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 HealthcareChoice, Engagement, Experience

Leo BarellaBlue Cross Blue Shield of Michigan

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It’s a matter of choice….

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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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The Old Paradigm: Treatment of Disease

Time

Dise

ase

Seve

rity

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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Major Drugs Ineffective for Many

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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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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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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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Cost Per Genome

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BENCHTOP GENOME CENTER

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Effective, Efficient Health Management

Time

Dise

ase

Seve

rity

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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Social Provider

Media Blog

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Social Provider

Media Blog

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$4,000

$79

KolibreeSmart toothbrush BlueAnatomy

Smart scale

TotalECG®Wireless 12 Lead ECG System

ClearProbeConnected Ultrasound Device

NICaSNon-Invasive Cardiac System

SpiroPerfectConnected Spirometer

& Pulmonary Function Test

AMDTelehealth Examination cameras

3M LittmanConnected Electronic

Stethoscope

WallDocConnected Integrated Examination Station

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Massimo Radical 7Handheld and portable pulse monitor

KinsaSmart thermometer Withings

Smart blood pressure monitor

LunaBed sensor that tracks temperature and sleep

MimoSmart baby monitors

UP3, Basis & W/MEGeneral health trackers

RejivaVital and bio snesor

CliniCloudSmart home health kit including stethoscope, thermometer and telemedicine

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It Will Largely Fall Onto the Healthcare Industry to Recognize the Value of Predictive Analytics and Implement Critical Use Cases

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Beyond Regulation, the Biggest Risk to Predictive Analytics Being Used in Healthcare is Adoption as Power Dynamics Shift

Our question: Can user experience and design influence decision making so deeply as to be regulated?

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New Data Streams, Including Those Direct From Patients, AreBeginning to be Used by Companies for Predictive AnalyticsSO MUCH DATAPercentage 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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