Health Care 2020: Emerging Innovations in the Health Care Payment and Delivery Landscape
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Transcript of Health Care 2020: Emerging Innovations in the Health Care Payment and Delivery Landscape
©2012 T
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HBS Health Industry Alumni Conference
March 14, 2012
Health Care 2020
Emerging Innovations in the Health Care Payment and
Delivery Landscape
©2012 T
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Looking to Put Health Care on a Budget
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Source: Health Care Advisory Board interviews and analysis.
Three Manifestations of Health Care on a Budget
Federal Budget
Framework
Budgeting in the
Private Market
Individuals
on a Budget
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Growth
Rate
Inflation
Health Care
Inflation
Time
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Driving Innovation in the Commercial Market
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Commercial Insurers Following Medicare’s Lead
Source: “Anthem Blue Cross, Sharp HealthCare Pilot San Diego-Area ACO,” available at: www.healthcarefinancenews.com; “Norton Healthcare, Humana Launch ACO Pilot,” “Aetna, Carilion Clinic
Building ACO in VA ,” available at www.healthleadersmedia.com; “An ACO Takes Root in San Francisco,” available at: www.chwhealth.org; “8 Aspects of UnitedHealthcare's Plans to Fund an ACO at
Tucson Medical Center,” available at: www.beckershospitalreview.com; “Advocate Health Care, Blue Cross and Blue Shield of Illinois Sign Agreement Focusing on Improving Quality, Bending the Health
Care Cost Curve,” available at: www.bcbsil.com; “Minnesota’s Largest Health Plan Signs ‘Total Cost Of Care’ Agreement With Park Nicollet Health Services,” available at: www.bcbs.com; “BCBS
Massachusetts Announces First Year Results of Alternative Quality Contract,” available at: www.bluecrossma.com; “CIGNA and Piedmont Physicians Group Launch Accountable Care Organization Pilot
Program,” available at: newsroom.cigna.com; Maine Health Management Coalition, available at: www.mehmc.org; Health Care Advisory Board interviews and analysis.
BCBS Massachusetts’s
Alternative Quality
Contract: Annual global
budget, quality incentives
for participating providers
Blue Shield California:
Two ACOs in Northern
California
CIGNA: Medical home
contract with Piedmont
Physicians Group
BCBS Illinois: Shared
savings contract with
Advocate Health Care
BCBS Minnesota:
Shared savings contract
with five providers
UnitedHealth Care: ACO
with Tucson Medical Center
Maine Health
Management Coalition:
Multi-stakeholder group
supporting ACO pilots
Providence Health &
Services: $30 M, two-year
contract with public
employee benefits board
Humana: ACO pilot
with Norton Healthcare
Anthem Blue Cross:
ACO pilot with Sharp
HealthCare medical groups
Aetna: ACO pilot
with Carilion Clinic
Budgeting in the Private Market
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Looking Ahead to a Decade (or More) of Change
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Entering an Era of “Accountable Care”
1) Evidence-based medicine
Betting on a Provider-Driven Solution Set
• Consolidation and integration
• Continuum-wide care
• Efficiency and standardization
• Group aggregation and employment
• Enhanced primary care practice
• Embedding IT to drive to EBM1
• Public—price cuts and risk shifts
• Private—risk-based contracting
• All—value-based payment models
• Increased cost-sharing with employees
• Heavier emphasis on health management
• Defined (or no) contribution
Who’s “accountable”?
Hospitals
Doctors
Payers
Employers
Patients
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Argument in Brief
Information Liberation
New Incentives
Rocket Fuel for Innovation
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There Has Never Been a Better Time to Be an Innovator in Health Care
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Community Health
Provider Directories &
Quality
“Blue Button”
Consumer Product
Information
Medical/Scientific Knowledge
Govt Spending
HHS(Growing)
Catalog of
Liberated Data
Open Health Data
Engaging Citizens in Health Improvement at the Community-Level
Source: Asthmapolis, iTriage, Ozioma, Healthline.
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“Deep Dive” – Data Liquidity for Personal Health
Blue Button,” DIRECT - Government Startups that Scale
Source: www.va.gov/open; www.bluebuttondata.org.
“Blue Button” in Brief “Direct” Secure Email Standard
President challenges VA to deliver
simple health download from PHR
on 08/10; delivered 10/10 and has
>400,000 users to date
An open collaboration to develop a simple
method for enabling secure Internet-based
health data transmission; specs posted in
90 days; first production transaction 1/11;
implementation by 65+ vendors
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“Meaningful Use”
New Incentives, Part I
Office-Based Physicians an EHR
ePrescribing on the Surescripts Network
Source: Office of the National Coordinator for Health IT; Source: Cebul, Randall D., et al.
New England Journal of Medicine, August 2011; Surescripts.
Quality of Diabetes Care
Cleveland Clinic Providers using EHRs vs. Paper Records
51%
44%
7%
16%
% Obtaining All Recommended Care Processes
% Obtaining 4 of 5 Outcome Standards
Growing Evidence Linking Quality to Health IT Adoption
Care Processes: Measure Hemoglobin; Kidney
Mgmt; Pneumococcal Vaccine; Eye Exam
Outcomes: LDL<100 mg/dl; smoking; glycated
hemoglobin <8%; BP <140/80; BMI<30
0.8%
20.7%
40.2%
0.0% 5.0%
10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0%
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Dramatic uptick in EHR adoption –
nearly doubling in one year and on
track to support “meaningful use” in the
coming years
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Cultivate Innovation Ecosystems
Substitutability the Key Design Principle to Modular Development
Source: Dr. Gunston Ho, Apixio;
Extending the EHR
Dr. Gunston Ho
3rd Party Applications
Search Tool Extends Aids Care
Primary care clinic earns 180% of
Medicaid to improve care
coordination; adopts EHR with
support from extension center
EHR interoperates with modern
search tool to better manage
care population
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Looking Ahead to a Wired Health System
10 Information Asset
Emerging Data Systems Change Outlook of Competitive Asset
Source: Executive Office of the President, “Realizing the Full Potential of Health Information Technology to Improve
Healthcare for Americans: The Path Forward,” available at: http://www.whitehouse.gov/sites/default/files/microsites/
ostp/pcast-health-it-report.pdf, accessed April 26, 2011.; Health Care Advisory Board interviews and analysis. 1) Electronic Health Record.
Disruptive
Technologies
• Cloud Computing
• National Network
• Health Information
Exchanges
• Focus on data ownership
• Health system has possession
of “the wires,” proprietary data
• Data analysis conducted in silos
• Data is prescriptive, predictive
• Focus on EHR1 capability
• Compete in a world of
greater transparency
Today: Differentiate
on Data Access
Future: Differentiate on
Data-Informed Care Plan
Physicians on the Fast Track
“Cloud-based technologies and PHRs1 are potential examples of disruptive technologies in health IT.
These types of technologies might allow the 80 percent of physicians who are non-digital to leapfrog
some of the existing limitations of EHR systems directly into more modern technologies.”
Report to the President
President’s Council of Advisors on Science and Technology
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New Incentives, Part II: Payment Reform
Pay for “Value” to Drive New Markets for Care Coordination Services
• Data Mining/Analytics
• Care Integration Tools
• Timely Clinical Data,
Decision-Support
• Technology to Extend
Physician Reach
• Consumer Engagement
Tools/Platforms/Apps
• Organized outpatient care, coordination and team-based approaches
Patient Centered Medical Homes
• Shared savings; Redesigned care processes for high quality, efficient delivery
Accountable Care Organizations
• Pilot program for episodes of care; incentivizes reduced costs around eight conditions
Bundled Payments
• Motivates hospitals to engage with care coordinators and better organize delivery systems
Readmission Reduction Programs
Innovations Needed:
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Shifting Risk and Accountability to Providers
Providing an Incentive to Remake the Delivery System
Source: Health Care Advisory Board interviews and analysis.
Degree of
Shared Risk
Care Continuum
Pay-for-Performance
Hospital-Physician Bundling
Episodic Bundling
Capitation/Shared-Savings Models
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Chronic Disease Growth Outpacing Population Growth
Source: Milken Institute, available at: http://www.milkeninstitute.org/
pdf/chronic_disease_report.pdf, accessed April 27, 2011; Health Care
Advisory Board interviews and analysis.
Projected Increase in Chronic Disease Cases
2003-2023
29.0% 31.0%
39.0% 41.0%
53.0% 54.0%
62.0% 19%: Projected
population
growth, 2003-
2023
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Enabling Constant Monitoring of Health Status
Reminders Help Patient Stay on Track and Reinforce Care Plan
Source: WellDoc Inc., available at: http://www.welldocinc.com,
accessed: May 4, 2011; Health Care Advisory Board Interviews and analysis.
Activation On the Go
Advice Triaged Across
Multiple Sources
• Real-time biometric
alerts via text message
• Longitudinal alerts and
reminders via web portal
• Secure provider
communication via e-mail
WellDoc Alert
“Your most recent blood
test shows that you have
low blood sugar. It’s time
to treat this before you eat
your meal or take your
meal time medication.”
Technology in Brief: WellDoc, Inc.
• Health care technology company based in Baltimore, Maryland
• Initial clinical trials showed successful reduction of HbA1c levels by 2.03 percent
• Mobile health coach device can be used with variety of patients; with or without
physician participation
• Two-year, 225-patient effectiveness study completed January 2010; participants
included University of Maryland, Care First Blue Cross Blue Shield, Sprint, LifeScan
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Telemedicine an “Embedded” Asset in Care Delivery
Putting it Altogether
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Web-based EMR provides
easy access to patient
charts, labs, and
pharmacies.
Two-way fully
duplex web-
based video
conferencing
system.
Remote desktop
login assistance
is available at
the physician’s
finger tip.
Patients can consult with a
CareClix physician from the
comfort of their home or office. No
equipment or special hardware
needed. Mobile apps are available
for mobile patient. Little or no wait
to consult with a physician.
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Crimson Supporting Total Value of Care
Managing Performance Across Three Dimensions
Measuring Total Value of Care
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2 3
Care Sustainability
Ensuring Financial and Operational Health
to Support Reinvestment and Growth
Key Metrics:
• Contribution margin
• Adjusted length of stay
• Cost per case
• Surgical revenue, percentage
of operating revenue
Care Outcomes
Improving Quality, Reliability,
and Experience of Care Provided
Key Metrics:
• Same-site 30-day readmissions
• Hospital-acquired conditions
• Complication of care rates
• Severity-adjusted mortality
1 2
3 Care Management
Managing Population Health and Preventing Chronic Disease
Key Metrics:
• At-risk population measures (e.g. diabetes, heart failure, hypertension, COPE, etc)
• Ambulatory-sensitive measures
• Preventive care measures and screening
Value Potential Total Value of Care
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©2012 T
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HBS Health Industry Alumni Conference
March 14, 2012
Health Care 2020
Emerging Innovations in the Health Care Payment and
Delivery Landscape