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HIMSS CEO Addresses Leveraging Information and Technology to Minimize Health’s Economic Challenges Session # 96 March 6, 2018 Hal Wolf CEO, HIMSS
HIMSS CEO Addresses Leveraging Information and Technology to Minimize Health’s Economic Challenges
Session # 96March 6, 2018
Hal WolfCEO, HIMSS
• Fastest Ageing Population
• High Chronic Disease Burden
• Geographic Displacement
• Extremely Challenging Funding System
• Highly Educated and Demanding Consumer
• Lack of Actionable Information
Challenges in Most Systems
Total Health Expenditure per Capita, USD, 2014
Source: World Health Organization, Global Health Expenditure Database 2014
Public Share of Total Health Expenditure, USD, 2014
Source: World Health Organization, Global Health Expenditure Database 2014
30.0%42.0%
46.0%48.0%
49.0%56.0%
66.0%66.0%67.0%
69.0%71.0%72.0%
73.0%75.0%75.0%
77.9%79.0%
82.0%83.0%
84.0%85.0%85.0%
86.0%86.0%87.0%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
IndiaSingapore
BrazilUSA
ChileChina
SwitzerlandIreland
AustraliaMaltaSpain
UAECosta Rica
Saudi ArabiaFinlandFrance
EstoniaNew Zealand
UKSweden
DenmarkNorway
QatarThailand
Netherlands
Economics of Healthcare
Source: United Nations (2015). World Population Prospects: The 2015 Revision.
Percentage of the population aged 60 years or over for the world and regions, 1980-2050
Pe
rcen
tage a
ge
d 6
0 y
ea
rs o
r o
ve
r
1980 1990 2000 2010 2020 2030 2040 2050
0
10
15
20
25
30
35
World
Europe
Northern America
Oceania
Latin America and the Caribbean
Asia
Africa
The Silver Tsunami is Approaching
Year: 2050Year: 2015
2.5
2
1.5
1
0.5
0
Bill
ion
s
Year: 2030
Source: United Nations (2015) World Population Prospects: The 2105 Revision
Age Increases, Demand for Services Increase
One Service Delivered to
patients under 60 years old
Three Services Delivered to patients over
60 years old
Global Average Ratio of Skilled Healthcare
Workers to Population
23 skilled health professionals per 10,000 people
10,000+Source: World Health Organization, A Universal Truth: No Health Without a Workforce, Third Global Forum on Human Resources for Health Report
Skilled Healthcare Workers Global Shortage
1412.9 M
Year: 2035Year: 2018
7.2 M
10
8
6
4
2
0
Mill
ion
s
12
Source: World Health Organization, A Universal Truth: No Health Without a Workforce, Third Global Forum on Human Resources for Health Report
Economics of Healthcare
Source: United Nations population statistics: McKinsey analysis
Number of workers per dependent,
Ratio of working-age population (aged 15-64) to dependent population (aged 0-14 and over 65)
Today Projected
India
Less developed economies
China
Developed economies
1.0
1.5
2.0
2.5
3.0
1950 2050204020302020201020001960 1970 1980 1990
Who Holds the Risk?
• National
• Regional
• Municipality
• Acute Facility
• Provider Group
Defining the Care Setting
Primary
Prevention
How We Think of Care Delivery and the Medical Model
Secondary
Prevention
Acute
Care
Chronic
Care
The Continuum of Care
Six Attributes of an Ideal Health
Care Delivery System
• Information Continuity
• Care Coordination and Transitions.
• System Accountability
• Peer Review and Teamwork for High-
Value Care
• Continuous Innovation
• Easy Access to Appropriate Care
What Makes a System Successful
Six Attributes of an Ideal Health
Care Delivery System
• Information Continuity
• Care Coordination and Transitions.
• System Accountability
• Peer Review and Teamwork for High-
Value Care
• Continuous Innovation
• Easy Access to Appropriate Care
What Makes a System Successful
Progression of Care Delivery Models
Traditional
Primary Care
Chronic
Care Model
Primary Care
Medical Home
Medical
Neighborhood
Integrated
Delivery System
Progression of Care Delivery Models
Traditional
Primary Care
Chronic
Care Model
Primary Care
Medical Home
Medical
Neighborhood
Integrated
Delivery System
Characteristics
Participants
Clinical System
Roles
Models of Care
Relationship, holistic,
and access
• Patient
• Primary Care Physician
(PCP)
Minimal use of
Clinical Decision
Support tools
Use registries and teams
to provide proactive care
to patients with specific
chronic conditions
• Patient
• PCP
• Chronic Care
Team
Registries using
clinical data to prompt
follow-up and outreach
Combines traditional
primary care with
chronic care model,
PCP as focus
• Patient
• PCP
• Primary Care Team
Primary care clinical data
potentially augmented
with claims data from
other settings
Brings providers of
patient care together in
an integrated way (real
or virtual)
• Patient
• PCP
• Multiple Care Teams
• Specialists
• Hospital/community
resources
All providers across the
continuum can access clinical
information and proactively
use Clinical Decision Support
tools to improve care
• Like medical neighborhood,
plus infrastructure, financing
and governance
• KP, Intermountain are
exemplar, ACOs trying to
recreate this model
• Same as medical
neighborhood
• ACO requires a central
governing body and a
medical director
End-to-end patient
view of clinical/care
data and financial data
Integrated Delivery System with Coordinated Care
More than assembling the pieces of a puzzle
To be successful “the integrated whole” must deliver substantially
more value to all within the system than the “sum of the parts”
The right care to the right patient at the right time in the most
appropriate setting
Shared commitment to eliminating functional, structural, funding
impediments to efficiency
Aligned incentives across and within entities – no one benefits by
sub-optimizing partners
Rational Technology to support the end to end vision of care
Integrated Delivery System with Coordinated Care
More than assembling the pieces of a puzzle
To be successful “the integrated whole” must deliver substantially
more value to all within the system than the “sum of the parts”
The right care to the right patient at the right time in the most
appropriate setting
Shared commitment to eliminating functional, structural, funding
impediments to efficiency
Aligned incentives across and within entities – no one benefits by
sub-optimizing partners
Rational Technology to support the end to end vision of care
A Patient’s View
Meet Bandit and Adam
Who had the
First Patient
Registry for
Prevention?
Population Care/
Mass Production
We Support the Medical Model with the Increased Use of Personalized Information
Personalized
Health
Sub
Segmentation(risk & condition-
based)
Integrated
Medical
Conditions
Patient
Preferences/
Personal
Circumstances
Genomics
Medical Model
But There’s
a Catch
The Consumer is Bringing Their Own Personalized Needs and Data
Personalized
Health
Population Care/
Mass Production
Sub
Segmentation(risk & condition-
based)
Integrated
Medical
Conditions
Personal Circumstances
Genomics
Patient Preferences
Health Model
Medical Model
How Do Weave Together the Personalization of the Two Models
Personalized
Health
Health & Medical Model
Population Care/
Mass Production
Sub
Segmentation(risk & condition-
based)
Integrated
Medical
Conditions
Patient
Preferences/
Personal
Circumstances
Genomics
The Challenge in Front of Us
New opportunities exist to integrate the
disparate components of the healthcare
ecosystem, create greater connectivity
and build 24/7 access to care.
Defining Digital Health
Digital Health By Any Other Name
“When I use a word,” Humpty Dumpty said
in rather a scornful tone, “it means just what
I choose it to mean – neither more nor less.”
Lewis Carroll
Telehealth
Telemedicine
Mobile Health (mHealth)
Virtual Health
Bio Med Devices (Wearables)
What is Digital Strategy?
Consumers,
Patients, &
Families
Physicians
& Care Team
Providers
Other Care
Continuum
Providers &
Partners
Payors
Digital strategy is the use of technology
enabled innovation to extend and deepen
connectivity between the health system
and its consumers, clinicians, payors
and care continuum partners.
Digital Strategy is about
Health System CONNECTIVITY
Source: Chartis Group 2016
Consumer Preferences Driving Changesin the Healthcare Landscape
Knowledge Management and Consumer ActionsSearching online for health information is the most well-adopted digital health category,
with 40% of those who search acting directly upon the information they find.
Consumer survey data, n=4,017 Source: Rock Health, Digital Health Consumer Adoption: 2015, accessed Feb. 2016
44%
33%
10%
7%
60%
57%
52%
49%
Prescription
Drugs
Diagnosis
Supplements
Treatment
Options
Information about prescription drugs or side effects
A diagnosis based on your symptoms
Information about supplements
Treatment options based on your diagnosis
Se
arc
he
d fo
r IN
FO
.
% A
cte
d U
po
n I
nfo
rma
tio
n
35%
45%
40%
36%
Asked his or her physician to prescribe a
specific drug or asked to discontinue a
specific drug
Proposed own diagnosis to his/her physician
Purchased or discontinued use of a
supplement
Proposed a treatment to his/her physician
Se
arc
he
d fo
r R
EV
IEW
S
Physician
Hospital
Nursing Home
Caregiver
Nearly half of Americans go online to find provider reviews.
While adoption of searching for health
information online is strong, consumers still
rank physicians, friends, and family highest
when it comes to trustworthiness of sources.
Knowledge Management and Consumer ActionsSearching online for health information is the most well-adopted digital health category,
with 40% of those who search acting directly upon the information they find.
Consumer survey data, n=4,017 Source: Rock Health, Digital Health Consumer Adoption: 2015, accessed Feb. 2016
44%
33%
10%
7%
60%
57%
52%
49%
Prescription
Drugs
Diagnosis
Supplements
Treatment
Options
Information about prescription drugs or side effects
A diagnosis based on your symptoms
Information about supplements
Treatment options based on your diagnosis
Se
arc
he
d fo
r IN
FO
.
% A
cte
d U
po
n I
nfo
rma
tio
n
35%
45%
40%
36%
Asked his or her physician to prescribe a
specific drug or asked to discontinue a
specific drug
Proposed own diagnosis to his/her physician
Purchased or discontinued use of a
supplement
Proposed a treatment to his/her physician
Se
arc
he
d fo
r R
EV
IEW
S
Physician
Hospital
Nursing Home
Caregiver
Nearly half of Americans go online to find provider reviews.
While adoption of searching for health
information online is strong, consumers still
rank physicians, friends, and family highest
when it comes to trustworthiness of sources.
Home Care: Digital Health and Mobile DevicesIn a survey of 250 home care users (either seniors receiving home care or loved ones arranging it), many
saw technology, including wearables and mobile devices, as a way to improve health care management.
Source: Comstock, J.,Survey: Half of aging in place seniors believe wearables will
improve home care. mobihealthnews, March 2017
Respondents were asked about other areas of home care where
they predicted wearables playing a role in the future:said they would value access to an online or mobile
app providing information about their loved one’s
home care visits.
said they would pay a premium for that access.
(34% said they would pay more than $25).
said they would be able to answer three to give
questions on a tablet after each visit.
88%
52% said they could alert home care providers about unusual
changes in activity level, heart rate, or temperature.
50% saw value in reminding providers about things like
appointments, prescriptions, and meal times.
40% thought wearables would be impactful by sending real-time alerts
from a home care agency to a member or their emergency contact.
40% hoped wearables could diagnose potential ailments in home care recipients.
75%
87%
Home Care: Digital Health and Mobile DevicesIn a survey of 250 home care users (either seniors receiving home care or loved ones arranging it), many
saw technology, including wearables and mobile devices, as a way to improve health care management.
Source: Comstock, J.,Survey: Half of aging in place seniors believe wearables will
improve home care. mobihealthnews, March 2017
Respondents were asked about other areas of home care where
they predicted wearables playing a role in the future:said they would value access to an online or mobile
app providing information about their loved one’s
home care visits.
said they would pay a premium for that access.
(34% said they would pay more than $25).
said they would be able to answer three to give
questions on a tablet after each visit.
88%
52% said they could alert home care providers about unusual
changes in activity level, heart rate, or temperature.
50% saw value in reminding providers about things like
appointments, prescriptions, and meal times.
40% thought wearables would be impactful by sending real-time alerts
from a home care agency to a member or their emergency contact.
40% hoped wearables could diagnose potential ailments in home care recipients.
75%
87%
Telemedicine
Usage of telemedicine is highest amongst the 35-54 age bracket across all mediums, with adopters reporting high satisfaction.
E-MAIL TEXT MESSAGE VIDEO
overall adoption overall adoptionoverall adoption
18-24
25-34
35-44
65+
55-64
45-54
29%
30%
31%
28%
28%
25%
35%
34%
37%
36%
35%
38%
36%
37%
33%
36%
37%
37%
Used Planning to Use No Plans to Use
11%
10%
13%
11%
9%
8%
32%
33%
31%
32%
28%
31%
57%
57%
56%
56%
63%
61%
9%
9%
7%
7%
41%
41%
40%
40%
37%
36%
53%
50%
50%
52%
56%
60%
6%
4%
Consumer survey data, n=4,017 Source: Rock Health, Digital Health Consumer Adoption: 2015, accessed Feb. 2016
12%28% 7%
Telemedicine
Usage of telemedicine is highest amongst the 35-54 age bracket across all mediums, with adopters reporting high satisfaction.
E-MAIL TEXT MESSAGE VIDEO
overall adoption overall adoptionoverall adoption
18-24
25-34
35-44
65+
55-64
45-54
29%
30%
31%
28%
28%
25%
35%
34%
37%
36%
35%
38%
36%
37%
33%
36%
37%
37%
Used Planning to Use No Plans to Use
11%
10%
13%
11%
9%
8%
32%
33%
31%
32%
28%
31%
57%
57%
56%
56%
63%
61%
9%
9%
7%
7%
41%
41%
40%
40%
37%
36%
53%
50%
50%
52%
56%
60%
6%
4%
Consumer survey data, n=4,017 Source: Rock Health, Digital Health Consumer Adoption: 2015, accessed Feb. 2016
12%28% 7%
The Growth of Consumer Data Generation
Expands the Healthcare Business Relationship
Traditionally, healthcare data exchange only occurred B2B. Digital health capabilities has expanded these
relationships to include B2C, C2B, and C2C.
Digital Transformation Leadership from the C-Suite
Digital transformation is expanding the roles and responsibilities of the C-Suite, but most initiatives are being led by the Chief Medical Officer.
Source: Altimeter, The 2016 State of Digital Transformation, 2016 n=500+
5%
34%
19%
15%
27%
Question:
Which executive is leading
the digital transformation
initiative?
Chief Digital
Officer
Chief Experience Officer
Chief Medical
Officer
Chief Executive Officer
Chief
Technology /
Information
Officer
A Customer Focus
A Customer Focus
A Customer Focus
A Customer Focus
Operationalizing Innovation…
Moving Beyond Visit-Centric Medicine
• Accountability for panel/population
• Transparency
• Use of EMR, registries, mobile
• Team care (including patient)
• Moving care out of doctor’s office
• One patient at a time
• Only know about patients
who appear in your office
• No use of IT
• Limited use of data
Traditional
Encounter
Based Care
New Model
Elements
Moving Beyond Visit-Centric Medicine
• Accountability for panel/population
• Transparency
• Use of EMR, registries, mobile
• Team care (including patient)
• Moving care out of doctor’s office
• One patient at a time
• Only know about patients
who appear in your office
• No use of IT
• Limited use of data
Traditional
Encounter
Based Care
New Model
Elements
The Clinical Ecosystem Impacted
• Clinical Operations
• Administration
• Commissioning
• Legal
• Patients
• Mobile devices
• Patient / Clinical
• Clinical Systems
• IT Infrastructure
• Facilities
• Physicians
• Nurses
• Other Care Providers
• Patients
Shelves are Full of Impactful Books on Innovation
Innovation Comes In All Sizes
Sometimes innovations is seen
as significant departures in an
industry, capability or medium
Innovation Comes In All Sizes
Sometimes innovations is seen
as significant departures in an
industry, capability or medium
Sometimes innovations are
seen as small and rapid
improvements and changes to
the an existing environment
Innovation as an Emerging Core
Competency for Healthcare Providers…?
How is Innovation Described?
Innovation Inside a Healthcare System…
Innovation only succeeds when the
interest of diverse stakeholders can be
aligned so that trade-offs are sufficiently
beneficial to overcome the cost or risk of
adopting the new “way of working”
Innovation Inside a Healthcare System…
The electric light did not come from the
continuous improvement of candles
It’s Not Just the Innovation
OO + NT = COO
It’s Not Just the Innovation
OO + NT = COOOld organization + New Technology = Costly Old Organization
Innovation and Change Management as a Focus of Minds is Not New
“Nothing is more difficult than to introduce a
new order. 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.”
Niccolo Machiavelli (1469 – 1527)
Thank You!
