The Health Care (R)Evolution: From Gifted Gadgets to Sustainable Solutions

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Dr. Joseph Smith, Chief Medical Officer & Chief Science Officer, West Health

Transcript of The Health Care (R)Evolution: From Gifted Gadgets to Sustainable Solutions

  • 1. DR. JOSEPH SMITHCMO, West Health

2. The Health Care (R)Evolution:From Gifted Gadgets to Sustainable SolutionsJoseph M. Smith, MD, PhDChief Medical and Chief Science Officer West Health 3. But the scariest thing 4. An Introduction to West Healthan independent, one-of-a-kind initiativeto lower the cost of health care 5. US healthcare spending is extraordinary 6. US healthcare outcomes are notUS infant mortality (at just over 6/1,000 livebirths) ranks 49th of 222 listed countries.US life expectancy (75.9 male, 80.9 female)rank 50th. ..The World Fact Book(CIA) 7. Medicare and Medicaid have grownenormously as a share of federal spending Major Programs as a Share of Total Federal Spending 1970 - 2010 40% Medicare and Medicaid havegrown from a combined 5% of 30%the federal budget in 1971 to23% in 2010 20% This has partially necessitateda decrease in defense 10%spending from 38% to 20% Medicare and Medicaid were0%$925 B in 2010 and will rise to 20101971 19741977 19801983 19861989 19921995 19982001 20042007$1,830 B in just 10 yearsDefense Social Security (2020)Medicare + MedicaidSource: CBO, The Budget and Economic Outlook, Fiscal Years 2011 to 20129 8. A fiscal scenario or a social and financial fiasco? 9. Coming Fiscal Cliff 10. In less than 100 days13 11. Over the next 10 years 14 12. A cliff of a different kind 13. More spendingdoes not equalmore quality 14. Unsustainable healthcare in thenewsnearly every 20 seconds 15. Economy and Health CareThis year, the U.S. public debt is projected to reach 62percent of the economynearly double the historical average with larger problems looming in the futureCongressional Budget OfficeFor the U.S., one of the most poorly positionedcountries, addressing the long-term debt challenge mustinclude prompt reform of Social Security, Medicare, andMedicaid..Heritage Foundation.Over the next 20 years, the U.S. will experience the secondhighest projected increase of all the G20 countries in healthcare and pension spending as a share of GDP.International Monetary Fund 16. $2.8 Trillion in Health Care Spending Plaguedby Waste and Growing at Unsustainable RateEvidence that $765 billion of spending adds little value to health or outcomes 19 17. Chronic Disease Burden20 million Americans have Diabetes20 million Americans have Kidney Disease50 million Americans have Hypertension65 million Americans have CardiovascularDisease2 of 3 Americans are overweight; 1 in 5 is Obese1 in 5 Americans over 40 will develop HeartFailureChronic diseases account for 96% of MedicarespendingComplications from chronic disease account for~75% of overall US healthcare spending! 18. The Graying Populations 19. The Graying Populations 20. The Graying Populations 21. The Graying Populations 22. Status quo cannot be sustainedDemandPhysiciansfor Care 23. Advances in Clinical Knowledge ImproveHealth but also Increase Complexity in CareVolume of knowledge growing at a near exponential rate, straining cognitiveabilities and challenging clinical decision making Medical Journal Articles Published per YearFacts per Clinical Decision by Year 26 24. Growing Complexity in Care DeliveryTaxes Capabilities of Providers27 25. The Imperative is the Opportunity "We must also address the crushing cost of health care. This is a cost that now causes a bankruptcy in America every 30 seconds. Were going to make sure that Americans dont have to choose between a health care plan that bankrupts the government and one that bankrupts families.. 26. Health Care Economy:Role of Medical Devices?Most analysts agree that the most importantfactor contributing to the growth of spendingfor health care in recent decades has been theemergence, adoption, and widespreaddiffusion of new medical technologies andservices. Congressional Budget Office 27. Taking Stock in Medical Device Innovation 28. And then there is the medical device tax33 29. Vision:Present state: Chronic diseases are episodically diagnosed andintermittently treated, consuming enormous resources driven byexacerbations, clinical decompensations, and complications.Future state: Chronic diseases will be met with continuouscare, improving outcomes and lowering costs by iterative coursecorrections, prediction and prevention of acute presentations.Path: Near, on, or in-body sensor technology, providing actionablediagnostic information, linked to learning systems and titratabletherapies, enabling continuously-tailored, feedback-controlledtreatment. 30. Wireless Health: Reasons for optimism 31. Worldwide Health Care Crisis Worldwide Opportunity. has an opportunity to be a leader in creating smaller medicaldevices to enable treatment of chronic diseases in homes instead ofhospitals. You can not treat those people in a hospital. You have to treatthem at home. Because of the aging population, this could be theeconomy that develops the devices and the protocols of how to really dohome health care.Jeff Immelt, CEO, General Electric/June 1, 2010What country was Mr. Immelt referring to? 32. Prototypical Device Solution 33. Wireless Sensors for Aging Infrastructure 34. If we can do it for our cars? 35. Electronic Sensors Ensure Safety Quick-reaction crash sensors activate the front, side, and curtainairbags, and the tension on the seatbelt. Seat occupancy detectors send a signal to prevent passenger seat frontand side airbags from deploying in the event of an accident, if the seat isempty or if a special childs seat is on board. Acceleration sensors report if the vehicle is deviating off its vertical axisand if it needs to apply the brakes to one, two or three wheels. Outside temperature sensors send a signal when there is a risk of blackice. Engine management system sensors provide information on exhaust gasquality, and still others diagnose the condition of the oil, or amount ofoxygen delivered for combustion so that service intervals can bedetermined more accurately. Height sensors detect the movements of an approaching vehicle andautomatically adjust the headlamps to prevent the drivers of oncomingcars from being blinded. Anti-pinching sensors in the windows and sliding roof stop them fromclosing at a pre-defined resistance level to prevent injuries, especially tochildren traveling in the car. Sensors are used in conjunction with the Global Positioning System (GPS)to tell the driver where he or she is at any given moment 36. Electronic Sensors Ensure SafetyShouldnt we do it forourselves? 37. Electronic Sensing for our HumanAging Infrastructure 38. ConvergencePervasive Technologies wirelesssocial connectivity networksubiquitouscloud sensingcomputing 39. Ten Targets for Wireless Medicine Disease# Wireless SolutionsAlzheimers5 M Vital signs, location, activity, balanceAsthma23 M RR, FEV1, Air quality, oximetry, pollen countBreast cancer3 M Ultrasound aided self-examCOPD10 M RR, FEV1, air quality, oximetryDepression/ 21 M Med compliance, activity, communicationMood DisordersDiabetes24 M Glucose, hemoglobin A1CHeart Failure 5 MCardiac pressures, weight, BP, fluid statusHypertension74 M Continuous BP, med complianceObesity 80 M Smart scales, caloric in/out, activitySleep Disorders 40 M Sleep phases, quality, apnea, vital signs Some anticipate that by 2014 there will be more that 400 million wireless sensors worn more than one for each person in the US! 40. What does your favorite doctor think?In his/her training:Facebook didnt exist, Twitter was asound, 4G was a parking space, Applicationswere what you sent to college, andSkype, for most people, was a typo Tom Friedman 45 41. Toward the goalin Diabetes 42. Toward the goalin Heart Failure 43. Toward the goalin Epilepsy 44. Physiological Sensor Development 45. Even Smaller Solutions 46. Early stage industry with huge potentialAgainst the backdrop of an obviously unsustainablehealthcare system to which we have just increased accessIncreased recognition of the wireless healthcare opportunity that we have been talking about for 10 years that requires risk capital to fulfill its potential that in turn requires regulatory clarity andtimeliness and that then requires a rational business model 47. Critical Success FactorsRequired elements to catalyze replacing costly collisionswith the beneficial explosion of wireless healthcare Cost reduction while preserving / enhancing outcomes Outcome measures (clinically and economically meaningful) Solutions as opposed to technologies (seamless integration) Transparent, timely, & predictable regulation and reimbursement Safe harbor / tort reform 48. Moving ForwardAligning IncentivesLack of reimbursement for health care innovations such as wireless healthsolutions have inhibited deployment in non-integrated delivery settings.However, innovations within integrated delivery systems show the wayforward:VHA Care Coordination Home Telehealth (CCHT) program 19% reduction in hospital readmissions and average cost of home care $1,600 compared toup to $77k for nursing home careCommunity Care North Carolina (enhanced medical home model) Estimated savings for FY2006 were $150-$170 million relative to what the state(Medicaid) would have spent under previous modelGeisinger (ProvenHealth Navigator medical home initiative) Among innovations, patients communicate online with doctors and send health monitoring info including blood glucose and blood pressure Between 2006-2008, demonstrated 20% reduction in hospital readmissions and 18 % reduction in hospital admissions 49. Our FDA regulates cigarettes! 50. One PerspectiveOur current healthcare system is a burning platformPerfection in medical devices and medical practice is anaspiration, but an irrational expectation, and an impossibleregulatory requirement.The FDAs handling of cigarettes offers interestingprecedents/predicates for medical device regulatoryapproval.We need innovation beyond the isolated gifted g