it’s time for impact - oliver wyman · survey: health leaders from the 2018 ow health innovation...
TRANSCRIPT
IT’S TIME FOR IMPACT
Hi De Hi De Hi De Ho
Mission, meet your peer group
prov
ide
achieve
insu
ranc
eco
mm
unity
qual
ity
indi
vidu
als inno
vativ
e
empl
oyee
s
peoplemed
ical
help
patie
nt
better
servicete
ammembers
customers
impr
oveoutcomes
access
solutionsone support
Well-being
possiblepatients
experience
create focu
saffordable
bestcustomer w
ork
finan
cial
Syst
em new
value
deliver right
ever
y
Same side of the table?
Patient Experience (Better Care)
Health of populations
(Better Health)
Reducing per capita cost
(Better Value)
We need a measurable yardstick for impactIHI Triple Aim
Patient Experience (Better Care)
Health of populations
(Better Health)
Reducing per capita cost
(Better Value)
What does greatimpact look like in a measurable way?
Indicators of ‘progress’ do not equal impact
~35MLives in ACOs
~11KUrgent care and
retail clinics
~$10B Annual VC funding for healthcare
<$1KFull genome
profile
60% Providers in at-risk contracts
30%Consumers open to receiving care
via Telehealth
52
39
37
36
34
32
26
14
13
-6
Department stores
Airlines
Credit Cards
Hotels
Banking
Supermarkets
Pharmacies
Health Insurance
Primary Care
Cable & Satellite TV
Avg. and best-in-class net promoter score (NPS) by industry
55
64
28
74
68
68
17
33
Source: Satmetrix 2019 NPS benchmarks; 1. 2017 benchmark
90
71
If NPS is the new EPS, our dividends are hollow
1
Where do we really stand?Life expectancy vs. health expenditure, 1970 to 2015
Source: World Bank. Health Expenditure and Financing - OECDstat (2017) QurWorldlnData.org/the-link-between-life-expectancy-and-health-spending-us-focus CC BY
55
60
65
70
75
80
85
90
0 2000 4000 6000 8000 10000
Life
exp
ecta
ncy
at b
irth,
tota
l (ye
ars)
Health expenditure (2010 int.-S)
Where do we really stand?Life expectancy vs. health expenditure, 1970 to 2015
Source: World Bank. Health Expenditure and Financing - OECDstat (2017) QurWorldlnData.org/the-link-between-life-expectancy-and-health-spending-us-focus CC BY
55
60
65
70
75
80
85
90
0 2000 4000 6000 8000 10000
Life
exp
ecta
ncy
at b
irth,
tota
l (ye
ars)
Health expenditure (2010 int.-S)
We’re lacking confidence in the bigger dialsSurvey: Health Leaders from the 2018 OW Health Innovation Summit
PRIMARY CAREMore virtual visits than office visits for primary careMental health is consistently integrated into primary care
TECHNOLOGY50% of customers will have a portable health record50% of clinical decisions will take genetics into account
VALUE AND COSTHealthcare costs decline as a percentage of GDP50% of provider payments include downside risk
2025 2030 20352020 2040 2050 NEVER
So do we just throw in the towel?
What is really possible?
Key figures reveal a story of big possibilityCurrent U.S. Healthcare expenditure (In $BN)1
40%
10%
50%
0%
60%
20%
100%
90%
80%
70%
30%
3661,184 706 582 399
Net Cost of Health InsuranceDME and Goods
Physician & Clinical SvcsHome Health, Nursing, Residential
Hospital Care
DentalPrescription Drugs
Commercial Insurance
Medicare Medicaid Other payer
Consumer out of pocket
Key figures reveal a story of big possibilityCurrent U.S. Healthcare expenditure (In $BN)1
40%
10%
50%
0%
60%
20%
100%
90%
80%
70%
30%
3661,184 706 582 399
A. Core system transformation: ~$2T in play
C. Redefined health boundaries for the $3.5T
B. Big adjacencies: ~$0.8T in play
Commercial Insurance
Medicare Medicaid Other payer
Consumer out of pocket
Opportunity is massive
RedefinedHealthBoundaries
3BigAdjacencies2Core System
Transformation1
15% 5-10% 10%
30-35% industry-level savings = ~$1 trillion in play
PRICE NORMALIZATION
SITE OF CARE
UTILIZATION MGMT.
OVERHEAD COSTS
CARE MODELSegmented, purpose builtPartnered, scale multipliersTech-enabled ecosystems
Digital first as defaultSelf-guided careNew hubs
Appropriateness of careProactive, personal
AutomationUtilities & new processes
TransparencyComparability
Inno
vatio
n
Diffusion
We know the system transformation levers – we must pull them much harder, faster
Meet FRED
$25k
Need new pyramid principles for pharmacy
POPULATION HEALTH PYRAMID
• 5-15% of people
• 25-50% of cost
• Failure of FFS sick care
Population Percentile
% of totalRx cost
Average Rx PMPY
Top 0.5% 35% ~$122,000
0.5% - 2.5% 30% ~$25,600
2.5% - 7% 17% ~$6,400
7% - 20% 13% ~$1,800
20% - 30% 3% ~$500
30% - 40% 1% ~$250
40% - 50% <1% ~$100
50% - 100% <1% ~$15
PHARMACY PYRAMID MATH SKEWS STEEPER(data is for U.S. commercial population)
Entire structure of demand must change
Extend into the consumer’s daily life
Reconstitute the framework of demand
Achieve real personalization
The full playbook: All levers are critical
Care model
Overhead costs
Site of CarePricing
Utilization mgmt
Cottage industries
Reinventing Pharmacy
Personal-ization
Into daily life
Framework of demand
Core system transformation Big adjacencies Health boundaries
Skeptical?
Renewed impact playbook can stabilize our trajectory for generations
This isn’t about fixing supply OR demand – it’s both Force multipliers are key: new healthcare taxonomy,
reimagined community ecosystems, leadership Full realization has a much bigger halo than 1-time
cost takeout – puts U.S. back squarely on the map
