1
The Radical
Transformation and
Disintermediation of
Healthcare: Evolving
Technologies in Care
Delivery
INSERT
Kevin Fick...
2
 An Overview of the
Forces Precipitating
Change in American
Healthcare
 Technology as a
Transformational and
Disinterm...
3
4
The Metaphor...
5
The Metaphor...
6
Jonathon Swift
1711“Vision...is
the art of
seeing
things
invisible.”
Jonathon Swift
1711
7
“The real voyage of
discovery consists not of
finding new lands but of
seeing the territory with
new eyes.”
- Marcel Pro...
8
The Premise…
 Society is demanding for all goods and services but –
especially for health care – that we…
- ↓ Costs
- ↑...
9
So, what
are
the forces
that are
affecting
healthcare
?
The Domains of Change – in Healthcare…
10
 Breakdown of traditional boundaries
 Workforce globalization
 Cross-industry convergence
 Rising tide of technolog...
11
So, What Does It All Mean?
 Consolidation – of hospitals / physicians
 Efficiency and Effectiveness – the new watchwo...
12
The Most Critical
Question!
12
Why?
13
Whydon’t
people CARE?
13
14
But, I think they
do CARE! They just
don’t CARE
enough… 14
15
Why?
15
16
We can no longer tolerate…
17
Value-Based
Payment Fee-for-Service Outcome Based
Incentives
Pass-A-Tube-Get-
A-Payment
Keep-Em-Healthy-
And-Make-A-Liv...
18
Payment
Focus
Role of the
Provider
Incentives
Volume-Based  Value-Based
The New World
Information
19
This is why
people don’t CARE
enough…
19
20
The Anticipation…
21
“"You can never
plan the future by
the past."
Edmund Burke
From
Deployment of Standards
To
Ubiquitous Interoperability
22
From the Primacy of Proprietary Systems
to the Priority of Open Source…
23
The Inevitable Move Toward Open Source
Standards…
 Metcalfe's Law predicts that the value of interoperability increase...
24
H
User Security
Files
The Goal? Apps Data Integration Across
The Healthcare Ecosystem
Secure
Cloud
Hosp
P
Payer
LabSNF
...
25
“"You can never
plan the future by
the past."
Edmund Burke
From
Virtual Monitoring
To
Virtual Care Delivery
26
 When is a radiologist a
radiologist?
 How is a cardiologist different
than a radiologist?
 How can a dermatologist
...
27
Advantages of TELECARE…
27
 Timely access to actionable information
for better patient care management
 Knowing what ...
28
OPPORTUNITY ANALYSIS = Super-Utilizers
 Opportunity: reduce cost of top 1% by 20% or top 5% by 20%
 Result: US Health...
29
Defined by Over a Decade of Experience
MODEL FOR SUCCESS
Outcomes &
Assessment
Reporting
It’s never just
about the
tech...
30
HOW IT WORKS
Self-reported
symptom &
behavior info via
IVR
Biometric information
via telemonitoring
devices
“Live” virt...
31
DATA SOURCES
TECHNOLOGIES FROM DOZENS OF DIFFERENT MANUFACTURERS
31
PERS Glucometer
Adapters
Medication
Adherence
Therm...
32
 The Problem:
• @ 240,000 admissions/year
• 28% (range: 25 – 36%) of “cellulitis” admissions are
inappropriate or a mi...
33
LOOKING FORWARD…
Bringing
the lab
home
GPS tracking and
Communications
Motion Analysis and
Action Detection
Technologie...
34
RESULTS
SUSTAINABLE OUTCOMES ACROSS DIVERSE HEALTHCARE ENVIRONMENTS
8
HARNESSING THE POWER
OF REMOTE PATIENT MONITORING...
35
“"You can never
plan the future by
the past."
Edmund Burke
From
Service Integration
To
Service Continuum
36
Traditional Focus of Care Delivery…
Acute
AmbCare
37
Alternate: Comprehensive Coordinated
Care (C3)
Preventive
Acute
SNF
Hospice
Alt Living
Remote Patient Monitoring
Transi...
38
“"You can never
plan the future by
the past."
Edmund Burke
From
Data Mining
To
Peripheral Intelligence
39
Decision-Support
Dashboards
Benchmarking
Personalization
Pattern Recognition
Data Mining
Knowledge Management
Artificia...
40
Standardization
Peripheral Intelligence
CaaS
In May, 2010 Lancet
Neurology published a
study showing that the
generic d...
41
HEALTHIER
COMMUNITIES
PRACTICE
INTELLIGENCE
KNOWLEDGE
INFORMATION
DATA
An INFORMATICS SAVVY ORGANIZATION is one
that ha...
42
Los Angeles – A Case Study in Public and Clinical Health
Can You Imagine?
43
Imagine, if you will…
44
“"You can never
plan the future by
the past."
Edmund Burke
From Quality as Outcome
To
Quality as Requirement
45
Managing the COMPLEXITY…
Coordinating the Care
Figure 2 - The Anatomy of Healthcare Delivery
46
 The Five Normals:
1. Normal weight
2. No smoking
3. Normal glucose / Hgb A(1)c
4. Normal cholesterol
5. Keep vaccinat...
47
“"You can never
plan the future by
the past."
Edmund Burke
From
Social Media
To
Social Activation
48
Use of Health Apps in Care Management…
 Patient Engagement = enhanced electronic collaboration between
patients/member...
49
Example: Social Activation & Engagement…
 Retrofit (www.retrofitme.com) – data-driven weight loss program
focused on p...
50
From Deployment of Standards To
Ubiquitous Interoperability
From Service Integration To Service
Continuum
From Virtual ...
51
And, The Implications?
52
A Story: The Woman and The Mountain
53
The tools are
available…but, the
transformation of
healthcare is missing the
essential requirement of
all change initia...
54
Systems-Centric
not
Professions-Centric
The World of Healthcare is Changing…
55
Global and Aggregated
not
Segmented
The World of Healthcare is Changing…
56
Networked and Virtual
not
Proprietary
The World of Healthcare is Changing…
57
Innovation-oriented
not
Replication-focused
The World of Healthcare is Changing…
58
Embracing
the future:
reaching for
the reality
beyond the
rhetoric…
A Perspective on the New Millennium...
59
A Final Consideration…Are you ready to
learn how to climb the lake?
If so…You’re ready to be a healthcare leader!
60
And, one final question:
How much do
you CARE?
60
61
Twitter http://www.twitter.com/MDkev
Email drkevin@creostrategicsolustions.com
…inspiring
creative change to
transform
...
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iHT² Health IT Atlanta Summit 2014 - Opening Keynote "The Radical Transformation and Disintermediation of Healthcare: Evolving Technologies in Care Delivery"

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Kevin Fickenscher, M.D., CPE, FACPE, FAAFP
President, Healthcare Division
Chief Medical Officer
AMC Health, Inc.
Former President and CEO
American Medical Informatics Association

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iHT² Health IT Atlanta Summit 2014 - Opening Keynote "The Radical Transformation and Disintermediation of Healthcare: Evolving Technologies in Care Delivery"

  1. 1. 1 The Radical Transformation and Disintermediation of Healthcare: Evolving Technologies in Care Delivery INSERT Kevin Fickenscher, MD President/CEO New York, New York
  2. 2. 2  An Overview of the Forces Precipitating Change in American Healthcare  Technology as a Transformational and Disintermediating Force  The Implications The Session… “You never change things by fighting against the existing reality. To change something, build a new model that makes the old model obsolete.” F. Buckminster Fuller
  3. 3. 3
  4. 4. 4 The Metaphor...
  5. 5. 5 The Metaphor...
  6. 6. 6 Jonathon Swift 1711“Vision...is the art of seeing things invisible.” Jonathon Swift 1711
  7. 7. 7 “The real voyage of discovery consists not of finding new lands but of seeing the territory with new eyes.” - Marcel Proust
  8. 8. 8 The Premise…  Society is demanding for all goods and services but – especially for health care – that we… - ↓ Costs - ↑ Quality - ↑ Service  The inherent incentives of the health care industry are disparate, inconsistent and dysfunctional – causing leaders significant challenges  Society is moving inextricably towards an information democracy rather than professionally dominated theocracy = Focal point for health care change = Appropriate management of information required = Intellectual capital of medicine = Simultaneously empowering (consumers) and disempowering (physicians)
  9. 9. 9 So, what are the forces that are affecting healthcare ? The Domains of Change – in Healthcare…
  10. 10. 10  Breakdown of traditional boundaries  Workforce globalization  Cross-industry convergence  Rising tide of technology  Continuous care delivery models  Shift from volume to value Health Care Forces “Change is the price of survival.” Sir Winston Churchill
  11. 11. 11 So, What Does It All Mean?  Consolidation – of hospitals / physicians  Efficiency and Effectiveness – the new watchwords  Productivity – the essential ingredient  Accountability – the required capability  Globalization – of care delivery  Virtualization – of support and delivery  Information Exchange / Data Analytics – fostering open data sharing, transparency and interoperability And, The Implications?
  12. 12. 12 The Most Critical Question! 12 Why?
  13. 13. 13 Whydon’t people CARE? 13
  14. 14. 14 But, I think they do CARE! They just don’t CARE enough… 14
  15. 15. 15 Why? 15
  16. 16. 16 We can no longer tolerate…
  17. 17. 17 Value-Based Payment Fee-for-Service Outcome Based Incentives Pass-A-Tube-Get- A-Payment Keep-Em-Healthy- And-Make-A-Living Focus Episodes Populations Role of the Provider Interaction on Individual Interactions Team-Based Care Continuum Information Retrospective Predictive The New World Volume-Based 
  18. 18. 18 Payment Focus Role of the Provider Incentives Volume-Based  Value-Based The New World Information
  19. 19. 19 This is why people don’t CARE enough… 19
  20. 20. 20 The Anticipation…
  21. 21. 21 “"You can never plan the future by the past." Edmund Burke From Deployment of Standards To Ubiquitous Interoperability
  22. 22. 22 From the Primacy of Proprietary Systems to the Priority of Open Source…
  23. 23. 23 The Inevitable Move Toward Open Source Standards…  Metcalfe's Law predicts that the value of interoperability increases geometrically with the number of compatible participants  Reed's Law predicts that the utility of a network (implied by interoperable equivalence) increases exponentially due to the number of possible subgroups that interoperability enables  CommonWell Health Alliance (the "Alliance") – HIT (vendor) interoperability initiative includes: Allscripts, AthenaHealth, Cerner, CVS Caremark, CPSI, Greenway, McKesson, RelayHealth and Sunquest
  24. 24. 24 H User Security Files The Goal? Apps Data Integration Across The Healthcare Ecosystem Secure Cloud Hosp P Payer LabSNF Warehous e EMR (Inpatient) EMR (Outpatient) Claims User Access and Device Access Manager Content Manager and Integration Manager Audit Logging and Reporting Public Content Multiple data sources PCP / Specialist Clinicians & Leadership Comprehensive Care Coordinators (C3) or Other Clinical Associates Patient
  25. 25. 25 “"You can never plan the future by the past." Edmund Burke From Virtual Monitoring To Virtual Care Delivery
  26. 26. 26  When is a radiologist a radiologist?  How is a cardiologist different than a radiologist?  How can a dermatologist support a primary care provider virtually?  What’s the value difference between a nurse practitioner and a family physician?  If 85 – 90% of pediatric care is protocol driven, who should provide it? Requiring Professional Collaboration…
  27. 27. 27 Advantages of TELECARE… 27  Timely access to actionable information for better patient care management  Knowing what is going on with a patient’s course of care, in between visits, when he or she cannot be physically in front of the clinician  Detecting pre-acute conditions before the patient clinically decompensates  Not waiting for the call from the ER before knowing that a patient is trending in the wrong direction
  28. 28. 28 OPPORTUNITY ANALYSIS = Super-Utilizers  Opportunity: reduce cost of top 1% by 20% or top 5% by 20%  Result: US Healthcare savings of $55B or $128B per year
  29. 29. 29 Defined by Over a Decade of Experience MODEL FOR SUCCESS Outcomes & Assessment Reporting It’s never just about the technology!! Clinical Support/ TCM Data Collection Set Up, Installation & Retrieval Patient Engagement & Registration Patient Identification & Referral Compliance Support EHR Integration MD Collaboration Internal & External Promotion 29 HARNESSING THE POWER OF REMOTE PATIENT MONITORING
  30. 30. 30 HOW IT WORKS Self-reported symptom & behavior info via IVR Biometric information via telemonitoring devices “Live” virtual diagnostic assessment via televideo/steth Medication compliance information via smart dispensers Data is collected, sorted and verified and presented as critical, actionable information on a secure web portal Patient’s Physician Care Manager PERS Data 30
  31. 31. 31 DATA SOURCES TECHNOLOGIES FROM DOZENS OF DIFFERENT MANUFACTURERS 31 PERS Glucometer Adapters Medication Adherence Thermometers Pulse Oximeters Cellular Modems Multi-user Kiosk Wireless Scales BP Monitors Interactive Voice Response Device/Data Source Neutral Televideo w/steth Meaningful and clinically actionable information from the patient’s home
  32. 32. 32  The Problem: • @ 240,000 admissions/year • 28% (range: 25 – 36%) of “cellulitis” admissions are inappropriate or a misdiagnosis not requiring hospitalization • = $83.4B/year in wasted admissions  Why? 1. Common lower limb disorders = lipodermatosclerosis, irritant dermatitis, venous eczema, lymphedema…and, thrombophlebitis 2. Most common dx is thrombophlebitis of the lower leg because it is red and inflamed but it’s not; simply inflammation of the small blood vessels 3. No clinical test can be done 4. Signs of chronic phlebitis will be present 5. The right hx is that it’s been coming and going and not acute  And, solving the problem can be as simple as wearing support hose, putting your feet up every day; and, losing weight… An Example of Making a Difference – Cellulitis…
  33. 33. 33 LOOKING FORWARD… Bringing the lab home GPS tracking and Communications Motion Analysis and Action Detection Technologies Wearable Sensors Smart Clothing Sleep apnea Monitoring Point of Care Wound Assessment Device
  34. 34. 34 RESULTS SUSTAINABLE OUTCOMES ACROSS DIVERSE HEALTHCARE ENVIRONMENTS 8 HARNESSING THE POWER OF REMOTE PATIENT MONITORING FOR ENHANCE TELECARE Decrease costs >35% ROIs exceeding 3:1 Reduce all-cause 30-day readmissions Enhance Care Management efficiencies Improve biometrics + reduce risks Reduce hospitalizations and ALOS Reduce Field Nurse Visits by 50% Daily patient compliance >80%
  35. 35. 35 “"You can never plan the future by the past." Edmund Burke From Service Integration To Service Continuum
  36. 36. 36 Traditional Focus of Care Delivery… Acute AmbCare
  37. 37. 37 Alternate: Comprehensive Coordinated Care (C3) Preventive Acute SNF Hospice Alt Living Remote Patient Monitoring Transition Chronic AmbCare
  38. 38. 38 “"You can never plan the future by the past." Edmund Burke From Data Mining To Peripheral Intelligence
  39. 39. 39 Decision-Support Dashboards Benchmarking Personalization Pattern Recognition Data Mining Knowledge Management Artificial Intelligence Standardization Peripheral Intelligence CaaS Predictive Knowledge Management… Using Informatics to Change Practice
  40. 40. 40 Standardization Peripheral Intelligence CaaS In May, 2010 Lancet Neurology published a study showing that the generic drug lithium did nothing to slow the course of amyotrophic lateral sclerosis (ALS In December, 2008, PatientsLikeMe, a for-profit patient networking site and data aggregator based in Cambridge, MA, came to a similar conclusion, more quickly and at much less cost. Predictive Knowledge Management… Using Informatics to Change Practice
  41. 41. 41 HEALTHIER COMMUNITIES PRACTICE INTELLIGENCE KNOWLEDGE INFORMATION DATA An INFORMATICS SAVVY ORGANIZATION is one that has an informatics-skilled workforce, a disciplined approach to information system design and use, and reliably managed IT operation. INFORMATICS implies a disciplined approach to information systems design and use that drives improvements in public health practice. PUBLIC HEALTH PRACTICE LEVELOFVALUE Source: Modified from work by Marty LaVenture, Bill Brand, Minnesota Department of Health. Karen Zeleznak, Bloomington Minnesota Division of Public Health Using Informatics to Change Practice
  42. 42. 42 Los Angeles – A Case Study in Public and Clinical Health Can You Imagine?
  43. 43. 43 Imagine, if you will…
  44. 44. 44 “"You can never plan the future by the past." Edmund Burke From Quality as Outcome To Quality as Requirement
  45. 45. 45 Managing the COMPLEXITY… Coordinating the Care Figure 2 - The Anatomy of Healthcare Delivery
  46. 46. 46  The Five Normals: 1. Normal weight 2. No smoking 3. Normal glucose / Hgb A(1)c 4. Normal cholesterol 5. Keep vaccinations up-to-date, esp. flu  How to manage: 1. Annual wellness visit. 2. Tobacco cessation. 3. Body Mass Index (BMI). 4. Diabetes screening test. 5. Cardiovascular disease screening. 6. Cholesterol level screening. 7. Screening tests Focusing on the SIMPLICITY… The Five Normals
  47. 47. 47 “"You can never plan the future by the past." Edmund Burke From Social Media To Social Activation
  48. 48. 48 Use of Health Apps in Care Management…  Patient Engagement = enhanced electronic collaboration between patients/members with healthcare organization(s), all major mobile devices and Web  Administrative / Employee = Reuse existing security and data to improve operations, ex; scheduling, forms, management reporting, bed management, workforce, etc.  Partner & Vendor / Third Party delivery / ACO = Apps integrate with external databases/systems to provide new function and access, such as; ACO Provider and Payer integrated info, billing, etc.  Health Delivery = New simplified and targeted access to complex content (e.g., genetics lab)  Health Education = Integrated content management and secure social networking allows for new collaboration, and tracking (e.g, my healthy world) 48
  49. 49. 49 Example: Social Activation & Engagement…  Retrofit (www.retrofitme.com) – data-driven weight loss program focused on professionals using wireless monitoring of weight, activity and sleep  Results: - 90% lose weight w/ average retention = 12 months (longest in industry / industry average = 6 – 12 weeks) - Men = 50% of customers - Average customer loses 9% of weight @ 20# + 90% keep weight after one year  Target busy professionals; upper income (avg = $80K/year)  Why are the results better at Retrofit that WeightWatchers with 80% vs 30% 12 month retention + 12 month weight loss: 20# vs 14# ???  Reason = Social Engagement 4
  50. 50. 50 From Deployment of Standards To Ubiquitous Interoperability From Service Integration To Service Continuum From Virtual Monitoring To Virtual Care Delivery From Data Mining To Peripheral Intelligence From Quality as Outcome To Quality as Requirement From Social Media To Social Activation S U M M A R Y
  51. 51. 51 And, The Implications?
  52. 52. 52 A Story: The Woman and The Mountain
  53. 53. 53 The tools are available…but, the transformation of healthcare is missing the essential requirement of all change initiatives… So, What Does It All Mean? Are you ready to participate?
  54. 54. 54 Systems-Centric not Professions-Centric The World of Healthcare is Changing…
  55. 55. 55 Global and Aggregated not Segmented The World of Healthcare is Changing…
  56. 56. 56 Networked and Virtual not Proprietary The World of Healthcare is Changing…
  57. 57. 57 Innovation-oriented not Replication-focused The World of Healthcare is Changing…
  58. 58. 58 Embracing the future: reaching for the reality beyond the rhetoric… A Perspective on the New Millennium...
  59. 59. 59 A Final Consideration…Are you ready to learn how to climb the lake? If so…You’re ready to be a healthcare leader!
  60. 60. 60 And, one final question: How much do you CARE? 60
  61. 61. 61 Twitter http://www.twitter.com/MDkev Email drkevin@creostrategicsolustions.com …inspiring creative change to transform healthcare that benefits the human condition Check Out My New Book: Toto's Reflections: The Leadership Lessons from The Wizard of Oz Kevin Fickenscher, MD President , Healthcare Services (301) 540-0795 – Assistant (Susan Seiger) (415) 450-1515 – Mobile

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