Presentation at Health:Further Summit. RowdMap on using market forces to create public good. Overview of challenges and solutions in healthcare innovation. Example focuses on High-value care for health plans, physicians and hospitals and consumers as payment models move from Fee for Service to Pay for Value.

1. Joshua Rosenthal, PhD
Public Good from Market Forces:
High-Value Care for Payers, Providers and Consumers

2. Context
Exit
Exit w/
Good Multiple
Idea
Prototype
Funded
1 %*
1 %*
1 %*
1 %*
*Health Care Start Ups
fail at astounding,
disproportionate rates
Public Good from Market Forces

3. Most ‘Successes’, Aren’t
Measuring Value Creation
Public Good from Market Forces

4. Measuring Value Creation
Public Good from Market Forces

5. User Guide (ALT)
Consultants /
Professional Services,
Providers
SaaS-based
data / analytic
platforms
Measuring Value Creation
Public Good from Market Forces

6. Health care has not done so well
“Just wait ‘till next year Financial Services & Energy!”
In this race vs. other verticals
Public Good from Market Forces

7. *Direct-to-Consumer Note:
People don’t like to pay
out of pocket for something
they don’t like to do or
don’t want to know about
Challenge: Direct to Consumer Apps
Public Good from Market Forces

8. Speaking at a major health care conference near you
Challenge: Fluff in nice suits
Public Good from Market Forces

9. I have better
engineering / architecture
Hmm, ‘fixing the pipes’
was not the answer
Challenge: Noise from Tech
Public Good from Market Forces

10. I have better
design & experience
Hmm, the pretty colors
on my social app didn’t stop me
Challenge: Bubbles (design)
Public Good from Market Forces

11. My data is bigger than yours Hmm,
this fixation indicates...
Silly boys
Challenge: Buzz (cf. big data)
Public Good from Market Forces

12. * Source: Dartmouth Atlas for Unwarranted Variation
*
Challenge: Perverse Incentives
Public Good from Market Forces

13. Perverse Incentives: Fee for Service
Payers aggregate –
but some have not historically been “health care”
“Actually, I make more money
off of bad drivers.”*
(Read w/ accent)
Public Good from Market Forces

14. Some Hospitals/Providers may historically generated revenue
by filling rooms*
Keep patients away?!?
I was trying to book you for an extra night!
Perverse Incentives: Fee for Service
Public Good from Market Forces

15. Challenge: Interpretation of Data
Public Good from Market Forces

16. Causal?
Then again… Maybe there’s something to it?
Public Good from Market Forces

17. Review
Health Care Start Ups
fail at astounding,
disproportionate rates
Public Good from Market Forces
FAIL

18. Public Good from Market Forces
Change: NEW INCENTIVES
Government Announces Sun-setting of Fee for Services
Government Announces New Pay-for-Value Models

19. Public Good from Market Forces
Change: OPEN DATA
Government Announces Public Data
Government Announces Entrepreneurs Data Access

20. Public Good from Market Forces
So?

21. Public Good from Market Forces
Do Good…
... but you are probably not profitable
If P < EHC x DWS, then 501c3
P: Profit; EHC: Employee Head Count; DWS: Dog Walker’s Salary; 501c3: Non-profit
It’s easy to do good...

22. Public Good from Market Forces
… and Create Value
... but you are probably doing bad things
“I’ll bill you.”
It’s easy to make money...

23. Public Good from Market Forces
It’s tough to do good & create value in Health Care
So let’s practice
together
Create Public Good by Creating Marketplace Value…
... Let’s look at an example

24. Public Good from Market Forces
Low-Value Care:
.30 / Each $ Is Wasted
Over $9B in
Orange County, CA
$850 Billion Unnecessary Spend in 2014
(Institute of Medicine)
Institute of Medicine (IOM) report, “Best Care at Lower Cost,” (Sept. 2012) estimates that
the United States lost $750 billion in 2012. (Adjusted in 2013 at $800BB, 2014 at $850BB.)
This is about 3% of GDP or roughly the DOD budget for the Iraq War over an 8 year span.
Low-Value
Care (30%)
Necessary Utilization
(70%)
“It’s generally agreed that about
30 percent of what we spend on
healthcare is unnecessary. If we
eliminate the unneeded care, there
are more than enough resources in
our system to cover everybody.”
-Dr. Elliott Fisher,
Dartmouth Institute for
Health Policy
“Bigger than higher prices,
administrative expenses, and
fraud, however, was the amount
spent on unnecessary healthcare
services.” In just a single year,
up to 42% of patients receive
“Low-Value” Care.
- Dr. Atul Gawande,
Department of Health Policy and
Management at the Harvard
School of Public Health &
Department of Surgery at
Harvard Medical School

25. Public Good from Market Forces
2016 World Economic Forum
Annual Meeting in Switzerland
On track to
sunset 50% of FFS
High-Value Care:
CMS Is Paying on It

26. Public Good from Market Forces
In a series of white papers, HCTTF, following research,
recommends that payers, providers and CMS use low-value
care as evaluation criteria for success in pay for value models
and incentivize providers based on it to create sustainable
economic models for transition to value-based care.
High-Value Care:
Market Advocating for It

27. Public Good from Market Forces
“Millions of people are receiving drugs that aren’t
helping them, operations that aren’t going to make them
better, and scans and tests that do nothing beneficial for
them, and often cause harm.”
Dr. Atul Gawande, Professor, Department of Health Policy and Management at the Harvard
School of Public Health & the Department of Surgery at Harvard Medical School.
High-Value Care:
Media Is Reporting on It

28. Public Good from Market Forces
"It's no secret that patients often undergo unnecessary procedures that can
be dangerous and costly." Through our collaboration with RowdMap, we are
providing patients with meaningful information about these no- or low-value
treatments, allowing them to make better, more informed decisions about
their doctors, hospitals and medical care.”
High-Value Care:
Consumers Demand It

29. Public Good from Market Forces
RowdMap has low-value care and
population health benchmarks for…
every physician
every hospital
every zip code
…in the United States. What if you knew which
providers would
drive your success?
High-Value Care:
We Have It

30. Public Good from Market Forces
Health plans and providers in 48 states and the District of Columbia
use RowdMap’s benchmarks to reduce the delivery of low-value care.
RowdMap’s benchmarks help manage the $850 billion the nation
spends on care that leads to no better outcomes.
The clients RowdMap serves collectively cover the lives of
more than 100 million Americans.
Payers in Marketplace/Exchange, MA, Medicaid,
Commercial and Government Programs
Providers including PCP & Specialty Groups, CINs & Systems,
ACOs, Bundles & other CMMI Program Participants.
High-Value Care:
Market Adopting It…

31. Public Good from Market Forces
High-Value Care:
Market Challenge

32. Public Good from Market Forces
High-Value Care:
Market Response
Creating High-Value Networks

33. Public Good from Market Forces
High-Value Care:
Market Response
Compensating Providers on Value

34. Public Good from Market Forces
High-Value Care:
Market Response
Improve the Flow of Care

35. Public Good from Market Forces
High-Value Care:
Market Response
Create a Virtuous Growth Cycle

36. Public Good from Market Forces
High-Value Care:
Market Response
Ensuring Financial Viability

37. Public Good from Market Forces
High-Value Care:
Market Response
Achieving Financial Sustainability

38. Public Good from Market Forces
High-Value Care:
Problem
How Much Outcome Does Your Dollar Buy?
You can have great outcomes…
On a surgery you don’t need
You can have great patient experience...
On a surgery you don’t need
You can have relatively low costs...
On a surgery you don’t need

39. Public Good from Market Forces
High-Value Care:
Response

40. Public Good from Market Forces
Your Turn!
How to Guide
for
Public Good from Market Forces
DIY It!
bit.ly/OpenDataYourHand
bit.ly/HEBUserGuide
bit.ly/HEBSources
bit.ly/CMSHowToGuide
www.healthdata.gov
As held at

41. Public Good from Market Forces
Your Turn!
How to Guide
for
Public Good from Market Forces
Yes – it is possible to do.
Some of the most meaningful healthcare innovation
is coming out of traditionally overlooked spaces and
areas: seniors, B2B, Medicare, Medicaid, Nashville,
I-65, ‘fly-over’ country, etc.

42. Public Good from Market Forces
High-Value Care for Payers,
Providers and Consumers
Special thanks to