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Consumer Centric Healthcare
Blue Cross Blue Shield of Michigan emphasizes a shift in healthcare from reactive treatment to consumer-centric, personalized medicine utilizing predictive analytics and patient data. The document discusses the challenges and inefficiencies in current medical practices while highlighting the potential of technology and education to empower patients in managing their health. It also addresses the ethical, legal, and economic implications of these changes in the healthcare landscape.
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Consumer Centric Healthcare
- 1. Blue Cross BlueShield of Michigan and Blue Care Network of Michigan are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association. Consumer Centric Healthcare Leo Barella VP EIT- Data Intelligence Blue Cross Blue Shield of Michigan
- 2. 2 “There is nothingmore difficult to take in hand …. than to take the lead in the introduction of a new order of things. 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. This coolness arises partly from fear of the opponents, who have the laws on their side, and partly from the incredulity of men, who do not readily believe in new things until they have had a long experience of them.“ - Nicolo’ Macchiavelli
- 3. 3 Trial & ErrorPattern Recognition Cause & Effect
- 4. 4 Pattern RecognitionTrial &Error Cause & Effect
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- 8. Two Thousand YearsAgo…. 8 “It is far more important to know what person the disease has than what disease the person has,” - Hippocrates
- 9. The Old Paradigm:Treatment of Disease 9 Time DiseaseSeverity Reactive Medial Care Diagnose Disease: Treat Symptoms; Costly, Trial and Error Treatment Diagnosis Select Drug Switch Drug Switch Drug Again
- 10. How Do WeDecide That a Drug “Works” 10 CURE NO EFFECT SIDE EFFECT SERIOUS SIDE EFFECT CURE NO EFFECT SIDE EFFECT SERIOUS SIDE EFFECT A B
- 11. Major Drugs Ineffectivefor Many 11
- 12. Ineffective Therapies CanCause Harm 12 Adverse Effects • Estimated 125,000 deaths per year (in 2014) • 6th leading cause of death in the US • Experienced by approximately 7% of patients (2.2 million) per year • Medication-related health problems account for an estimated 3- 7% of hospital admissions (Pirmohamed M, et al 2004) • During their hospital stay, 15% of patients experienced adverse drug reactions (Davies, et al 2009) • Increased patient non-compliance
- 13. Google answers toanything The Consumerism Megatrend 13 Implications on Healthcare Americans Want Control Control TV programming with TiVo Seek employment through LinkedIn Keep personal videos on Facebook Maintain their music with iTunes Buy & sell goods through eBay Purchase stock over the internet Bank electronically at ATMs They don’t want limits, restrictions, waiting lines, or other barriers to their health
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- 16. 16 Videoconferencing for follow-upvisits Self-monitoring device to check condition & send information to DR. electronically Videoconferencing for sick visits App that enable access to medical records & treatment information App to set & track progress towards health improvement goals App that reminds you to take medication
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- 22. 22 Personalized Medicine “Products andServices that leverage the science of genomics and proteomics (directly or indirectly) and capitalize on the trends toward wellness and consumerism to enable tailored approaches to prevention and care.” PricewaterhouseCoopers The new science of personalized medicine
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- 29. Effective, Efficient HealthManagement 29 Time DiseaseSeverity Predisposition Screening Diagnosis/Prognosis Right Drug Monitoring Efficient Medial Care Health Management; Molecular Screening, Early Detection; Rapid Effective Treatment; Improved Quality of Care
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- 32. New Data Streams,Including Those Direct From Patients, Are Beginning to be Used by Companies for Predictive Analytics 32 SO MUCH DATA Percentage of venture-backed predictive analytics companies using various types of data (2011-Q3 2014) SAM HO, M.D. Chief Medical Officer, UnitedHealthcare “Current data sets generally revolve around claims but that’s going to be changing with lots of clinical data and transactional information with lifestyle becoming more readily accessible”
- 33. Personalizing Care ThroughPredictive Analytics Represents a Significant Opportunity to Reduce Costs in the Healthcare System 33 $192B OVERTREATMENT • Eliminating care that cannot help patients – care that outmoded, supply-drive, and eschews science • Restricting treatment and intervention to the patients who will benefit based on the individual and the context $128B FAILURES OF CARE DELIVERY • Continuously studying care to identify what works for whom and in what context • Scaling best practices including preventive care and early warning systems that demonstrate effectiveness $35B LACK OF CARE COORDINATION • Ensuring those at the highest risk of costly medical episodes are identified, monitored, and cared for between visits and following hospitalization
- 34. Actionable lifestyle prescriptionfor reducing risk of disease Greater control & patient-centered access to medical records Treatment decisions will be improved by patient education Greater knowledge of one’s genetic risks Changing Role of the Consumer (Patient) 34
- 35. New ethical &legal issues/quandaries Greater reliance on HIT for decision support Improved care through use of aggregate patient data Highly networked, team based care Physician as manager, rather than repository of medical knowledge Changing Role of the Health Care Provider 35
- 36. Regulatory mandates coulddisrupt development budgets & market plans “Personalization” of drugs will require partnering with diagnostics companies Uncertain economics of drug development & commercialization New Business Strategies for Pharma 36
- 37. Increased need todemonstrate cost efficiencies Proactive strategies to limit reimbursement Increased pressure to change paradigm towards preventive medicine Greater emphasis on clinical validity & utility of diagnostic tests New Demands On and From Payers 37
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- 42. 42 IT Evolution ComparedHealthcare
- 43. The Evolution ofHealthcare Consumerism Generations of Consumerism 43 HIGH IMPACT Traditional Plans Traditional Plans With Consumer Information 1st Generation High Deductible Plans 2nd Generation Focus on Behavior Changes 3rd Generation Health & Performance 4th Generation Personalized Health & Healthcare 5th Generation Community Health & Healthcare LOW IMPACT Behavioral Change, Improved Health, & Lower Cost Potential
- 44. The Promises ofConsumerism 44 Major Building Blocks of Consumerism Personal Care Accounts Health Management Condition Management Health Literacy Incentives & Rewards The Promise of Demand Control & Savings The Promise of Wellness The Promise of Health The Promise of Transparency The Promise of Shared Savings It is the creative development, efficient delivery, efficacy, and successful integration of these elements that will prove the success or failure of consumerism.
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- 46. Personalized Medicine: ImpactsCare 46 ~ 38 types of Leukemia ~ 51 types of Lymphomas “Disease of the Blood” Lymphoma Leukemia Aggressive Lymphoma Indolent Lymphoma Chronic Leukemia Acute Leukemia Preleukemia 5 Year Survival ~0% 70% Ries LAG, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L, Mariotto A, Feuer EJ, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2002, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2002/ Based on November 2004 SEER data submission, posted to SEER web site 2005 Source: Mara G. Aspinall, former President, Genzyme Genetics
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- 48. It Will LargelyFall Onto the Healthcare Industry to Recognize the Value of Predictive Analytics and Implement Critical Use Cases 48
- 49. Beyond Regulation, theBiggest Risk to Predictive Analytics Being Used in Healthcare is Adoption as Power Dynamics Shift 49 Our question: Can user experience and design influence decision making so deeply as to be regulated?