180˚ Health Forum April 25, 2012 The Westin Copley Place Boston, MA
Reactive Proactive Paper Digital Silos Teaming Volume Value Talk Action
Prescriptive Analysis Harnessing data for prevention and cure
Hans Rosling, M.D. - World Population • 1961 – two worlds: o Asia – lots of babies with low life expectancy. o America – less babies with longer life expectancy. • 2012 – one world: o Now two babies per woman with a long life expectancy. o Proportion of old people is greater as there are less children. • Population growth in Asia and Africa. • Stroke (Cerebrovascular Disease (CVA)) is replacing AIDS as the “killer” in Africa. • New opportunities – new challenges.
Siddhartha Mukherjee, M.D. - Cancer • 50 years ago, cancer was one disease with one treatment. • Chemotherapy was a non-specific treatment. • 1950 to 2010 – War against Cancer. • $5 billion investment in research. • Under 55 years old, 25% reduction in mortality. • Over 55 years old, slight increase in mortality.
Cancer Discovery • Cancer can be a genetic disease (or a disease that is caused by the distortion of cells). • Cancers, in fact, are very personal. • 2010 – launch of personalized medicine. • Away from evidence-based medicine. • From iterative treatments to transformative treatments. • From larger and larger clinical trials to smaller and smaller trials.
Political themes • Changing nature of patient advocacy. • Trials WITH patient; not ON patient. • Research agenda set by the patient agenda. • Change research funding from iterative to transformative. • Data is rich and Complex BUT o Genetic data is finite.
Disruptive Innovation Bridging the Transition
Clayton M. Christensen • Slide rule to pocket computer. • All industries follow this pattern – decentralization follows centralization – only starting in health care. • Health care affordable – lower cost venues and lower cost providers more accessible and sophisticated. • Complex to simple. • From intuitive trial and error (problem solving) to problem pattern recognition to rules based world. • Intuitive medicine to evidence-based medicine to precision (personalized) medicine.
Sue Siegel • Personalized medicine to precision medicine. • Think of Watson on Jeopardy. • Mapping genomes is becoming accessible and affordable. • Three big changes coming in health care: 1. Ability to target therapy 2. Empowered and engaged consumer 3. Data driven medicine. How could we partner with technology to drive care in our LHIN?
Jamie Haywood • Co-Founder of PatientsLikeMe.com o 146,215 patients; 1,000 conditions o Treatment, symptoms, journals. • Social network – how to shorten time it takes to make a difference to a single person. • How accessible is our data? • Is our data done by the individual person?
Does Washington Matter? Don Berwick, M.D. and Malcolm Gladwell
Don Berwick, M.D. • Patient self hemodialysis – 60% people – 50% reduction in cost, significant reduction of complications. • Outcome? Return to work. • Nuka care: o team based care for every person o 50% decrease in ED visits o 53% reduction in hospital admissions o 20% reduction in primary care visits o hospital cost increases since 2004 – 7%; other systems 40% increases.
Don Berwick (cont’d) • Health care wastes – over treatment, failure to coordinate care, failure in care delivery (infection), excessive admin costs, excess health care prices. • Total waste in the system – minimum 21%!!!! • Types of improvement: o decrease defect o take costs out of production o introduce new products and services (example at the beginning) o choose wisely (only do procedures which are necessary).
Don Berwick (cont’d) • To achieve this: o Put patient first. o Protect the disadvantaged. o Start at scale – NO TIME FOR SMALL TESTS OF CHANGE. o Act locally – only local environments can drive down costs and improve quality.
Malcolm Gladwell • Networks vs. hierarchies. • Story of the p-valve at Toyota. • Hierarchies could not respond this way. • What if health care was more networked? • What if data was more accessible (privacy not a core value of a network). • Hospitals need to move towards being empty. • Turn the lights on transparency in all areas. • Education is changing – the classroom is becoming the place for 1:1 tutoring – everything else is online.
Challenge to all Health Care Achieve the same quality at 50% of cost - technologically this is possible – everyone MUST move towards this! ~ Don Berwick Better Health, Better Care, Better Value
Bill Clinton, US President “Sharing and co-operating seen as weakness”. “No one is going to be right all the time – even a broken clock is right twice a day”. “Need to remove disincentives to compromise”.
Mark Britnell Advice to LHINs • Be bold – say what you mean and mean what you say. • Find out the pressure points in the system, find alternative provider and then commission the service. • MUST have alternatives for commissioning to be effective. • MUST align with the consumer. • LHIN creates the ‘what’ – provider creates the ‘how’.
Mark Britnell (cont’d) • Providers don’t think they need to change. • LHINs need to indicate that the game has changed. • Integration challenges 100 year culture. • Getting everyone around the table to integrate may not be the answer. • Must empower the integrator – General contractor – hires subcontractors with a common goal in mind (building a building). • Pick three to four target populations that you can impact. • MUST demonstrate change.
Mark Britnell (cont’d) • LHINs need to change from the funder to the commissioner. • Funding – provide funds to HSPs. • Purchasing – purchase service to address a need/pain (wait times). • Commissioning - STAND WITH THE PUBLIC: o Understand population o Design services around needs o Set standards o Hold people to account o Integration is the means, NOT the ends.
Mark Britnell (cont’d) • LHINs should be doing the customer satisfaction surveys for providers. • We must become indignant and outraged with bad care – infections. • We must link funding with quality care. • Factor Drummond’s report into our future state. • Bark like a big dog! • Don’t wait for strategic direction – just get moving.
THANK YOU
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