortality in the US
• 9.6 million dual eligible population cost the system over $270 billion annually, and they are more likely to suffer from chronic disease
• With aging population, prevalence of obesity, and growing unhealthy lifestyles, it’s only getting worse without change!
Unprecedented Pressure for Change
Why Change Healthcare Delivery Systems?
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Our Current System Does not Work
Obesity (BMI ≥30 kg/m2)
Diabetes
1994
1994
2000
2000
No Data <14.0% 14.0%–17.9% 18.0%–21.9% 22.0%–25.9% 26.0%
No Data <4.5% 4.5%–5.9% 6.0%–7.4% 7.5%–8.9% >9.0%
Source: CDC’s Division of Diabetes Translation. National Diabetes Surveillance http://www.cdc.gov/diabetes/statistics
2010
2010
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• Demographics
• Nature of Disease Burden
• Unclear Evidence the Current Configuration is Effective/Cost Effective?
• Health Care Delivery Rooted in Industrial Age
• Changing Lifestyles
• Changing Expectations
Why Change the Location of Care?
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# of hospital discharges with diabetes as 1st -listed diagnosis grew from 454,000 to 688,000.
Data sources: Centers for Disease Control http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm
Number (Thousands) of Hospital Discharges with Diabetes as First-Listed
Diagnosis ( US 1988–2009)
Acute Care Systems for Chronic Disease?
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“Every System is Perfectly Designed to Achieve Exactly the Results it Gets”
• Legacy of health information/billing systems
• Income/allocation designed to support physical assets
• Financial stability of acute care sector
• Focus on end-stage “salvage” versus prevention
Challenges of Legacy Systems
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Post Acute Care in the United States
• Medicare Post Acute Care Spending (short-term skilled nursing and therapy services) on recovery from acute illness $62 billion.
• Post acute care Largest Driver of Geographic Variation.• One in 9 deaths in 2009 included heart failure as contributing
cause.• Traditionally most acute care hospitals and physicians pay little
attention to post acute care.• Medicare Spending Nearly as Much on post-acute care and
readmissions in the First 30 days after Hospital Discharge as it does for the Initial Admission.
• Under fee for service Acute Providers have had little financial incentive to invest in post-acute care resources.
• Medicare readmission penalties, bundled payment and shared-savings programs Change the Landscape.
Data sources: Mechanic, R. New England Journal of Medicine. 370;692-694. 2014.
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Care In Home And Non-Hospital Settings
Different than: Delivering care in acute hospital settings.
Has: Other stakeholders, non-medical considerations and needs redefined relationships.
Offers: Opportunities for health care transformation that meld technologies across the continuum of care in new therapeutic relationships.
Requires: Patient centric care that covers preventative, investigative, curative, rehabilitative and palliative; as needed
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What will be Different?
Post Acute Care: – A Redundant Term
Access: – Right Care in the Right Place at the Right Time
Variable Process: – Standardized Processes Supply, Chain Principles
Shared Decisions: – Non-Paternalistic
Patient-Centric: – No longer Provider Centric
Outcomes Driven:- Based on Evidence (Patient Centered)
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Sharing-Risk When Outcomes are Assured
New Payment Models
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Scaled Home Telehealth Program Outcomes
– Growth of Patient Numbers 2003 – 2007 from 2,000 to 31,570.
– Analysis of Cohort of 17,025 Patients.
– 25% Reduction in Bed Days of Care.
– 19% Reduction in Hospital Admissions.
– Mean Patient Satisfaction Score of 86%.
– Cost per Case $1,600 per Patient per Annum.
Reference. Darkins, A., Ryan, P., Kobb, R., Foster, L., Edmonson, E., Wakefield, B., et al. (2008). Care coordination/home telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemedicine and e-Health, 14(10), 1118– 1126.
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Implantable Device Diagnostics Can Predict Heart Failure Events Earlier
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Heart Failure Exacerbation
Fluid Retention
Decrease in Impedance
Measurement of Interthoracic Impedence
Advanced Device Diagnostic For Heart Failure Management
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Device Diagnostics Have Been Shown to be Reasonably Good at Predicting Heart Failure Events
Merging Sensor/Device Data Onto Merged Connected Health Platforms
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Earlier And More Effective Interventions
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With this approach, we can serve a broader set of HF patients…
…and in the future expand our model to include key comorbidities
HTN
Diabetes
COPD
AfibCKD
Stroke
AMI
Integrated Solutions Can ServeBroader Population, With Multiple Diseases
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With this approach, we can serve a broader set of HF patients…
…and can take a similar approach to manage diabetic patients
Integrated Solutions Can ManageLarger Populations and Multiple Diseases
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