The Future of Health Care

To receive this presentation in person, contact: mike.jackson@shapingtomorrow.com

Presented by:

The Future of Health Care

June 8, 2010

Michael Jackson Chairman Shaping Tomorrow Virginia Richardson Institute for Leadership in Medicine

www.shapingtomorrow.com

Hospital of the Future

2

www.theILM.org

www.shapingtomorrow.com

Strategic Foresight Scan

Evaluate

Filter

Act

Synthesize

Strategize

3

www.theILM.org

Forecast

www.shapingtomorrow.com

10:90 Research Gap • HIV/AIDS Lessons Demonstrate Need for Horizon Scanning • 10+ Years Translation Lag from Research to Clinical Practice • 90% of Research Spending on 10% of the illnesses • Neglect Greatest Health Issues • Continuous Reactive Planning

Sources: Awasthi et al. (2005). The future of academic medicine: Five scenarios to 2025 .; and Cuervo et al. (2008). Global forum update on research for health (Vol. 5):

4

Fostering innovation for global health. www.theILM.org

www.shapingtomorrow.com

The Global S-Curve

5

www.theILM.org

www.shapingtomorrow.com

Anticipatory Leadership www.theILM.org www.TheILM.org

6

www.theILM.org

www.shapingtomorrow.com

The P’s of Future Medicine

Principal P’s: Precise Panoramic Predictive Preventive Patient Centered Price Competitive Point of Care Personalized Participatory

7

www.theILM.org

www.shapingtomorrow.com

Healthcare Stakeholder Map Current

Agencies

Medical/Health Professional

Legal Boards

Political

Provincial Governments

Health System

Branches Of Health

Service Providers

Hospitals

Source: Shortell and Kaluzny. (2000). Health Care Management: Organizational Design and Behavior (4th ed.).

8

www.theILM.org

www.shapingtomorrow.com

Future Healthcare Network The Patient Will Become the Nucleus of Healthcare Pharmaceuticals Biotechnology

Nurses

Dentistry Physicians

Nutrition

Diagnostics

Patient Medical Devices

Hospitals Public Health

Healthcare Technology Academia

Medicine

Source: Richardson. (2007). A new course in patient-centered care.

9

www.theILM.org

www.shapingtomorrow.com

Healthcare Horizons Horizon Centers of Care Gatekeeper Genetics Implants & Prostheses Longevity Hospitals

2010 Institutions

Clinics, Surgery Centers & Hospitals

Primary Care Physicians

2025 Home / Mobile Avatar, Online, “Smart” Technology AI via Portable Electronic Diagnostics and Automated “Care”

Simple - Testing for Simple

Universal - Testing, Treatment

Manmade Materials

Regenerative Biochemical

Degenerative 80 to 90 Years,

Nearly Non-Degenerative

Treatment Center for Disease - LOS in Days

Teaching Center for Patients,– LOS in Hours

Disorders Reaches Affordability Critical Mass (<$1,000/profile) Surgical Repair Materials, Drug Delivery, and Synthetic Biochemical Materials Aging and Metabolic Breakdown

and Prevention is Mainstream Including Reproductive Health

Process and Technological Advances (Regenerative Organs, Artificial Hemoglobin, etc.)

125+ Years, Increased Quality of Life

Source: Updated from Coates, Mahaffie and Hines. (1997). 2025: Scenarios of US and global society reshaped by science and technology.

10

www.theILM.org

www.shapingtomorrow.com

Provider Disruption Sub-

Specialist

Specialist Primary Care Physician Physician Assistant

Trending Toward Health Care Provided At Lower Levels in the Pyramid

Registered Nurse Med Tech Patient

11

www.theILM.org

www.shapingtomorrow.com

Future Technology Trajectory

Smaller Less Invasive Convenient

Faster Cheaper

Earlier in the Disease Cycle

12

www.theILM.org

www.shapingtomorrow.com

Health Industry Trends Short Term  Economy – back to basics  £/€/$ - pharmaceutical costs Vaccine to regulated prevention Nursing & physician shortages Graying population Enhanced graduate medical education Technology - health extender Greener health delivery

Pay for performance/outcomes Incentives for healthy living Sources: IBM and PriceWaterhouseCoopers

13

www.theILM.org

www.shapingtomorrow.com

Blood Protein Diagnostics

In vitro blood protein diagnostics Major organs or cells secrete protein blood molecular fingerprint Single cell analysis

Blood fingerprint will report organ status, distinguish health from disease, and which disease

14

www.theILM.org

www.shapingtomorrow.com

Human Genome HapMap $ of Human Genetic Variation (Disease Diagnosis) “Gene Chip”– Multiple Gene Examination

Personal Genome Sequencing DTC (Direct-to-Consumer) Identified Origins and Causal Relationships of Complex Diseases “Epigenetic" Factors Linked to Diseases, Heritability Across Generations Stem Cell Transplants Human Reproductive Cloning

15

www.theILM.org

www.shapingtomorrow.com

Cloning & AI

Social

Legal Ethical

16

www.theILM.org

www.shapingtomorrow.com

The Nano-Medical Universe

Nano-Medicine Nano-Bots Nano-Robotic Therapy Nu-Bots Nano-Sensors Bio-Nanobots

17

www.theILM.org

www.shapingtomorrow.com

Smart Living Topic one text

Smart Clothes

Sense Body Functions

Smart Bathrooms

Evaluate Body Fluids

Smart Kitchens

Prepare Body Nutrients

Smart Houses

Promote “Intrapendence”

18

www.theILM.org

www.shapingtomorrow.com

Mind/Body Bionics

Health Avatars Capable of Artificial Thought Neuroprosthetic Brain Implants to Prevent Disease

19

www.theILM.org

www.shapingtomorrow.com

Virtual Reality Surgery

Remote 3D Diagnostics

Global Access to Experts

RoboticAssisted Procedures

Minimally Invasive Surgeries

20

www.theILM.org

www.shapingtomorrow.com

Remote Tele-Treatment Electronic ICU (eICU): Sentara Hospitals eICU Outcomes: Multi-site Access to Intensivists 25% Reduction in ICU Hospital Mortality Rate 17% Decrease in ICU LOS

20% Increase in ICU Capacity Created by Shorter ICU LOS 26% Reduction in Hospital Costs for ICU Patients Sources: Pronovost. (2002). Imagining the ICU of the Future; and Leapfrog. (2007).

Leapfrog Group ICU Fact Sheet.

21

www.theILM.org

www.shapingtomorrow.com

Mental Health Short Term:  Social Issues Treated as Psychological Disorders  Re-Institutionalization – Forensic Beds – Involuntary Admissions – Residential Care / Supported Housing

 Availability in Psychiatric Resources

Long Term: Personalized & Pre-emptive Treatment Emphasized Mental Capital & Wellbeing Brain Stimulation Therapy / Mental Aerobics Genetics – Secondary Mental Health Benefits Drugs to Grow Brain Neurons Brain Prosthesis Source: WHO. (2010). Mental Health.

22

www.theILM.org

www.shapingtomorrow.com

Alzheimer’s & Dementia Silver Tsunami

Short Term:

Projected to double every 20 years worldwide 2010: 35 M; 2030: 66 M; 2050: 115 M

Inadequate £/€/$ on Alzheimer’s research  Institutionalization - residential care  Provider and staff shortages  Treatment resources Long Term: Enzyme inhibitors – reduce plaque

Amyloid gene vaccine – produce antibodies Deep brain stimulation Microglia detection Genetic therapy

23

www.theILM.org

www.shapingtomorrow.com

Medical Tourism/Outsourcing

Source: Woodman, J. (2007). Patients beyond borders, Singapore Edition: Everybodyâ&#x20AC;&#x2122;s guide to affordable, world-class medical tourism.

24

www.theILM.org

www.shapingtomorrow.com

Spinal Fusion Surgery

Source: All Medical Tourism. (2010). www.allmedicaltourism.com.

25

www.theILM.org

www.shapingtomorrow.com

Internet Search Outcomes 80%

Internet Users Go Online for Health Information

66% 27%

Began Online Health Inquiry at a Search Engine Began at a Health-Related Website

58%

Found their Internet Search Affected a Decision About How to Treat an Illness or Condition

55%

Indicate Search Changed their Overall Approach to Maintaining their Health or the Health of Another

54%

Report Search Led to Asking a Doctor New Questions or to Getting a Second Opinion from Another Doctor

35%

Report the Internet Information Affected a Decision About Whether to See a Doctor

Source: Fox. (2006). Online Health Search. Pew Internet & American Life Project.

26

www.theILM.org

www.shapingtomorrow.com

Ratings War

79%

40%

33%

# of Consumers Who Take into Account a Hospitalâ&#x20AC;&#x2122;s Success Rates as Measured by Independent Source

# of Elective Patients Who Considered the Hospitalâ&#x20AC;&#x2122;s Quality Rating When Making Their Hospital Choice.

# of Patients in Need of Hospitalization, and Exposed to Ratings, Changed Their Decision on Where to Get Treatment

J.D. Power and Associates, 2004

Source: Rice. (2006). Influences, usage, and outcomes of internet health information searching: Multivariate results from the Pew surveys.

27

www.theILM.org

Opinion Research, 2004

Harris Interactive, 2003

www.shapingtomorrow.com

Evidence-Based Medicine Archimedes Simulation Models A single model that contains pathways relating to multiple diseases such as:

Full-scale simulation model of human physiology, diseases, behaviors, interventions, and healthcare systems Uses advanced methods of mathematics, computing, and data systems to determine best treatment option and cost-based analysis 28

Source: Eddy. (2005). Evidence-based medicine: A unified approach. Health Affairs 24(1): 9-17. Information on the Archimedes Model can be found at http://archimedesmodel.com. www.theILM.org

Diabetes and Complications Coronary Artery Disease  Hypertension  Congestive Heart Failure  Stroke  Dyslipidemia  Obesity  Metabolic Syndrome  Asthma  Colon Cancer  Breast Cancer  Lung Cancer www.shapingtomorrow.com

Precision Medicine Continuum Current Future Precise

Gaucher’s Disease

Kidney Stone

Fractures

Appendicitis Pneumonia

Empirical

Asthma

HER2/Neu(+) Breast Cancer

Type 1 Diabetes

Heart Attack

FAP/HNPCC(+) Colon Cancer

Prostate Cancer Stroke

Cystic Fibrosis Inflammatory Bowel Disease

Osteoporosis

Obesity Lupus Alzheimer’s Disease

Intuitive

Extent of Treatment Efficacy

Strep Throat Abdominal Aortic Aneurysm

Migraine

2010 Depression

Intuitive

HIV/AIDS

Multiple Sclerosis SARS

Pulmonary Embolism

Schizophrenia Chronic Back Pain

Allergies

2015

Osteoarthritis

H5N1 Influenza

2025 Multi-drug Resistant TB

Empirical

Precise

Extent of Understanding of Mechanism Causing the Disease Source: Christensen, Grossman and Hwang. (2009). The innovator’s prescription: A disruptive solution for health care.

29

www.theILM.org

www.shapingtomorrow.com

Longevity

Life Span

• Increase to 125+ Years

End of Life • Immediate – Informed Consent Issues – Based on Short-term: Degenerative Metrics End of Life • Future – Informed Consent Issues – Based on Non-Health Social Factors Long-term: 30

www.theILM.org

www.shapingtomorrow.com

Games for Health Education “Wii” bit of Technology Aids Medical Education

http://asunews.asu.edu/20080222_wiistudy www.healthgamesresearch.org

31

www.theILM.org

www.shapingtomorrow.com

Future Mental Model Shifts Mental Model I

Mental Model 2

Curative

Preventive

Pharmaceutical Western Medicine = The Health System

Complementary Western + Contemporary= The Wellness System

Nutrition based

Nutrition focus

Institution based

Home based

Face to face treatment

Space to place treatment

Government responsibility to health

Individual responsibility mediated by government

Information control by professional experts

Open system information

Source: Marsh, N., McAllum, M., Purcell, D. (2002). Strategic foresight: The power of standing in the future.

32

www.theILM.org

www.shapingtomorrow.com

Future Provider Competencies Patient-Centered Equilibrium Value Innovation Orientation Multicultural Linguistics / Technologies Global Mindset

Inclusive Culture Values Orientation Disruptive Innovator / Early Adopter Global Alliance Modality Strategic Foresight & Leadership

33

www.theILM.org

www.shapingtomorrow.com

Scenario Planning DIABETES & OBESITY Prediabetes

Total diabetes

Not diagnosed

Cost

The Frog Didn’t Jump

65M

50M

15M

$351B

We Did the Best We Could

50M

45M

10M

$395B

Caring Communities & Access to Health Care

45M

40M

1M

$345B

Evolving Systems with Enlightened Leaders

35M

28M

0.3M

$220B

2025 Scenario

Source: Rowley and Bezold. (2006). “The futures of US health care: The case of diabetes & the paths for eliminating health disparities,” Institute for Alternative Futures.

34

www.theILM.org

www.shapingtomorrow.com

Uncertainty LEVELS OF UNCERTAINTY

1.

A Clear-Enough Future

2.

Alternative Futures

3.

A Range of Futures

4.

True Ambiguity

Each level of uncertainty requires a different strategic approach

Source: Courtney. (2001). 20/20 foresight: Crafting strategy in an uncertain world.

35

www.theILM.org

Effective strategy is not â&#x20AC;&#x153;one size fits allâ&#x20AC;?

www.shapingtomorrow.com

Timeline

36

www.theILM.org

www.shapingtomorrow.com

Next Steps

Continuous Anticipatory Planning Future Issues Brief: Mental Health: The Perfect Storm The Alzheimerâ&#x20AC;&#x2122;s Silver Tsunami Healthcare Globalization

Leadership/Foresight Training

Scenarios Planning Roadmap Analysis Strategic Action Plan

37

www.theILM.org

www.shapingtomorrow.com

ILM Foresight Fellows

Global Foresight Fellowships Leadership & Educational Programs Peer-to-Peer Research/Analysis Think Tank Incubation and CoCreative Forums Global Peers ILM Knowledge Center

www.theILM.org

38

www.theILM.org

www.shapingtomorrow.com

Thanks for Listening Best wishes for your journey to the future Further Information Dr. Michael Jackson, Chairman Shaping Tomorrow www.shapingtomorrow.com The Habit, Blackladies Kiddemore Green Road | Bishops Wood Staffordshire ST19 9BQ | England (H)ome: +44 (0)1902 851918 (O)ffice: +44 (0)1902 851-985 (M)obile: +44 (0)7966 155-912 (E)mail: mike.jackson@ShapingTomorrow.com (S)kype: shapingtomorrow

39

www.theILM.org

www.shapingtomorrow.com