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Envision Virginia Beach 2040 Healthcare Considerations

November 17, 2011

Gary R. Yates, M.D. Senior Vice President and Chief Medical Officer

Sentara Healthcare

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A Look Into the Future Impact of Healthcare

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Population by Age and Sex (Millions)

Demographics as Destiny

Note: The reference population for these data is the resident population. Source: US Census Bureau, 1983, 2001, 2004.

Baby Boom 1980

Age

Female Male

0 5 10 15 15 10 5 0–4 5–9

10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84

85+

2020

Age

Female Male

0 5 10 15 15 10 5 0–4 5–9

10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84

85+

2000

Age

Female Male

0 5 10 15 15 10 5 0–4 5–9

10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84

85+

2040 A

ge Female Male

0 5 10 15 15 10 5 0–4 5–9

10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84

85+

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Your 65+ Market in 2020 (Huge Implications for 2040)

Out of 100 Seniors: • 80 overweight or obese • 84 with chronic condition • 62 with multiple chronic conditions • 20 depressed • 35 live alone • 50 need help with ADL • 25 with 15+ health care interactions

per year • % working?

ADL = activities of daily living. Sources: US Census Bureau; Sg2 Analysis, 2008.

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US Population and Those 65 and Older

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City of Virginia Beach

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Healthcare 2040 • Life Expectancy - United States (US Census

Bureau) – 2005 Estimated Number of Centenarians – 67,473 – 2040 Estimated Number of Centenarians – 580,605

• Cause of Death

– Accidents, by 2030, will be a leading cause of death – Parkinson’s disease (PD), along with other neuro degenerative

diseases (Alzheimer’s disease and motor neuron disease), is expected to surpass cancer as the second most common cause of death by the year 2040.

• Prevalence increases with age • 1 in 100 individuals over 65

– Deaths related to heart disease and cancer will continue to decrease

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Will We Have Enough Physicians?

Supply and Demand Projections HRSA: 22% growth by 2020 to 951,700 physicians HRSA: shortfall of 55,000 physicians by 2020 COGME: shortfall of 85,000 physicians by 2020

MD Demand

MD Supply

Number of Physicians (in Thousands)

HRSA = Health Resources and Services Administration; COGME = Council on Graduate Medical Education. Sources: US Department of Health & Human Services, 2006; HRSA, 2008; US Government Accountability Office, 2008; Association of American Medical Colleges, 2007; Cejka Search, 2006.

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Will We Have Enough Nurses?

RN Demand

RN Supply

Supply and Demand Projections HRSA: shortfall of 490,641 nurses by 2020 Buerhaus P et al: shortfall of 285,000 RNs by 2020, and

500,000 by 2025

Number of RNs (in Thousands)

Sources: CareerBuilder, 2005; Buerhaus P et al. The Future of the Nursing Workforce in the United States: Data, Trends and Implications. Jones and Bartlett Publishers: 2008; Projected Supply, Demand, and Shortages of Registered Nurses 2000–2020. HRSA: 2002; Sg2 Analysis, 2008.

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Community/ Lifestyle Center

Diagnostic Center

Coordinated System of Care

Post-Acute Care

Care Team Center

Self Access Center

Procedure or Regenerative Center

Acute Care Center

Patient Home

Acuity

CARE = Clinical Alignment and Resource Effectiveness.

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The Economic Imperative

All Other Health Care

Medicaid

Medicare

Projected Spending on Health Care as a Percentage of GDP, 2007–2082

GDP = gross domestic product. Source: Congressional Budget Office.

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Don’t Expect Large Infusions of New Cash Into the System

HI Trust Fund Balance as Percentage of Annual Expenditures

By 2012, payout for benefits will exceed payroll taxes.

By 2019, all reserves will be exhausted.

The challenge: CMS must engineer a fiscal “safe landing.” HI = Federal Hospital Insurance; CMS = Centers for Medicare & Medicaid Services. Sources: Annual Report of the Board of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, 2007; CMS.

Historical Estimated

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The Perfect Storm

• Growing Population

• Chronic Diseases at Epidemic Levels

• Healthcare Provider Shortage

• Fewer Dollars

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Healthcare 2040

• Ultra-personalized Healthcare – National biorespository and

genetic information system – Mandatory participation for safety and public health – Geonomic information integrated with electronic health

record – Identification and treatment of individual diseases at

earliest opportunity – Information to drive training and employment needs to

match needs to resources

FutureTimeline.net

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Healthcare 2040 • Nanotech Implants and Devices

– One or more used by every citizen – Tailored to meet the exact needs of

citizens – Stores vital clinical information for use

during emergency situation – Tracking device for individual with mental

illness – Programmed to detect or monitor specific

conditions such as diabetes – Dispense medication when needed – Alert healthcare provider

Note: Definition – the study and control of

phenomena and materials at length scales below 100 nm. Human Hair is about 80,000 nm wide.

Nanotechnology Sensor can “Smell” Cancer in

Exhaled Breath

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Healthcare 2040

• Nanomedicine – Medical application of

nanotechnology to treat disease

– One nanometer is one-millionith of a millimeter

– Nanoparticles used to localize and target treatment

– Increases accuracy; without damage to surrounding tissue/organs

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Healthcare 2040

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Healthcare 2040 • Complex organ

replacements grown from stem cells – 2011 – First synthetic

organ transplant using stem cells

• Windpipe to terminal cancer patient

– 2020 – Regeneration of heart cells

– 2040 - Need for external donors is eliminated

• Organs genetically matched to the patient

• No chance of rejection – Cure versus ongoing

treatment

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Healthcare 2040 • Telehealth

– Care between venues and episodes of care

– Management of Chronic Disease

– Primary care visits – Specialist Consultation

• MD to MD • Patient to MD

– Link Rural to Urban Providers – Expands Capabilities or Urban

Providers – Is there an APP for that?

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Healthcare 2040

• Use of Tobacco Largely Eradicated – 1990 – 25% US

Population – 2010 – 20% US

Population – By 2020 – smoking in public banned –

US and many other countries – 2040 – Less than 5% Global Population

FutureTimeline.net

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Healthcare Care 2040

• Private Health Insurance – Exist as up-market product only – To cover elective, cosmetic, and highly

esoteric treatments • Advanced genetic therapy • Aging management

– The new “extended warranty coverage product”

• The "public option" and the "private option" will each work just fine.

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Healthcare 2040 Healthcare Anywhere in Many Ways

NanoCare

Implantable Care

Wearable Biosensors

Telehealth

At Home Care

APP for that Care

Personal Health Record

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Behavioral Health A Crisis Today; Challenges for

the Future

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Watson – Artificial Intelligence

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Changing Role of the Physician • From Point of Contact for All Health Care Needs • To Trusted Advisor/Direct Care for the Sickest of

the Sick • Coordination and Management of Care for

Larger Practice Panels – Today 2,000 patients in a PCP panel – Tomorrow 6,000-10,000 patients in a panel, cared for

by a team of individuals • All working at the highest level of their credentials

• And the team members will likely differ from our definition of team today……Meet

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Healthcare 2040 Community Impact

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Home Sweet Home • Growing Old, At Home

– Tomorrow’s elder population • Longer lives • Better Health • Active Lifestyles • Boomers and Zoomers

– Challenge • Maintaining independence

• “Aging in Place” – Homes that provide enjoyment and stimulation – Support declining functional limitations

• Boomers/Zoomers – Housing designs that

• Accommodate rather than discriminate • Sympathize rather than stigmatize • Appeleal to all ages and abilities

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Smart In-Home Monitoring System

• Medical Automation Research Center (MARC)’ University of Virginia – technological solutions for in-home monitoring of

residents in order to provide quality of life indicators – in-home monitoring system is composed of a suite of

low-cost, non-invasive sensors (strictly no cameras or microphones),

– data logging and communications module – integrated data management system, linked to the

Internet – observations can be made from the activity data

generated by the monitored individual • general health and activity levels • activities of daily living (ADL), • index of well-being • measure of the decline in ability over time.

– observations may yield early indicators of the onset of a disease.

– additionally, a sudden change of activity (or inactivity) can indicate an accident.

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Smart Home Advancement From Research to Commercialization

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Smart Home Technology • Impact on Healthcare Resources

– Formal care providers receive a report on the health of the monitored subjects

– Improves informal care effectiveness without increasing intrusion

– Reduces cost of informal care, which is particularly high for older adult populations

– Reduces burdens on the informal caregiver, and hence reduced stress and improved mental and physical health conditions

– Involves the care recipient in health promoting activities and decision-making.

– Delays admittance to specialized institutions, and hence a reduced cost of formal elder care.

– Reduced formal care burdens, and hence improved formal care.

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Broadband, Healthcare’s Adrenaline • Provide Healthcare

applications over residential broadband – Wellness programming – Pre-op videos with

authentication – Chronic Disease Management – Post Op monitoring – Doctor visits – Personal EMR – Two way Video

Cox Connecting with Healthcare

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Life Long Communities • Active seniors yet trans-generational • Truly walkable community • Government resources redirected

– School buses to transport seniors to stores • Freedom from cars • Access to health care services

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Economic Impact • Future retirees are likely to spend far more of their

budget on health care expenses than current retirees.

– Median out-of-pocket costs expected to grow from about $2,600 in 2010 to $6,200 in 2040 in constant 2008 dollars*,

– About 10 percent of older adults with the most pressing medical needs will spend more than $14,000 per year on health care in 2040, even with Medicare coverage.

• exclude the cost of a nursing home, home care, and other types of long-term care

• Income for those age 65 and older will increase more slowly from $26,800 in 2010 to about $34,600 in 2040 in constant 2008 dollars.

• The Urban Institute estimates that seniors in 2040 will spend a median of 19 percent of their income on health care in 2040, up from 10 percent today.

• The share of adults spending over a fifth of their income on their health is expected to increase from 18 percent today to 35 percent in 2030 and 45 percent in 2040.

* Urban Institute

The health care industry is

currently one of the fastest

growing sectors of the economy and will likely remain so as the need

increases for long-term care facilities and doctors who treat the elderly

and a more diverse

population.

Economic Development

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Workforce • Shortage of healthcare

professionals will be exacerbated as the working age population shrinks

• In 1960, there were 5.1 workers per Social Security beneficiary – in 2000 there were 3.4 – ratio is expected to fall to 2.1 by 2040

• The workforce will age – Impact on productivity – Maintaining skills and knowledge

Aged Caring for the Aging

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The Spectrum of Health and Strategies to Improve It

An Opportunity Map for Societal Investment in Health Jonathan E. Fielding, MD, MPH Steven M. Teutsch, MD, MPH. JAMA May 25,2011 Vol 305, No. 20

Focus Intervention to Achieve

Greater Health and Economic Efficiency

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The Spectrum of Health and Strategies to Improve It

Focus Intervention to Achieve

Greater Health and Economic Efficiency

Inte

rven

tion

Leve

l

An Opportunity Map for Societal Investment in Health Jonathan E. Fielding, MD, MPH Steven M. Teutsch, MD, MPH. JAMA May 25,2011 Vol 305, No. 20

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Education • Science • Technology • Information Technology • Information Analysis • Health Professions • Public and Private Partnerships • Community Matching –Needs

to Programs • Learning through Connectivity • Simulation Laboratories • Sustaining Skill Competencies

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Healthcare 2040 What Would Hippocrates Say Now?