Matthew Holt talk at HIMSS N. Cal

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Matthew Holt talk at HIMSS N. Cal

  1. 1. Matthew Holt
  2. 2. Forecasting the future is really hard
  3. 3. Guess ONE:65m uninsured; 19% of GDP 2010 Reality? & Guess TWO: 52 million uninsured $10,000 per capita 47m uninsured; 16% of …leads to… spending only $8,300 Per capita GDP & Reform after 2010 Share of GDP 17.3% $8,600 per capita …leads to… No Reform after 2010
  4. 4. Who do Americans Believe Can Predict the Future? 50 45 40 35 30 25 20 15 10 5 0 Bi Fa As Ps Po Ou M bl rm tro yc lls ag Percentage who ic al er log hi cs ter ija B ic Pr s er s oa 8B believe op Al s rd all he m cy an acSource: Peter D. Hart Research Associates, for the Shell Poll 1998
  5. 5. Unemployment:The hours are great, but…
  6. 6. Founded 2003 First month’s visits 73
  7. 7. Media sources people trust
  8. 8. Health Care Costs Too Much
  9. 9. 7000 Dollars spent per capita 6000 Canada France UsAverage 5000 Germanyspending onhealth United Kingdom Themper capita United States 4000($US PPP) 3000 2000Source: Gerard F. 1000Anderson, Ph.D.,and PatriciaMarkovich,Data: OECD HealthData 2008 (June 02008)Commonwealth 1980 1984 1988 1992 1996 2000 2004Fund 2008
  10. 10. Health spending as share of GDP 16 Average spending on 14 health Us per capita ($US PPP) 12 Them 10 Canada France 8 Germany Switzerland United Kingdom 6 United StatesSource: Gerard F.Anderson, Ph.D.,and PatriciaMarkovich,Data: OECD HealthData 2008 (June 42008) 1980 1984 1988 1992 1996 2000 2004CommonwealthFund 2008
  11. 11. I = f(PDI) = f(M5B + MBZ)Where:• I is increase in health care costs• PDI is physicians’ desired income• M5B is mortgage payment on a 5 bedroom house with a pool• MBZ is monthly lease on a new 300 series Mercedes
  12. 12. Rapid Increase in Uninsurance; in the Middle Working adults in US who were uninsured for at least 3 months in a 2 year period 60% 51% 52% Lowest 48% 50% 48% quintile 41% 44% Second 40% 39% 35% 37% Third 24% 25% 20% 20% 21% Fourth 18% 8% 10% 10% 11% 11% Highest 4% 5% 6% 6% 5% quintile 0% 1999* 2000 2001 2002 2003Source: Analysis of the March 1988–2004 Current Population Surveys byDanielle Ferry, Columbia University, for The Commonwealth Fund
  13. 13. And it got much worse (2010) Adults in Percentage of families with a those who had job loss in past insurance 2 years = 47% = 24% or Percentage of 43 million those who lost insurance = 57% or 9mSource: The Commonwealth Fund Biennial Health Insurance Survey (2010).
  14. 14. But in health care:the future is like the present, only longer
  15. 15. We do a shitty job withchronically ill patients
  16. 16. Who can’t do chronic care? Views of the Health Care System from those with chronic illness Percent AUS CAN FR GER NETH NZ UK US Only minor changes needed 22 32 41 21 42 29 38 20 Fundamental changes needed 57 50 33 51 46 48 48 46 Rebuild completely 20 16 23 26 9 21 12 33 Base: Adults with any chronic conditionData collection: Harris Interactive, Inc.Source: 2008 Commonwealth Fund International HealthPolicy Survey of Sicker Adults.
  17. 17. Disease managed? Maybe not… % of diabetics who received four key preventative services* 80 67 59 60 43 39 40 40 31 20 0 CAN FR GER NETH UK US* Hemoglobin A1c checked in past six months; feet examined for sores or irritations inpast year; eye exam for diabetes in past year; and cholesterol checked in past year.Data collection: Harris Interactive, Inc.Source: 2008 Commonwealth Fund International Health PolicySurvey of Sicker Adults.
  18. 18. Did Not Get a Recommended Test, Treatment or Follow-up Due to Cost, by Income 50% Below average income Above average income 36% 25% 17% 18% 14% 14% 9% 11% 4% 4% 2% 0% AUS CAN NZ UK US2001Commonwealth Fund International Health Policy SurveyCommonwealth Fund/Harvard/Harris Interactive
  19. 19. Adults Uninsured for Any Time Had Highest Rates of Cost-Related Problems Getting Needed CarePercent of adults ages 19–64 who had any of four access problems*in past year because of cost75 2001 2005 2010 63 66 60 59 55 5250 37 41 29 28 3125 21 0 Total Insured all year Insured now, time Uninsured now uninsured in past year*Did not fill a prescription; did not see a specialist when needed; skipped recommended medical test, treatment, or follow-up; had amedical problem but did not visit doctor or clinic.Source: The Commonwealth Fund Biennial Health Insurance Surveys (2001, 2005, and 2010).
  20. 20. We do different things to the same people in different places
  21. 21. Cost & Quality in Healthcare Health Affairs April 7, 2004 More spending ≠ better Ritz-Carlton outcomesQuality Motel 6 Cost
  22. 22. Portland 22.7%Salem 16.9% BendEugene 23%18.4% Medford 16.4%
  23. 23. Our primary care system is broken
  24. 24. New physicians follow the money
  25. 25. Data: MGMA
  26. 26. This is America:There’s always a “new” technology
  27. 27. IT History Quiz, Part 1• 1947 Christmas Eve – Shockley & pals invent the transistor• 1959 – Noyce (Intel) & Kilby (the other guy from TI) invent the integrated circuit (separately)• 1981 – IBM introduces the PC (Bonus Question--Why did they give it away?) – Expected to sell 295,000 in first ten years!• 1986 – Microsoft and Oracle go public
  28. 28. IT History Quiz, Part 2• 1991 & 1993 – WWW & Mosaic Browser• 1998 – Google founded• 2004 – Google goes public (Bonus Question--Why didn’t Matthew buy the stock?) – Thought it was overvalued at $80 a share!• 2004 – Facebook (but for students only for 3 years)• 2007 – Apple releases iPhone• 2010 – Apple releases iPad
  29. 29. The Rise of the CyberChondriacs 2007 160 million adults 84% of those online Source: Harris Interactive
  30. 30. The ever-so-slow EMR uptake Source: CDC
  31. 31. EMRs: Yes We Can! EMR Use: The N factor Netherlands 88% Norway 90% NZ 80% 10 years ago!Source: Harris Interactive 2002
  32. 32. EMR EvolutionHITECH $34 Billion
  33. 33. 1. Denial2. Anger3. Bargaining4. Depression5. Acceptance
  34. 34. This is America:There’s always a “new” generation
  35. 35. Matthew’s Screwed! Matthew’s wife AmandaMatthew’sbusinesspartner, Indu
  36. 36. Regina Holliday Patient EMR/Data Advocate/ArtistTed Eytan MDKaiserPremanenteEMR Evangelist
  37. 37. Technology + people= massive potential for change
  38. 38. Web 2.0 Ecosystem (circa 2005)
  39. 39. What is “Health 2.0” Holt’s best guess at the constituent parts• Personalized search that looks into the long tail, and cares about the user experience• Communities that capture the accumulated knowledge of patients and caregivers – and explain it to the world• Intelligent tools for content delivery -- and transactions• Better integration of data with contentAnd not just a maybe…. Technologies fusing as patients increasingly guide their own care
  40. 40. Health 2.0: User-Generated Healthcare Content Social Networks Search Tools Transaction Data
  41. 41. Search & Online Communities +
  42. 42. Emergence of Consumer-Focused Tools 1. Personalized 2. Analytical 3. Supporting Decisions 4. Enabling Transactions
  43. 43. INDIVIDUALBiological/ClinicalUser-generated Claims EMR
  44. 44. POPULATIONGovernment Data Private Data
  45. 45. REFERENCEFood DatabasesDrug Mapping/GPS Weather
  46. 46. PermissionsIdentity
  47. 47. Unplatforms
  48. 48. This is America:There’s always a “new” idea
  49. 49. In the end. It’s the human touch
  50. 50. Can You and Your Loved Ones Answer These Questions?1.On a scale of 1 to 5, where do you fall on this continuum? 1 2 3 4 5 Let me die in my own bed, without any Dont give up on me no matter what, try any proven medical intervention and unproven intervention possible2.If there were a choice, would you prefer to die at home, or in a hospital?3.Could a loved one correctly describe how you’d like to be treated in the case of a terminal illness?4.Is there someone you trust that you’ve appointed to advocate on your behalf when the time is near?5.Have you completed any of the following: written a living will, appointed a healthcare power of attorney, or completed an advanced directive? engagewithgrace.org The One Slide Project
  51. 51. matthew@matthewholt.net thehealthcareblog.com Health2con.com

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