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Integrated Care
The document discusses the need for integrated healthcare to address rising costs and the challenges posed by aging populations and chronic diseases. It notes that global healthcare spending is increasing at over 8% annually, driven largely by increased spending on drugs, hospitals, physicians, and longer lifespans. Integrated care approaches that coordinate across providers and care settings can help improve outcomes and reduce inefficiency. The document outlines different models of integrated care and trends in global healthcare systems moving towards integration. It argues that new data sources, analytics and technologies like IBM's Watson platform can provide insights to help transform healthcare delivery through more proactive, personalized and collaborative approaches.
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Integrated Care
- 1. © 2014 IBMCorporation 1© 2015 IBM Corporation Abha Keshava Director, Product Management, IBM Smarter Care
- 2. © 2014 IBMCorporation 2© 2015 IBM Corporation © 2014 IBM Corporation IBM’s point of view: Integrated care Abha Keshava 28 May 2015
- 3. © 2014 IBMCorporation 3© 2015 IBM Corporation Global trends are forcing the need for change 2 million aged over 65 in UK will lack informal care from adult offspring by 2030…a 66% increase from 1.2 million in 2012 1 out of 466% $7 trillion+ Aging Population The cost for health and social programs worldwide, and it is rising Increasing Costs 1 in 4 Americans - 2 of 3 over age 65 –have multiple chronic conditions, accounting for 93 percent of Medicare expenditures Chronic Disease
- 4. © 2014 IBMCorporation 4© 2015 IBM Corporation Sources: 1 World Bank 2014, 2 World Health Stats 2014 (WHO), 3 WHO / by country, 4 World Economic Forum, 5 IDF, 6 Whitehouse.gov Health care consumes 15% of global government budgets, up from 13% a decade ago 2 Rising costs: the global health care model is not sustainable • Global economic growth is in a moderate 3% range1 • Global Financial Crisis in 2008 drove spending cuts and coverage restrictions in many countries. With additional spotlight on efficiency, significant policy reforms are beginning today1 • Health care costs are rising at a higher rate of over 8% 2 • 75-80% due to increased spending on prescription drugs, hospital and physician spending3 • 20-25% due to longer life expectancy, aging populations: care costs increase as we age3 • Chronic diseases threaten global economy, as #1 cause of death by 2020. Costs 400% more in productivity loss than the cost of treating the disease 4 • One in 10 adults will have diabetes by 2030 5 • 30% of health care costs are due to inefficiency in current systems6
- 5. © 2014 IBMCorporation 5© 2015 IBM Corporation A global issue: legislation creates new incentives to meet these challenges Germany increases benefits for care needs, including relatives, in January 2015 and combines management of public health and social well being Ireland launches new funding model: “Money Follows the Patient, to manage care across settings with stakeholder engagement. National Dementia Strategy in progress … United States Medicaid funding for chronic care management (CCM) came into effect January 2015 UK launches a $5.3B Better Care Fund to help join up local health and care services China NHFPC launches new rural health care initiative and “will speed up population health informatization”
- 6. © 2014 IBMCorporation 6© 2015 IBM Corporation Integrated care is a global strategy to reduce inefficiency across health and social welfare systems and improve patient-centered care Source: World Health Organization Global Burden of Disease (GBD) 2013 Types of Integrated Care: During 2014 and 2015, WHO will develop a Global Strategy to achieve universal health coverage with more people-centred and integrated health services Horizontal: single patient co- ordination across health, social and other care providers Vertical: managed care in a network of primary, hospital, community and tertiary care Holistic: population health model; health care, social care and wellness. Sectoral: multiple providers in a single sector e.g. mental health
- 7. © 2014 IBMCorporation 7© 2015 IBM Corporation “Towards people- centred health services delivery: a Framework for Action for the World Health Organisation” (WHO) European Region. Int J Integr Care 2013; Oct–Dec “Integration of health andsocial care would bettersafeguard adults from harm” BMJ 2013; 346:f3266 China – “HealthyChina 2020”:radical socialhealth insurancereformsThe Economist New accountable care organizations save Medicare $372 million The Buffalo News Integrated information is transforming health and socialservicesSouth Wales Guardian “Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care.” Int J Integr Care 2013; Jan–Mar Healthcare and social care are merging – and rightly so…
- 8. © 2014 IBMCorporation 8© 2015 IBM Corporation Counseling and education Clinical interventions Long-lasting protective interventions Changing the context to make healthy decisions Socioeconomic factors This is further proven - socio-economic factors have the highest impact on health CDC Health Impact Pyramid Environmental & social factors account for approximately 55% of health status Smallest impact Largest impact Genetics:5% Medical care: 20% Environmental and social factors: 55% Behavioral factors: 20%
- 9. © 2014 IBMCorporation 9© 2015 IBM Corporation End-of-life Considerations and care Care and case management Follow-up engagements after treatment Wellness Prevention, education, nutrition and fitness Episodic care Infrequent treatment for specific ailments Chronic care For ongoing conditions like diabetes and cancer Supporting health and care systems across the continuum
- 10. © 2014 IBMCorporation 10© 2015 IBM Corporation Turnkey solutions Healthy behavior Proactive early detection Best practice care protocols Outpatient support Care coordination - Incentives - Early detection - Regular exams - Warning of disease - Prescriptive care - Alerts of non conformance - Additional clinical insights based on literature - Prevent readmissions - Management outside the hospital - Across providers - Care plans for multidisciplinary teams - Leverage of new models (PCMH) Starting point for IBM solution Wellness Diagnosis and early intervention Disease maintenance Late stage/co- morbidity mgmt. There are different needs for Health solutions across the care continuum
- 11. © 2014 IBMCorporation 11© 2015 IBM Corporation Educators Providers, hospitals Pharmaceuticals, life sciences and health retailers Human services Payers Researchers Empowering a spectrum of stakeholders
- 12. © 2014 IBMCorporation 12© 2015 IBM Corporation EMR adoption reaches $22.3B adoption in 2015 HOWEVER they do not support the aspirations or the workflow of integrated care, rather they are a complementary enabler for integrated care solutions Sources: EMR Adoption statistics Accenture 2014 1 Rudin, Bates 2014, 2 Bates 2010, 3 O’Malley et al 2010, 4 Graetz 2009, 5 Rudin 2014, 6 PWC 7 Cipriano et al Improved outcomes Efficiency Integrated Care + Multiple provider + Patient engagement + Personalized care plans + Workflow & Collaboration Electronic Medical Records (EMR) Provider-centric Billing oriented Mature reporting EMRs Single EMR Structured Provider-centric Predefined terms System of record Uniform care Care Pathways Multi-EMR integration Dynamic, ad-hoc Patient-centric Non-standard terms Support for future goals Personalized plans Group decision making Integrated Care
- 13. © 2014 IBMCorporation 13© 2015 IBM Corporation Integrated care approaches improve health, reduce costs Unchecked, costs increase across the continuum of care Promote healthy behaviors Proactive early detection Best practice care protocols Out patient support Care management for complex conditions Costs increase due to: •Aging populations •Chronic disease •Complex conditions Proactive, evidence-based approaches Late Stage/ Co-Morbidity Mgmt. Diagnosis and Early Intervention Disease Maintenance Late Stage, Co-morbidity Wellness Diagnosis and Early Intervention Disease Maintenance Address the whole patient with proactive approaches across the continuum of care Costs
- 14. © 2014 IBMCorporation 14© 2015 IBM Corporation Personal data is exploding
- 15. © 2014 IBMCorporation 15© 2015 IBM Corporation Integrated approaches need new insights and engagement © 2015 International Business Machines Corporation 15 Late Stage/ Co-Morbidity Mgmt. Wellness Diagnosis and Early Intervention Disease Maintenance Late Stage Co-Morbidity Wellness Diagnosis and Early Intervention Disease Maintenance Insights • Real-world evidence improves care pathways and service delivery • Combine personal and population health data with new sources • Apply advanced analytics and cognitive computing for transformational insights Engagement • Enable providers to act on meaningful insights • Drive to outcomes: monitor results and payment flows, benchmark performance Data • Structured and unstructured
- 16. © 2014 IBMCorporation 16© 2015 IBM Corporation Announced April 13, 2015: IBM Watson Health IBM and Partners to Transform Personal Health with Watson Open Cloud Systems of Record Systems of Insight Systems of Engagement Enterprise Innovation Enabled by Cloud Pervasive Security Intelligence IBM Watson Health 1.Watson Health Cloud 2.Insights as a Service 3.Health solutions
- 17. Enabling ecosystems: data,insights, solutions Insights Cognitive & Advanced Analytics Data Structured & Unstructured Solutions IBM & Ecosystem Solutions Individuals Researchers Gov’t Payers Providers Human ServicesPharma IBM Watson Health Cloud HIPAA-enabled, standards-based, scalable
Editor's Notes
- #4 When we talk about trends with our customers, overwhelming evidence points out the real need for change. The population is aging, healthcare costs are rising and economic productivity improves when people’s health and social context are addressed. These are only a few of the global trends but we know each country has a set of issues forcing the need to improve the health system. We also know that different industries that are stakeholders in Health – with a capital H - see the same problems in different ways
- #5 http://www.euro.who.int/en/about-us/partners/observatory/activities/research-studies-and-projects/the-impact-of-financial-crisis-on-health-systems-in-europe Case Study: MFTP funding in Ireland, started in 2014 “money follows the patient” , starting in hospitals, in future extending to primary care. http://health.gov.ie/future-health/structural-reform-2/money-follows-the-patient/ Example: Ireland’s GNP fell by nearly 20% during the GFC between 2008 and 2011 while unemployment remained around 14%, requiring assistance from the ‘troika’ (EU, EU Central Bank and the IMF), with a key condition that public spending including healthcare be cut. KEY MESSAGE: EFFICIENCY GAINS ARE NOT OPTIONAL – IT IS MANDATORY http://www.whitehouse.gov/administration/eop/cea/TheEconomicCaseforHealthCareReform/ http://apps.who.int/iris/bitstream/10665/112738/1/9789240692671_eng.pdf?ua=1 http://www.worldbank.org/en/publication/global-economic-prospects
- #10 To really improve Health we know we need an integrated approach to care that improves health and reduces costs. We need to address the patient in full from wellness through late stages of life and be proactive on the approaches across the continuum of care. With the acquisition of Phytel complementing the capabilities of IBM Care Management, we now have the capabilities to address the complete range of solutions targeting holistic care management specifically for vulnerable populations reduce costs and deliver better quality outcomes
- #11 Picture is quite telling of the problem Where focus is today is that last chevron – better care and CHEAPER CARE Emerging and growing rapidly is preventative care- proactive at the population level
- #12 To achieve holistic care across the care continuum for individuals, there clearly needs to be orchestration and collaboration amongst various stakeholder organizations – and the individual him/herself too.
- #13 The current marketplace of EMRs scores very poorly1 EMRs do not come close to meeting provider needs with respect to care coordination”2 It is not possible to bolt on functionality 2 Lack of standards for exchanging data3 Steep learning curves’ 3 ‘Lack of role/responsibility agreement in EMRs’ 4 ‘A need for central registries which do not exist today’ 5 ‘Lack of defined outcomes for care plans’ 2 EMRs more often “forced workarounds” 3 Growing demand to manage information and cognitive overload Patients want assurance of “no decision about me without me” 6 Lack of support for future care plans and goals, personalization and group decision making tools 7 Using an EMR for care coordination would be like using a database as an email system http://www.euro.who.int/en/about-us/partners/observatory/activities/research-studies-and-projects/the-impact-of-financial-crisis-on-health-systems-in-europe Case Study: MFTP funding in Ireland, started in 2014 “money follows the patient” , starting in hospitals, in future extending to primary care. http://health.gov.ie/future-health/structural-reform-2/money-follows-the-patient/ Example: Ireland’s GNP fell by nearly 20% during the GFC between 2008 and 2011 while unemployment remained around 14%, requiring assistance from the ‘troika’ (EU, EU Central Bank and the IMF), with a key condition that public spending including healthcare be cut. KEY MESSAGE: EFFICIENCY GAINS ARE NOT OPTIONAL – IT IS MANDATORY
- #15 The average person will generate 1,100 terabytes of data (vs. 6 terabytes of genomic data) About 60% of data that determines health outcomes is exogenous – behavioral, socio-economic, etc. – and never captured as part of a person’s electronic medical records This is “big data” in its traditional characteristics – volume, velocity, variety – and generated in uncontrolled environments The generation/capture of this exogenous data is crucial for any emerging health ecosystems All of this exogenous data is generated in uncontrolled environments (that is, no hospital or supply side control) – highly fragmented value chain that needs neutral entity that can collect, store, manage, curate, analyze data for insights The ability to identify risk factors related to an adverse condition, e.g. heart failure diagnosis, very important for improving care quality and reducing cost IBM working on a systematic approach to combine known risk factors with additional potential risk factors derived from data
- #17 So IBM saw the opportunity to make a significant difference and formed IBM Watson Health Our CEO Ginni Rometty has called it IBM’s “moon shot” and an opportunity for the company to leave a significant legacy to enable transformation of the health ecosystem IBM Watson Health Approximately 2,000 dedicated employees, serving 500 hospitals and healthcare groups and over 300,000 providers Partnerships: with Johnson & Johnson, Apple and Medtronic to create new offerings that leverage information collected from personal health, medical and fitness devices Acquisitions: Explorys and Phytel two healthcare technology companies that are widely recognized for their leadership in applying big data and analytics to help improve the quality of health Data Mart - HIPAA-compliant, standards-based, massively scalable open health data repository Insights as a Service providing knowledge and actionable information through advanced analytics and cognitive capabilities Health solutions from IBM and a an ecosystem of partners built on an open innovation platform to improve the overall health experience and quality of care delivered, when it matters and where it matters *********** IBM is uniquely positioned to play a central role in healthcare transformation because: Foundational technology components for a powerful platform Advanced knowledge and data-driven analytics (Watson) Leadership security, mobility and cloud technologies IBM Research Advanced semiconductors (small-scale sensor devices) Genomics (analytics for drug repurposing) Data-driven analytics for personalized healthcare Partnering for market access and industry expertise Trusted, non-aligned player
- #18 The Watson Health Cloud is the foundation. It will provide a secure and open platform for organizations across the care ecosystem to share health data, surface new insights and create new applications that address individuals’ needs at any stage of the care continuum with proactive, preventative and evidence-based approaches. The new open platform will offer access to personal data of more than 50 million individuals in the US. This will expand to include populations from other nations as well. The information will be securely de-identified – or anonymized – then shared and combined with a dynamic and constantly growing aggregated view of clinical, health and social research data. IBM and our ecosystem of clients, partners and medical researchers will be able to query this expanse of data to see new patterns, causalities and dependencies by surfacing new connections between diverse and previously siloed data sets. Think of all the systems that track peoples’ personal information: EHRs, Physician Management Systems, Employment Records, Social Services Files, Claims Data, Clinical Trials, Academic Studies. This will spur the creation of a new generation of data-driven applications and solutions designed to advance health and wellness. Individuals and the larger cohorts or populations to which they belong will benefit. Providers will share and apply those insights in real-time to drive better, faster and less expensive treatments and more positive outcomes for individuals.