Healthcare X PRIZE - Executive Summary
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Healthcare X PRIZE - Executive Summary

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This is the executive summary of the Initial Prize Design which was released for public comment on April 14, 2009. These draft provides an overview of what the Healthcare X PRIZE is, some of the ...

This is the executive summary of the Initial Prize Design which was released for public comment on April 14, 2009. These draft provides an overview of what the Healthcare X PRIZE is, some of the detail of the competition, and how you can get involved in to help create a Prize that moves us toward a new health paradigm focused on individual vitality and increasing the health care value in communities.

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Healthcare X PRIZE - Executive Summary Healthcare X PRIZE - Executive Summary Presentation Transcript

  • Healthcare X PRIZE Initial Design and Prize Guidelines Summary for Public Comment V1.0 Published 4/14/09 Join the discussion at: www.xprize.org/wellpoint 1 Initial prize design—for public comment: www.xprize.org/wellpoint
  • Introduction to effort 2 Initial prize design—for public comment: www.xprize.org/wellpoint
  • INTRODUCTION TO X PRIZE APPROACH • Vision: “Bring about radical breakthroughs for the benefit of humanity through the power of  incentivised competitions to stimulate innovation” • Mission: We design and conduct X PRIZE competitions to address the grand challenges of our times. • Attributes: Highly leveraged investments, efficient by only paying the winner, and sparks a new industry  as a by product of the competition - Target market failures; Define the problem, let teams compete to create the solution  g ; p , p - Clear, objective & simple rules in a hard but attainable grand challenge (3‐8 year horizon) - Assure that a “back end business” is viable and an industry can be created - Global competition that yields a telegenic finish Global competition that yields a telegenic finish • Example: Ansari X PRIZE - $2.5M startup, $10M prize purse, $100M invested, and $1B industry created - 26 teams, 7 nations, and global interest generating 5B media impressions 3 Initial prize design—for public comment: www.xprize.org/wellpoint
  • INTERVIEWS WITH EXPERTS HIGHLIGHTED IMPLICATIONS FOR A HEALTH PRIZE Problem Statement: Problem Statement: Expected Breakthroughs: Expected Breakthroughs: • Financial incentives not aligned with doing • Payment needs to re‐align to desired  the right things outcome • We don't know holistically what works  • Outcome tracking needs to occur holistically relative • Solutions need to be holistic  and steer  to other things consumers to best performers • Fragmented system with substandard Fragmented system with substandard  • Focus on engagement / behavior  / distribution of best practice modification • Need to move to quot;healthquot; system vs. sick  • Need to focus both on public health and a  system more efficient system • We have a very short term focus in terms of  • Consumer need choices that are engaging  addressing future needs (pull) • Consumer not engaged in care even if they • Providers accountable for autonomous  want to be want to be approaches via transparency of outcome approaches via transparency of outcome • Best providers not rewarded for better  performance 4 Initial prize design—for public comment: www.xprize.org/wellpoint
  • WHERE WE ARE IN THE EFFORT Healthcare Prize Development Timeline Healthcare Prize Development Timeline Ideation Phase Design Phase Planning Phase Nov 08 Dec Jan 09 Feb Mar Apr May Jun Jul Aug Sep Initial Design Announcement April 14th Next steps in the design phase: 1. Announcement of initial prize design to engage interested parties and gain access to more experts/ ideas 2. Public comment utilized to test and refine goals and initial design 3. Experts engaged for deep dives in areas critical to prize development effort 4. Validated prize design moves into planning phase 5 Initial prize design—for public comment: www.xprize.org/wellpoint
  • The Initial Prize Design 6 Initial prize design—for public comment: www.xprize.org/wellpoint
  • HEALTHCARE X PRIZE DEVELOPMENT OBJECTIVES We seek to improve the value of the current health system by: W kt i th l f th t h lth t b • Rewarding entities who optimize health value   • Reinvesting resources to enhance individual vitality by encouraging activation and Reinvesting resources to enhance individual vitality by encouraging activation and  personal responsibility for health • By increasing the vitality of individuals, we seek to advance the health of community  overall ll 7 Initial prize design—for public comment: www.xprize.org/wellpoint
  • GOAL OF HEALTHCARE X PRIZE: To create an optimal health paradigm that  To create an optimal health paradigm that empowers and engages individuals and  communities in a way that will dramatically  improve health value  improve health value 8 Initial prize design—for public comment: www.xprize.org/wellpoint
  • PROPOSED COMPETITION: Goal: Community health 50 %↑ in Total cost Draft Guidelines: • Health value = Improvements in Community Health Index and Total Cost • Teams create mechanisms to engage, coordinate, advise, evaluate, and influence individuals and  relevant care providers in their assigned test community in ways that generate health value • Each finalist competes in a pre‐selected community/ employer test community of ~10K individuals;  results compared against an equivalent control group in a similar/adjacent community results compared against an equivalent control group in a similar/adjacent community • Aggregate results over 3 year contest determine winner. 50% threshold required to win purse.   Competition and results audited by independent panel of judges 9 Initial prize design—for public comment: www.xprize.org/wellpoint
  • DIFFERENCE FROM OTHER EFFORTS: 1. Focus on health outcomes and value at community level:  1 Focus on health outcomes and value at community level: Community Health Index tracks outcomes across a community; Total Cost tracks expenditure  across all parties 2. Consumer Engagement:  2 Consumer Engagement: Consumer engagement required to generate results 3. Payment Incentives: Teams may create payment innovations to improve incentives for consumers, providers,  vendors to demonstrate desirable behaviors/ outcomes 4. Comprehensive and Proactive Outlook: p Teams responsible for health across all care settings and multi‐year time horizon.  Increased  focus and  investment in proactive, longer‐term health improvement programs 5. Local partnerships:  Teams must develop relationships with at least some local health care providers and/ or  community organizations 10 Initial prize design—for public comment: www.xprize.org/wellpoint
  • IMPACT POTENTIAL Successful implementation of the Healthcare X PRIZE could create within 10 yrs: 1. A new model and system of health that demonstrates a >50% improvement in healthcare value  ( (HCV). ) 2. A measurable and globally accepted population health metric, tentatively called the “Community  Health Index” (CHI), which becomes a benchmark for measuring future improvements in health at a  pp population level 3. An individual health metric, tentatively called the “Individual Vitality Score”, which can helps  individuals (and providers helping them) understand and benchmark their current health status and  potential for improvement 4. A personalized “Vitality Dashboard” where consumers will be able to understand current health  status, “portfolio” of improvement options, projected return from health improvement efforts 5. A new Optimal Health paradigm that helps consumers optimize their health and rewards providers  5 A new Optimal Health paradigm that helps consumers optimize their health and rewards providers that can demonstrably create improved health value 11 Initial prize design—for public comment: www.xprize.org/wellpoint
  • WE LOOK FORWARD TO YOUR INPUT  AND PARTICIPATION Visit our website: www.xprize.org/wellpoint Add your comments to the proposed approach/ guidelines • Add yourself to the mailing list for updates • Follow the conversation on our blog, twitter, facebook, etc. • Let us know if you d be interested in creating a team as the effort moves forward Let us know if you’d be interested in creating a team as the effort moves forward • 12 Initial prize design—for public comment: www.xprize.org/wellpoint
  • Details in development 13 Initial prize design—for public comment: www.xprize.org/wellpoint
  • PHILOSOPHY FOR MEASUREMENT Measures will contain desired outcomes only (no intermediate or process metrics) • Status improvements we want to happen – Clinical events that we want to remove from the human experience – Where possible, measures tracked will be objective and come from established collection tools • Measures will be at the community/population level • Measures will be actionable.  There are case examples available that suggest teams can influence outcomes  • in a significant way Costs will be captured across as many payment alternatives as possible and reflect the payment owed at  • time services rendered “Test‐group” communities will be actuarially equivalent across demographics, socio‐economics, and health  • status.  We will divide similar or adjacent communities into 2 equivalent groups, with the team selecting  status We will divide similar or adjacent communities into 2 equivalent groups with the team selecting control vs risk groups Data will not be projected. Specific sub‐populations may be oversampled to make absolute results  • comparable Weighting will place functional improvement at equal stature with sick care • Initial prize design—for public comment: www.xprize.org/wellpoint
  • COMMUNITY HEALTH INDEX ‐ DEFINITION Draft category Draft category Draft metric Draft metric • Hospitalization/ Rehospitalization • Days hospitalized • ER visits • Number ER visits Eliminate acute  • Communicable disease • CDC surveillance report of prevalence exacerbation • Major morbidity • Incidence Prevent • Disability (Long Term) • Prevalence of LT Disability long term  • Long term care • Prevalence LTC usage impairment p • Mortality • Incidence by age Incidence by age  • Sick days • Total days unplanned absence (school, work) Reduce • Disability (Short Term) • Total days ST Disability short term  impairment  p • Functional Fitness • TBD Optimize  • Self Reported • SF‐12 Individual  Vitality 15 Initial prize design—for public comment: www.xprize.org/wellpoint
  • TOTAL COST – DEFINITION •$ h $ through existing claim system, or otherwise processed by claims h l h db l Direct • $ assigned to medical care (HSA codes) going through debit card • $ submitted for reimbursement on other OOP spend • $ spent on communication / coordination with individuals  • $ spent on consumer or provider activation (e.g., lottery, rewards, incentives) • Sick and disability pay added to total cost • Not counted in cost, many improvements included in vitality index , yp y Indirect No  • Costs are all direct and accounted for pj projections Phase in /out • Team gets operating budget for first 6 months “dry run” which doesn't count against total cost 16 Initial prize design—for public comment: www.xprize.org/wellpoint
  • INDIVIDUAL VITALITY SCORE– DEFINITION • Scoring system to help consumer summarize current health status • Approach developed by each team to best engage consumers; team  pp p y gg ; innovation • Individual vitality score used to engage individuals in their health and health  actions 17 Initial prize design—for public comment: www.xprize.org/wellpoint
  • WHAT IS THE PHILOSOPHY BEHIND THE PRIZE DESIGN GUIDELINES? • Tracking of Community Health Index and Total Cost audited by trusted third party • Open sharing of results and implementation experiences by sponsor  Transparent  • Regular and detailed public updates on team progress  and Objective j • Independent judges oversee team down‐selection to finalists d d d d l fl • Teams may enter from anywhere as long as able to compete in test beds • All funding sources are ok for development of team platform g p p Open contest; Open contest; global idea  • “Salary cap” on operating expenses to ensure equal playing field between finalists in test beds recruitment • Limited use of existing, controlled facilities within a test bed to maximize potential entrants • Broad population health spectrum to maximize relevant approaches, and limit non‐systemic  solutions Demonstrable • High target: need to generate radical change impact w/in • Large enough / long enough to demonstrate real sustainable value Large enough / long enough to demonstrate real sustainable value 3 year window 3 year window • Teams need to prove consumer and/or provider engagement 18 Initial prize design—for public comment: www.xprize.org/wellpoint
  • WHAT ARE THE PHASES OF THE COMPETITION? Entry Concept Pilot Finalist • Registration document • Intervention model • Demonstration  • Intervention model and  Requirements – Concept p – Targets g successful pilot of key  p y p pilot exceed targets g • – People – Interventions assumptions (50‐100 pts  Team in place • Beta product / interface – Resources / Assets – Engagement network test) • – $10k – Modeled impact Alpha product • Execution strategy /  • Business plan, modeled  high‐level plan  financials • Concept sketch • Concept that’s  • Model showing target  • Pilots exceeding  • Matching / selection into  Proof reasonable impact requirements test‐beds • Likely mergers between • Testable key  • • Evidence of consumer  Actual progress in test‐ complementary  assumptions and provider  beds (live competition,  concepts engagement reported monthly,  detailed quarterly  reports) t) • Fall 2009 • Summer 2010 • Spring 2011 • Early 2015 Timing 19 Initial prize design—for public comment: www.xprize.org/wellpoint
  • WHAT CAPABILITIES MIGHT TEAMS DEPLOY? • Financing/ Payment: • Incentives that promote optimal outcomes/ desired behavior/ allocation to optimal treatments g/ y p p / / p • Behavior modification: • Programs that successfully change behavior  • Outcomes/ Comparative • Population‐level record of outcomes vs. treatment and understanding which approaches deliver better outcomes Effectiveness: • Personalized decision • Decision support helping consumers compare different treatments and select best for them (outcomes, risk, $) support: • Measurement/ tracking/ • Database/ records captured over time, allowing for feedback loops and suggestions/ reminders feedback: • Coordination of care: • Programs that create oversight/ handoffs that ensure a holistic view of consumer across providers • E‐Health: • Communication tools allowing for an extended interaction/ conversation (e.g., email, chat, video, home monitoring) • Information and programs that create leverage of provider expertise (e g teleconsult physician extender home monitor) Information and programs that create leverage of provider expertise (e.g., teleconsult, physician extender, home monitor) • Convenience: • Removing the barriers to seeing a provider (e.g., convenient location, extended schedule, home visit) • Care Experience:  • Changes to the type of care offered (e.g., 60 minute visit, prescription for exercise, reduced use of referrals/ tests) • Others??? 20 Initial prize design—for public comment: www.xprize.org/wellpoint
  • WHICH POPULATIONS WILL BE INCLUDED? Recommended Comment  • Ethical considerations Ethical considerations End of life End of life • Coordination and best practices through acute illness will prevent error. Use of Acutely ill home health / remote monitoring likely to reduce “fragmentation”.  Chronically • Coordination puts “care” back in healthcare and saves lives ill Disease Severity • Behavioral / lifestyle foundational to avoiding preventable illness (e.g., smoking,  At‐risk / obesity, fitness, etc.) but poorly executed today y, , ) p y y lifestyle lif t l • No scaled, proven solutions today Early health • Similar goals to at‐risk, but costs likely to be additive in short‐term risks • All costs additive No risks 21 Initial prize design—for public comment: www.xprize.org/wellpoint