consumer centric healthcare
TRANSCRIPT
Blue Cross Blue Shield of Michigan and Blue Care Network of Michigan are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association.
Consumer Centric Healthcare
Leo BarellaVP EIT- Data Intelligence
Blue Cross Blue Shield of Michigan
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“There is nothing more difficult to take in hand …. than to take the lead in the introduction of a new order of things.
Because the innovator has for enemies all those who have done well under the old conditions, and lukewarm defenders in those who may do well under the new. This coolness arises partly from fear of the opponents, who have the laws on their side, and partly from the incredulity of men, who do not readily believe in new things until they have had a long experience of them.“
- Nicolo’ Macchiavelli
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Two Thousand Years Ago….
“It is far more important to know what person the disease has than what disease the person has,”- Hippocrates
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The Old Paradigm: Treatment of Disease
Time
Dis
ease
Sev
erity
Reactive Medial Care
Diagnose Disease: Treat Symptoms; Costly, Trial and Error Treatment
Diagnosis
Select Drug
Switch Drug
Switch Drug Again
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How Do We Decide That a Drug “Works”
CURE
NO EFFECT
SIDE EFFECT
SERIOUS SIDE EFFECT
CURE
NO EFFECT
SIDE EFFECT
SERIOUS SIDE EFFECT
A
B
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Ineffective Therapies Can Cause Harm
Adverse Effects• Estimated 125,000 deaths per year (in 2014)
• 6th leading cause of death in the US
• Experienced by approximately 7% of patients (2.2 million) per year
• Medication-related health problems account for an estimated 3-7% of hospital admissions (Pirmohamed M, et al 2004)
• During their hospital stay, 15% of patients experienced adverse drug reactions (Davies, et al 2009)
• Increased patient non-compliance
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Google answers to anything
The Consumerism Megatrend
Implications on Healthcare
Americans Want Control
Control TV programming with TiVo
Seek employment through LinkedIn
Keep personal videos on Facebook
Maintain their music with iTunes
Buy & sell goods through eBay
Purchase stock over the internet
Bank electronically at ATMs
They don’t want limits, restrictions, waiting lines, or other barriers to their health
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Videoconferencing for follow-up visits
Self-monitoring device to check condition & send information to DR. electronically
Videoconferencing for sick visits
App that enable access to medical records & treatment information
App to set & track progress towards health improvement goals
App that reminds you to take medication
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Personalized Medicine
“Products and Services that leverage the science of genomics and proteomics (directly or indirectly) and capitalize on the trends toward wellness and consumerism to enable tailored approaches to prevention and care.”
PricewaterhouseCoopersThe new science of personalized medicine
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Effective, Efficient Health Management
Time
Dis
ease
Sev
erity
Predisposition Screening
Diagnosis/Prognosis
Right Drug Monitoring
Efficient Medial Care
Health Management; Molecular Screening, Early Detection; Rapid Effective Treatment; Improved Quality of Care
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New Data Streams, Including Those Direct From Patients, AreBeginning to be Used by Companies for Predictive AnalyticsSO MUCH DATA
Percentage of venture-backed predictive analytics companies using various types of data (2011-Q3 2014)
SAM HO, M.D.Chief Medical Officer, UnitedHealthcare
“Current data sets generally revolve around claims but that’s going to be changing with lots of clinical data and transactional information with lifestyle becoming more readily accessible”
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Personalizing Care Through Predictive Analytics Represents a Significant Opportunity to Reduce Costs in the Healthcare System
$192B
OVERTREATMENT
• Eliminating care that cannot help patients – care that outmoded, supply-drive, and eschews science
• Restricting treatment and intervention to the patients who will benefit based on the individual and the context
$128B
FAILURES OF CARE DELIVERY
• Continuously studying care to identify what works for whom and in what context
• Scaling best practices including preventive care and early warning systems that demonstrate effectiveness
$35B
LACK OF CARE COORDINATION
• Ensuring those at the highest risk of costly medical episodes are
identified, monitored, and cared for between
visits and following hospitalization
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Actionable lifestyle prescription for reducing risk of disease
Greater control & patient-centered access to medical records
Treatment decisions will be improved by patient education
Greater knowledge of one’s genetic risks
Changing Role of the Consumer (Patient)
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New ethical & legal issues/quandaries
Greater reliance on HIT for decision support
Improved care through use of aggregate patient data
Highly networked, team based care
Physician as manager, rather than repository of medical knowledge
Changing Role of the Health Care Provider
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Regulatory mandates could disrupt development budgets & market plans
“Personalization” of drugs will require partnering with diagnostics companies
Uncertain economics of drug development & commercialization
New Business Strategies for Pharma
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Increased need to demonstrate cost efficiencies
Proactive strategies to limit reimbursement
Increased pressure to change paradigm towards preventive medicine
Greater emphasis on clinical validity & utility of diagnostic tests
New Demands On and From Payers
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The Evolution of Healthcare Consumerism Generations of Consumerism
HIGH IMPACT
Traditional Plans
Traditional Plans With Consumer Information
1st Generation
High Deductible
Plans
2nd Generation
Focus on Behavior Changes
3rd Generation
Health & Performance
4th Generation
Personalized Health &
Healthcare
5th Generation
Community Health &
Healthcare
LOW IMPACT
Behavioral Change, Improved Health, & Lower Cost Potential
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The Promises of Consumerism Major Building Blocks of Consumerism
Personal Care Accounts
Health Management
Condition Management
Health Literacy
Incentives & Rewards
The Promise of Demand Control & Savings
The Promise of Wellness
The Promise of Health
The Promise of Transparency
The Promise of Shared Savings
It is the creative development, efficient delivery, efficacy, and successful integration of these elements that will prove the success or failure of consumerism.
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Personalized Medicine: Impacts Care
~ 38 types of Leukemia
~ 51 types of Lymphomas
“Disease of the Blood”
Lymphoma
Leukemia
Aggressive Lymphoma
Indolent Lymphoma
Chronic Leukemia
Acute Leukemia
Preleukemia
5 Year Survival ~0% 70%
Ries LAG, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L, Mariotto A, Feuer EJ, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2002, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2002/ Based on November 2004 SEER data submission, posted to SEER web site 2005
Source: Mara G. Aspinall, former President, Genzyme Genetics
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It Will Largely Fall Onto the Healthcare Industry to Recognize the Value of Predictive Analytics and Implement Critical Use Cases