Disruptive Innovations in US Primary Care: Overview and Digital Health … · 2019. 1. 29. ·...
Transcript of Disruptive Innovations in US Primary Care: Overview and Digital Health … · 2019. 1. 29. ·...
PHCPI framework: Presentation Crosswalk to Service Delivery Elements
C1. Facility Organization and Management
C1.a Team-based care organization
C1.b Facility management capability and leadership
C1.c Information systems
C1.d Performance measurement and management
C3. Access
C3.a Financial
C3.b Geographic
C3.c Timeliness
C4. Availability of Effective PHC Services
C4.a Provider availability
C4.b Provider competence
C4.c Provider motivation
C4.d Patient-provider respect and trust
C4.e Safety
C5. High Quality Primary Health Care
C5.a First Contact C5.b Coordinated C5.c Comprehensive C5.d Continuous C5.e Person-Centered
C2. Population Health Management
C2.a Local priority Setting
C2.b Community engagement
C2.c Empanelment
C2.d Proactive population outreach
C. Service Delivery
Disruptive Innovations in US Primary Care: Overview and Digital Health Example Andy Ellner, MD, MSC Harvard Medical School Center for Primary Care Sean Duffy Omada Health
Potentially Disruptive Innovations in U.S. Primary Care
9 November, 2016 Andy Ellner, MD, MSc Director, Program in Global Primary Care and Social Change, HMS Assistant Professor of Medicine, Division of Global Health Equity, Brigham and Women’s Hospital
A disclosure
I am co-founder of Firefly Health, a company that is building a digital and care team platform to deliver better, safer primary care at large scale.
Ms. W
• 45 yo female, single, mother of two • History of abusive relationships • Works nights as housecleaner • Smokes and drinks alcohol above
recommended limits • Has depression and uncontrolled
diabetes and hypertension • Low engagement with medical treatment
Roadmap
• Global health systems in 2016 • The future of health systems innovation • Five potentially disruptive trends
Universal Health Coverage
Goal: eliminate financial hardship due to out of pocket expenditures on health services by providing financial risk protection Other important factors: • Strong health system • Robust healthcare
workforce • Supportive legislation
Deaths by cause and income
The neglected epidemic of chronic disease, The Lancet, Volume 366, Issue 9496, 29 October 2005-4 November 2005, Page 1514
The Crisis in Value
Health Care Expenditures and Life Expectancy in the United States and Ten Other Developed Countries SOURCE: V.R. Fuchs and A. Milstein | May 18, 2011 | DOI: 10.1056/NEJMp1104675
What determines health?
Schroeder, NEJM, 2007
Source: Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey.
Distribution of health expenditures for the U.S. population, by magnitude of expenditure, 2009
1% 5%
10%
50%
65%
22%
50%
97%
$90,061
$40,682
$26,767
$7,978
Annual mean expenditure
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%U.S. population Health expenditures
Re-thinking Health Spending
“Unlike virtually all other sectors of the U.S. economy, health care has experienced no gains over the past 20 years in labor productivity.”
Re-thinking Health Spending
Kocher and Sahni, NEJM, 2010
“Novel ideas, products, services, and processes—including new ways to promote healthy behaviors and better integrate health services with public health and other social services—which achieve better health outcomes and/or patient experience at equal or lower cost.”
Defining health systems innovation
Ellner et al, Acad Med, 2015
The Evolution of Health Systems
Time and Income Level
Disease Burden Acute Chronic
Health system orientation
React and rescue
Engage and empower
Technical excellence
Working within/leading
teams and systems
Passive Active
Key provider competencies
Role of ‘patient’
What does the future of primary care look like?
A Simple Framework for Re-orienting Care
1. Person 2. Place 3. Time
IT better communication, coordination, support and data
Financing aligned with value
Trend 1: Capitated or global payment
Trend 2: Non-visit Care
Virtual visit Triage E-consult
Trend 3: Task sharing
Customer Relationship Management
“Patients” Non-MDs
Clinical Protocols
Trend 4: Big data and Artificial Intelligence
Predicting risk Improving Diagnosis
Trend 5: Behavioral health
Behavior Change Depression
Ms. W
Smartphone app:
• Gives access to and control over health information
• Supports her around her health goals
1. Reducing smoking and alcohol
2. Managing her diabetes and hypertension
• Gives easy access to her care team for virtual care
Ms. W
Primary Health Care team • Health coaches reach out to her twice a year to check in • Nurses, supported by protocols and technology, provide most
basic acute and chronic care • Generalist physicians, with virtual support from specialist
consultants, triage high-acuity/complexity presentations and provide much of complex care virtually
• Psychologist or social worker helps with depression
Thank you!