IHT2
Day 2
Day 2 Jay Srini
jsrinij@gmail.com
412 760 9593
THE DESTINATION
Several Initiatives have been
launched
• MEDICAL HOME
• SHARED SAVINGS
• BUNDLED PAYMENT
• PAY For PERFORMANCE
• ACAs … BUT
SUPPLY /DEMAND Asymmetry
• Growth in chronic illness will continue to spiral upward,
• 40 percent increase in heart diseas...
SO HOW DO WE GET THERE
• MAJOR IMPEDIMENT: SHORTAGE OF CLINICAL EXPERTISE and COST
HAMPERING SCALABILITY OF PILOT SOLUTION...
IMAGINE IF THIS WERe FASTER….
FASTER CURES.. What about FasteR
CARE!!!
Concerns
• The first group, "The Alarmed," is made up 16% of the public. They believe health change is an
urgent problem b...
ONE SIZE FITS ALL – Not a Reality in
Medicine
• http://www.managedcaremag.com/archives/1304/1304.shareddecision.html
Patie...
Only 10–15 percent of an individual’s health status is attributable to the health care services he or she
receives. The re...
SHARED DECISION MAKING NOT A
NEW PHENOMENON:• In a 2001 report, Crossing the Quality Chasm, the Institute of
Medicine reco...
IN Fact WE have RECONGNISED IT FOR
More than 3 decades• One of the first instances where the term ‘shared decision making’...
WHERE ARE WE NOW
NOT FAR ENOUGH in our journey
• The care patients receive doesn't always align with their
preferences. For example, in a s...
SHARED DECISION MAKING AND
EFFECTIVENESS
• A 2011 Cochrane Collaborative review of 86 studies showed
that as compared with...
SHARED DECISION AND OPTIMAL
CHOICES
• Consistently, as many as 20% of patients who participate in shared
decision making c...
Why payers see alignment
• In 2008, the Lewin Group estimated that implementing shared decision
making for just 11 procedu...
HEALTH AFFAIRS STUDY
HEALTH AFFAIRS:
Source: Veroff D, Marr A, and Wennberg DE. Enhanced support for shared decision making reduced costs of ca...
WHERE DOES ACA FIT IN
• Section 3506 of the Affordable Care Act directly relates to Shared Decision
Making. Specifically i...
WHAT DO PATIENTS/CONSUMERS
WANT
HOW IMPORTANT IS IT FOR YOUR PHYSICIAN PROVIDE YOU OPTIONS FOR SDS
THE FORGOTTEN ASSET
• We have positioned patients as passive
recipients of care, not fully recognizing that
• they have tr...
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iHT² Health IT Summit San Francisco – Jay Srini, Chief Strategist, SCS Ventures, Adjunct Faculty Assistant Professor, University of Pittsburgh

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iHT² Health IT Summit San Francisco – Jay Srini, Chief Strategist, SCS Ventures, Adjunct Faculty Assistant Professor, University of Pittsburgh

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  • n particular, given the shortage of primary care providers,1 affordable, high-quality health care for increasing numbers of elderly, chronically ill people may not be available without adopting new ways of delivering care. The growth in chronic illness will continue to spiral upward, with a 40 percent increase in heart disease and a 50 percent increase in cancer and diabetes projected for 2023.2 Baby boomers are just beginning to enter their high-maintenance health care years of sixty-five-plus,3⇓⇓–6 while workforce statistics show that physicians and nurses are both in short supply.7,8 The Centers for Medicare and Medicaid Services (CMS) predicts that health care costs could reach almost 20 percent of gross domestic product (GDP) by 2022 without interventions.9 Policy makers, payers, providers, and patients are actively exploring ways to control the cost of health care through value-based purchasing plans, innovative care delivery systems, and novel means of empowering patients to manage their own illnesses.Another approach is the development of accountable care organizations (ACOs), through which providers may be financially rewarded for controlling costs and improving outcomes but assume some measure of financial risk if they fail to do so. ACOs thus will have incentives to use specialist physician care for patients in the most efficient manner. For example, providing remote dermatology or radiology consultations to primary care providers instead of referring patients to additional (and expensive) specialty visits may become a safe and recommended practice.
  • Carol Costello… cnn on climate change…
  • http://www.managedcaremag.com/archives/1304/1304.shareddecision.html
  • These forces are coming into play at a critical moment. By 2050 the US population will grow from the current 314 million to nearly 400 million.1 The number of Americans age sixty-five and older will nearly double, growing to eighty-four million or one in five US residents.1 Right now we spend approximately 84 percent of our health care dollars on patients with chronic conditions—a cohort that is expected to grow.2More chronic illness means more-intensive use of health care resources. Nearly 20 percent of gross domestic product (GDP), or more than $2.6 trillion, is already devoted to health care.3 We cannot afford more. The only answer is to demand greater value.Previous SectionNext Section
  • ^ President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry (1998). "Quality First: Better Health Care for All Americans".Jump up 
^ Engel GL (May 1980). "The clinical application of the biopsychosocial model". Am J Psychiatry137 (5): 535–44. PMID 7369396.Jump up 
^Levenstein JH (1984). "The patient-centred general practice consultation". South African Family Practice5: 276–82.
  • Emily Oshima Lee, M.A., and Ezekiel J. Emanuel, M.D., Ph.D.N Engl J Med 2013; 368:6-8January 3, 2013DOI: 10.1056/NEJMp1209500Share:Emily Oshima Lee, M.A., and Ezekiel J. Emanuel, M.D., Ph.D.N Engl J Med 2013; 368:6-8January 3, 2013DOI: 10.1056/NEJMp1209500Share:
  • http://bhmpc.com/2013/05/shared-decision-making-trend-ticking-upwards/
  • iHT² Health IT Summit San Francisco – Jay Srini, Chief Strategist, SCS Ventures, Adjunct Faculty Assistant Professor, University of Pittsburgh

    1. 1. IHT2 Day 2 Day 2 Jay Srini jsrinij@gmail.com 412 760 9593
    2. 2. THE DESTINATION
    3. 3. Several Initiatives have been launched • MEDICAL HOME • SHARED SAVINGS • BUNDLED PAYMENT • PAY For PERFORMANCE • ACAs … BUT
    4. 4. SUPPLY /DEMAND Asymmetry • Growth in chronic illness will continue to spiral upward, • 40 percent increase in heart disease and a • 50 percent increase in cancer and diabetes projected for 2023. • Baby boomers are just beginning to enter their high-maintenance health care years of sixty-five-plus ( non debatable) • VS • physicians and nurses- (Clinicians) are both in short supply. ( workforce statistics data) • Scope of practice regulations are restrictive for non physician clinicians
    5. 5. SO HOW DO WE GET THERE • MAJOR IMPEDIMENT: SHORTAGE OF CLINICAL EXPERTISE and COST HAMPERING SCALABILITY OF PILOT SOLUTIONS.
    6. 6. IMAGINE IF THIS WERe FASTER…. FASTER CURES.. What about FasteR CARE!!!
    7. 7. Concerns • The first group, "The Alarmed," is made up 16% of the public. They believe health change is an urgent problem but have no clear idea of how to fix it. (Aging Baby boomers) • The second group (30%) is "The Concerned." They believe it is your neighbors problem no theirs.. They are in control! (millennial, currently healthier baby boomers) • The third group, "The Cautious" (23%), are people on the fence. (Enlightened baby boomers, quantified self folks, ). • The fourth group, "The Disengaged" (10%), doesn't know anything and does not want to know ( consumed by life issues or lack thereof) • The fifth group, "The Doubtful" (12%), do not believe there is away to solve it. ( the sky is falling and the cup is half full)
    8. 8. ONE SIZE FITS ALL – Not a Reality in Medicine • http://www.managedcaremag.com/archives/1304/1304.shareddecision.html Patients: The recent advancements in technology have ushered in an era of patient empowerment. Previously, patients were largely reliant on doctors for any knowledge or information regarding their health; now, patients have the tools to track and monitor their health at home or on-the-go, allowing them to be active members of their own health team. http://www.linkedin.com/today/post/article/20140218152316-12941029-5-technological- breakthroughs-changing-the-future-of-doctor-patient-relationships
    9. 9. Only 10–15 percent of an individual’s health status is attributable to the health care services he or she receives. The rest is driven by behavior, genetics, and social determinants including living conditions, access to food, and education status. That means that the trillions of dollars the United States spends on health care services contribute to only one-tenth of the nation’s health. An individual’s behavior is by far the single most important contributor to his or her overall health. It is also a substantial driver of health care costs.
    10. 10. SHARED DECISION MAKING NOT A NEW PHENOMENON:• In a 2001 report, Crossing the Quality Chasm, the Institute of Medicine recommended redesigning health care processes according to 10 rules, many of which emphasize shared decision making. • One rule, for instance, underlines the importance of the patient as the source of control, envisioning a health care system that encourages shared decision making and accommodates patients' preferences.
    11. 11. IN Fact WE have RECONGNISED IT FOR More than 3 decades• One of the first instances where the term ‘shared decision making’ was used was in a report entitled the ‘President's Commission for The Study of Ethical Problems in Medicine and Biomedical Research.[1] This work built on the increasing interest in patient- centredness and an increasing emphasis on recognising patient autonomy in health care interactions since the 1970s. • Charles described a set of principles for shared decision making, stating “that at least two participants, the clinician and patient be involved; that both parties share information; that both parties take steps to build a consensus about the preferred treatment; and that an agreement is reached on the treatment to implement. ”These principles rely on an eventual arrival at an agreement but this final principle is not fully accepted by others in the field. The view that it is acceptable to agree to disagree is also regarded as an acceptable outcome of shared decision making. • ^ Charles C, Gafni A, Whelan T (March 1997). "Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango)". Soc Sci Med 44 (5): 681–92. doi:10.1016/S0277-9536(96)00221-3. PMID 9032835.
    12. 12. WHERE ARE WE NOW
    13. 13. NOT FAR ENOUGH in our journey • The care patients receive doesn't always align with their preferences. For example, in a study of more than 1000 office visits in which more than 3500 medical decisions were made, less than 10% of decisions met the minimum standards for informed decision making. • Braddock CH III, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Informed decision making in outpatient practice: time to get back to basics. JAMA 1999;282:2313-2320 • Similarly, a study showed that only 41% of Medicare patients believed that their treatment reflected their preference for palliative care over more aggressive interventions. • Covinsky KE, Fuller JD, Yaffe K, et al. Communication and decision-making in seriously ill patients: findings of the SUPPORT project: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Am Geriatr Soc 2000;48:Suppl:S187-S193
    14. 14. SHARED DECISION MAKING AND EFFECTIVENESS • A 2011 Cochrane Collaborative review of 86 studies showed that as compared with patients who received usual care, those who used decision aids had increased knowledge, more accurate risk perceptions, reduced internal conflict about decisions, and a greater likelihood of receiving care aligned with their values. Moreover, fewer patients were undecided or passive in the decision-making process — changes that are essential for patients' adherence to therapies.
    15. 15. SHARED DECISION AND OPTIMAL CHOICES • Consistently, as many as 20% of patients who participate in shared decision making choose less invasive surgical options and more conservative treatment than do patients who do not use decision aids • Stacey D, Bennett CL, Barry MJ, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2011;10:CD001431-CD001431
Medline
    16. 16. Why payers see alignment • In 2008, the Lewin Group estimated that implementing shared decision making for just 11 procedures would yield more than $9 billion in savings nationally over 10 years. • • In addition, a 2012 study by Group Health in Washington State showed that providing decision aids to patients eligible for hip and knee replacements substantially reduced both surgery rates and costs — with up to 38% fewer surgeries and savings of 12 to 21% over 6 months.4 The myriad benefits of this approach argue for more rapid implementation of Section 3506 of the ACA.
    17. 17. HEALTH AFFAIRS STUDY
    18. 18. HEALTH AFFAIRS: Source: Veroff D, Marr A, and Wennberg DE. Enhanced support for shared decision making reduced costs of care for patients with preference- sensitive conditions. Health Aff 2013;32(2):285–293. NOTES: Medical costs were capped at $200,000 per year. Advanced imaging includes magnetic resonance imaging, X-ray computed tomography, and positron emission tomography. Standard imaging includes standard X-rays and ultrasound. **p < 0:05

***p < 0:01

****p < 0:001
    19. 19. WHERE DOES ACA FIT IN • Section 3506 of the Affordable Care Act directly relates to Shared Decision Making. Specifically it would offer funding resources to an independant organization to develop standards for Shared Decision Making, and tools to assist in the implementation of Shared Decision Making. • Additional funding in the form of grants may be available to providers who are willing and able to show effective implementation of these tools in the practice setting. • Finally, there is authorization from the Center of Medicaid and Medicare to begin testing the impact of Shared Decision Making Models across metrics that take into account both cost, quality and satisfaction.
    20. 20. WHAT DO PATIENTS/CONSUMERS WANT HOW IMPORTANT IS IT FOR YOUR PHYSICIAN PROVIDE YOU OPTIONS FOR SDS
    21. 21. THE FORGOTTEN ASSET • We have positioned patients as passive recipients of care, not fully recognizing that • they have tremendous insights, expertise and experience that can help us build cost-efficient, high-quality, safe systems of care,” • Bev Johnson, president and CEO • of the Institute for Patient- and Family-Centered Care. •

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