Future of Health

Future of Health

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  FUTURE OF HEALTHCARE Dr. S. A. Tabish FRCP, FACP, FAMS, MD HA (AIIMS)
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  Challenges • Challenges ofHealthcare Tech - Adapt to High-Tech Healthcare • Technology is advancing and restricting healthcare, learn how to utilize it for safe care. A great physician-patient relationship is something that every patient would love to have.
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  Current Practices • Innovationis blurring traditional health care boundaries • The life sciences and health care industry is on the brink of large- scale disruption. • In a future of health that’s defined by radically interoperable data, open yet secure platforms, and consumer- driven care, what role will you play?
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  Fundamental Shifts • Fundamentalshifts in innovation tend to occur in seven-year cycles. • While it’s possible to foresee what could happen over the next one or two cycles, looking ahead to 2040 (three cycles from now) will likely reveal a completely different reality than what we can comprehend today. What will emerge in the next 21 years that will dramatically reshape the life sciences and health care industry?
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  Healthcare to Health •There will be a fundamental shift from “health care” to “health.” • Wwhile disease will never be completely eliminated, through science, data, and technology, we will be able to identify it earlier, intervene proactively, and better understand its progression to help consumers more effectively and actively sustain their well-being. • The future will be focused on wellness and managed by companies that assume new roles to drive value in the transformed health
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  • More Patients •More Technology • More Information • The Patient Will Be the Ultimate Consumer • Different Delivery Model • Opportunity for Innovation • Costs will Increase • Uninsured Will Increase • Providers will be paid less
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  The Coming Transformation •The problems in our health care systems include subpar quality and patient safety, a misplaced focus on acute care rather than on prevention and population health, inadequate person centeredness, and unsustainable cost. • The next decade will see major shifts in the design of health systems and health care, propelled by digital health, growing consumerism, mounting financial constraints [NEJM]
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  Drivers of Change •Transformation requires strong drivers. One will be the digital health revolution. We expect digital transformation to change health care as it has changed banking and retailing. • Consumerism is growing, as people become more knowledgeable and active in their care. The health industry will need to become more person- centered, personalized, and more transparent • Another driver is unsustainable cost structures across the developed world, creating a “burning platform” for providers, insurers, consumers, and policy makers
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  Drivers of Change •The health care workforce is facing fundamental changes. • New specialties will require new health professions. • Workforce shortages, seen in many countries, will force adoption of new technologies to stretch the available workers.
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  Current Health System •Modern health systems often fail to provide care that is focused on patient and family needs and expectations. • Most systems can’t consistently measure outcomes that matter to patients, and can’t improve their health-related quality of life and overall function. • Current health systems often can’t effectively involve patients and their families in the care process or provide empathic care
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  Future Health Systems •Most systems can’t consistently measure outcomes that matter to patients, and can’t improve their health-related quality of life and overall function • Hospitals today are typically responsible for the largest portion of spending in health care, but we expect that within 10 years, care will move from the hospital into the community and the home. • Hospital-at-home programs are growing, because they improve outcomes at lower cost and with higher patient satisfaction
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  Future Trends • Personalizedmedicine will increasingly improve our ability to predict and prevent acute complication of chronic disease, thus preventing many hospitalizations. • Advances in digital health will allow us to deliver hospital-level care in the home through telemedicine. • The Covid-19 pandemic has accelerated this trend considerably.
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  What is Needed? •Consumerism is growing, as people become more knowledgeable and active in their care. • The health industry will need to become more person-centered, personalized, and more transparent. • If we are to sustain health and prevent disease, we must focus on the healthy, predicting and preventing chronic illness
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  Future HC Systems •Future health systems need to be learning systems • Evidence-based Medicine: “science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience
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  What is needed? •If health care systems are to evolve, they must shift both operations and leadership out of the hospital. • New technologies such as augmented reality, surgical navigation, and tele-mentoring will enable procedures to shift to community surgical centers, and this shift can be accelerated by changes in reimbursement. • Telemedicine services will enable clinicians to deliver chronic disease management programs not anchored to a hospital or clinic
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  Future Trends • Patientsafety and quality have been a concern since the early days of structured measurements • The next decade will see considerable transformation in how health systems are designed, propelled by opportunities such as digital health, growing consumerism, and mounting financial constraints.
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  Quality and Accessare Key  Vary – a lot; Not clearly related to dollars spent  Matter – can be measured and improved  Measurement science is evolving: – Structure, process and outcomes – Broad recognition that patient experience is essential component  Strong focus on public reporting is good – Motivates providers to improve – Not yet ‘consumer friendly’
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  Delivery As AScience “The fundamental problem with the quality of American medicine is that we’ve failed to view delivery of health care as a science. … That’s a mistake, a huge mistake.”
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  Coordination of Care
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  Opportunities for theField    
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  Future Trends inHealth Care Quality and Access  Knowledge Creation  Synthesis & Dissemination  Translating Research Into Practice  21st Century Health Care
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  Objective/Aim Improve the quality,safety, efficiency and effectiveness of health care for all Citizens
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  HC Priorities Effective Health CareProgram Medical Expenditure Panel Surveys Ambulatory Patient Safety Patient Safety  Health IT  Patient Safety Organizations  New Patient Safety Grants  Comparative Effectiveness Reviews  Comparative Effectiveness Research  Clear Findings for Multiple Audiences  Quality & Cost-Effectiveness, e.g. Prevention and Pharmaceutical Outcomes  U.S. Preventive Services Task Force  MRSA/HAIs  Visit-Level Information on Medical Expenditures  Annual Quality & Disparities Reports  Safety & Quality Measures, Drug Management and Patient-Centered Care  Patient Safety Improvement Corps Other Research & Dissemination Activities
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  Usual Source ofCare  Overall, the proportion of persons with a specific source of ongoing care is higher for females in all racial and ethnic groups  This proportion was significantly lower for the poor (78.1%), near poor (81.4%) and middle income (87.2%) groups than for high income groups (92.3%) 2007 National Healthcare Disparities Report Higher costs, poorer outcomes and greater disparities are observed among individuals without a usual source of care
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  Future Trends inHealth Care Quality and Access  Knowledge Creation  Synthesis & Dissemination  Translating Research Into Practice  21st Century Health Care
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  Effective Health CareProgram A. Evidence synthesis (EPC program) – Systematically reviewing, synthesizing, comparing existing evidence on treatment effectiveness – Identifying relevant knowledge gaps B. Evidence generation (DEcIDE, CERTs) – Development of new scientific knowledge to address knowledge gaps. – Accelerate practical studies C. Evidence communication/translation (Eisenberg Center) – Translate evidence into improvements – Communication of scientific information in plain language to policymakers, patients, and providers
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  New Priority Conditionsfor the Effective Health Care Program  Arthritis and non- traumatic joint disorders  Cancer  Cardiovascular disease, including stroke and hypertension  Dementia, including Alzheimer Disease  Depression and other mental health disorders  Developmental delays, attention-deficit hyperactivity disorder and autism  Diabetes Mellitus  Functional limitations and disability  Infectious diseases including HIV/AIDS  Obesity  Peptic ulcer disease and dyspepsia  Pregnancy including pre-term birth  Pulmonary disease/Asthma  Substance abuse
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  Advances in Genomics A recent DEcIDE report identified major gaps in our ability to generate evidence on utilization and outcomes of genomic testing  The American Health Information Community (AHIC) has called on AHRQ to help develop standards to code and exchange pharmacogenomics-relevant EHR information  Reports: – Genomic Testing in Ovarian Cancer, Breast Cancer, Colorectal Cancer and Depression Patients – Horizon Scans on Cancer and non-Cancer Genetic Tests (for CMS) – Collection, and Use of Cancer Family History in Primary Care (CDC- funded) – BRCA Testing in Breast and Ovarian Cancers, and Screening for Hereditary Hemochromatosis (USPSTF recommendations)
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  Evidence-Based Guidelines  NGCis a comprehensive database of evidence-based clinical practice guidelines and related documents  NQMC is a database and Web site for information on specific evidence-based health care quality measures and measure sets  The goal of both is to promote the dissemination, implementation and use in order to inform health care decisions
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  Future Trends inHealth Care Quality and Access  Knowledge Creation  Synthesis & Dissemination  Translating Research Into Practice  21st Century Health Care
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  New Clinical Recommendations –Screening for Prostate Cancer – Screening for Hearing Loss in all Newborns – Screening for Bacterial Vaginosis in Pregnancy – Screening for Illicit Drug Use – Screening for Chronic Obstructive Pulmonary Disease – Screening for Phenylketonuria – Screening for Congenital Hypothyroidism
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  Emerging Methods inComparative Effectiveness & Safety  Variation in methods among systematic reviews undercuts transparency  Methods reduce the likelihood of scientific impartiality  Methods help minimize misclassification of data  Methods must continue to evolve and not remain stagnant  AHRQ has and will continue to make investments in improving methods
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  Future Trends inHealth Care Quality and Access  Knowledge Creation  Synthesis & Dissemination  Translating Research Into Practice  21st Century Health Care
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  Health Care in2060  What will it look like? – There is no way to tell. In the meantime, goals to be addressed include:  Determining what can be done to improve the system right now  A continuing sense of urgency for long-term solutions involving innovation, enhanced risk taking and new delivery system approaches
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  Quality Standards Design systemsto collect quality of care information and define what constitutes quality health care Incentives Reward those who provide and purchase high-quality and competitively priced health care Price Standards Aggregate claims information to enable cost comparisons between specific doctors and hospitals Interoperability Set common technical standards for quick and secure communication and data exchange Cornerstones of Value-Driven Health Care
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  21st Century HealthCare Improving quality by promoting a culture of safety through Value-Driven Health Care 21st Century Health Care Information-rich, patient- focused enterprises Information and evidence transform interactions from reactive to proactive (benefits and harms) Evidence is continually refined as a by-product of care delivery Actionable information available – to clinicians AND patients – “just in time”
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  Scope of theOpportunity in Health Care  A major challenge in 21st Century health care is evaluating all innovations and determining which: – Represent added value – Offer minimal enhancements over existing choices – Fail to reach their potential – Work for some patients and not for others
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  How Do WeEnhance Our Efforts? Key T1 activity to test what care works Clinical efficacy research Key T2 activities to test who benefits from promising care Outcomes research Comparative effectiveness Research Health services research Key T3 activities to test how to deliver high-quality care reliably and in all settings Measurement and accountability of health care quality and cost Implementation of Interventions and health care system redesign Scaling and spread of effective interventions Research in above domains T1 T2 T3 Basic biomedical science Clinical efficacy knowledge Clinical effectiveness knowledge Improved health care quality and value and population health Source: JAMA, May 21, 2008: D. Dougherty and P.H. Conway, pp. 2319-2321. The “3T’s Roadmap to Transform U.S. Health Care: The ‘How’ of High-Quality Care.” The “3T’s” Road Map to Transforming Health Care
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  Connecting ‘Achievability’ andReliability  A robust health care system must include capacity for: – Rapid translation of beneficial advances or breakthroughs – Connectivity with the biomedical enterprise Achievability: What can work under ideal circumstances for some people Reliability: Getting it right for all patients every time – the first time
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  Future Trends inHealth Care Quality & Access  Knowledge Creation  Synthesis & Dissemination  Translating Research Into Practice  21st Century Health Care
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  Effective Transformation • Healthsystems represent complex dynamic systems, and implementation strategies need to adapt based on the change at hand as well as system characteristics • We can let the market drive health system change in a fragmented, uncoordinated, and reactive way, or manage the change in a coordinated and deliberate way to optimize the impact on patient outcomes and organization performance. We will need to take a proactive approach if we are to see these changes take shape earlier. All stakeholders — policy makers, payers, care recipients, and caregivers — must be at the table to enable and deliver effective transformation