Central Ohio Primary Care July 2014
Population Health Management …sharing learning from a national perspective
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WHY: The need to transform healthcare in the U.S.
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WHY: The need to transform healthcare in the U.S. Variations in QUALITY: Readmissions within 30 days medical discharge Central Ohio region is one of 57 regions ranked with highest variation
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WHY: The need to transform healthcare in the U.S. Variations in COST: Recent study for Lower Back MRI
Columbus Ohio Average: $1,711 Price Range: $1,335 - $2,749
Nashville TN Average: $1,066 Price Range: $531 - $1,975
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WHY: Spending not aligned with what influences our health status?
What influences our health status 10%
Where our nation spends its health care dollars (~$3+ Trillion)
Access to Care
20%
Environment
20%
Genetics
Access to Care
88%
50%
Lifestyle & Behavior
Other
8%
Health Behaviors
4%
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Source: Centers for Disease Control and Prevention, University of California at San Francisco, Institute for the Future
WHY: Patients largely determine their own outcomes!
Patient–driven care • “Others have struggled to find a proper definition of patient-centeredness. Three useful maxims that I have encountered are these:” – “The needs of the patient come first.” – “Nothing about me without me.” – “Every patient is the only patient.” Donald M. Berwick, What 'Patient-Centered' Should Mean: Confessions Of An Extremist Health Affairs, 28, no.4 (2009):w555-w565
New definition: Patients largely determine their own outcomes. www.hcgc.org
WHAT: Transformation from Volume to Value-based Healthcare 2010-2016: Wave 1 - Patient -Centered Care 2014-2020: Wave 2 – Consumer Engagement 2018-2025: Wave 3 – The Science of Prevention
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Source: The Volume-to-Value Revolution, Oliver Wyman, 2012,
2010-2016: Wave 1 - Patient -Centered Care • Healthcare providers focus their care model on patient needs. • Physicians break the cycle of transactional patient visits that generate a diagnosis and a standardized, non-personal treatment plan. • Physicians shift from a one-size-fits-all approach to a population-health approach, aligning careteam resources to meet the needs of different patient segments. • Patients with different needs are treated by care teams designed to meet the unique needs of the patient—this is the essence of population-health management. www.hcgc.org
Source: The Volume-to-Value Revolution, Oliver Wyman, 2012,
2010-2016: Wave 1 - Patient -Centered Care
$1.2 trillion
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Source: The Volume-to-Value Revolution, Oliver Wyman, 2012,
2010-2016: Wave 1 - Patient -Centered Care
$910 billion
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Source: The Volume-to-Value Revolution, Oliver Wyman, 2012,
2014-2020: Wave 2 – Consumer Engagement
• New patient centered businesses competing on price, value, and outcomes, mobile apps that support consumer health decision making. • Consumers will use healthcare dollars to actively vote for better care. • Wave 1 population-health managers will invite extra-industry players into the market to improve their value proposition to the consumer and to increase points of engagement. • Some extra-industry players will barge in with disruptive (and much more valuable) models. • With the convergence of electronic health records, health kiosks, personal genomics, mobile apps, and home-based monitoring, consumers will expect and demand personalized real-time access to health services. • Wave 2 will be driven by pent-up consumer demand from aging baby boomers and tech-savvy Millennials. www.hcgc.org
Source: The Volume-to-Value Revolution, Oliver Wyman, 2012,
2014-2020: Wave 2 – Consumer Engagement
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Source: The Volume-to-Value Revolution, Oliver Wyman, 2012,
2018-2025: Wave 3 – The Science of Prevention
• Imagine holding a mobile device up to your child’s ear and transmitting the relevant biometric information to the retail health cloud for an immediate diagnosis and treatment plan. • Imagine a $100 saliva-based genomic-sequencing test at a walk-up kiosk—available in 50,000 retail health stores—along with a personalized health plan and a mobile app or avatar to help navigate your personal health profile. • Wave 2 will help Wave 1’s great population managers become even more effective and will devastate provider-centric players who have lagged the market. • Wave 3 will make the most highly evolved and adaptive population health managers more powerful and will significantly constrict the Wave 1 players who don’t continue to accelerate innovation. www.hcgc.org
Source: The Volume-to-Value Revolution, Oliver Wyman, 2012,
2018-2025: Wave 3 – The Science of Prevention
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Source: The Volume-to-Value Revolution, Oliver Wyman, 2012,
HOW: Disrupting a culture of distrust and blame
LESS OF THIS‌
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HOW: Disrupting a culture of distrust and blame
MORE OF THIS… LESS OF THIS… SHARED RESPONSIBILITY for patients/parents/caregivers and healthcare teams having important conversations necessary to receive high-quality healthcare at a lower cost
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HOW: Accepting disruptive change as the norm in healthcare Measure value: achieving good outcomes as efficiently as possible Medicine is in for a radical change as we shift to performance-driven teams
Integrating care to be patient-centered www.hcgc.org
All members of performance-driven teams will need to function at “the top of their license�
Central Ohio Primary Care July 2014
Thank you for your time!
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