Towards a Continuous Learning Ecosystem:Data Innovations and Collaborations to Improve Clinical Outcomes and              ...
Outline• The Healthcare Ecosystem:   – Current State  Continuous Learning Ecosystem• Interactions at the Point of Care• “...
The Healthcare Ecosystem: Current State     Individuals                        Individuals                                ...
The Continuous Learning Ecosystem                                    Patient/                                    Individua...
Interactions at the Point of Care                                                             Follow Instructions:        ...
Data, Analytics & Knowledge             Demographics   Diagnosis   Medication   Procedure   Allergy   Contraindication   O...
Interactions at the Point of Care: Populations                                                                Medication/T...
Interactions at the Point of Care: Research                                                                  Comparative E...
Aligning Research and Practice         Do physicians have the orientation to do research in the context of clinical practi...
Data, Analytics and KnowledgePopulation   Clinical Care       Genome                       Toxicity/   Cost            Ris...
Coordinated Healthcare Intervention            Therapeutic Intervention                                        Information...
Scenario: Emergence of the Third Party RO/A                                 Engagement Protocols                          ...
Towards an Economic Decision Model    U = R – (Ic + Ir)                                                                U =...
Conclusions•   The Health Ecosystem needs to evolve into a Continuous Learning Ecosystem to achieve    cost/outcome object...
Bloghttp://continuouslearningecosystem.blogspot.comLook forward to comments, feedback, critique, suggestions!
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Towards a Continuous Learning Ecosystem: Data Innovations and Collaborations to Improve Clinical Outcomes and Reduce Cost of Care

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A bird's eye view of the healthcare system viewed as a continuous learning ecosystem. This suggests the need for deep collaborations and continuous sharing of insights to enable reduction of costs and improvement in outcomes

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Towards a Continuous Learning Ecosystem: Data Innovations and Collaborations to Improve Clinical Outcomes and Reduce Cost of Care

  1. 1. Towards a Continuous Learning Ecosystem:Data Innovations and Collaborations to Improve Clinical Outcomes and Reduce Cost of Care Vipul Kashyap*, Ph.D. Cigna Healthcare vipul.kashyap@cigna.com April 9, 2013 Medical Informatics World, 2013, Boston, MA * Acknowledgments – Jeff Catteau, Knowledgent (jeff.catteau@knowledgent.com) Discussions and feedback on the Economic Decision Model
  2. 2. Outline• The Healthcare Ecosystem: – Current State  Continuous Learning Ecosystem• Interactions at the Point of Care• “Coordinated Healthcare Intervention”• Making it Happen: Incentivizing Research & Knowledge Sharing – Economic Decision Model• Conclusions and Next Steps
  3. 3. The Healthcare Ecosystem: Current State Individuals Individuals Individuals (Populations?) (Populations?) HospitalsEmployers Health Pharmaceutical Advocacy Companies Providers Health Plans/ Clinical Research Payors Organizations (CROs)Employer/Payor Perspective Pharma Perspective Provider Perspective Siloized Ecosystem – Lack of collaboration/coordination – Inefficient!
  4. 4. The Continuous Learning Ecosystem Patient/ Individual Lifelong Continuous Engagement Continuous LearningAbility to share and exchange clinical information and knowledge is a critical enabler
  5. 5. Interactions at the Point of Care Follow Instructions: Lab Tests, Medications, othersMedical History? Medications?Allergies? Contraindications?Referrals? Follow Up? Reimbursement Continuous Learning Ecosystem: Roadblock Does the physician have time and incentive to identify insights, research new ideas and share them with other stakeholders?
  6. 6. Data, Analytics & Knowledge Demographics Diagnosis Medication Procedure Allergy Contraindication Order Referral Result ReimbPatient 1Patient 2Patient 3Patient 4Patient 5Patient 6Patient 7Patient 8Patient 9Patient 10Patient 11Patient 12Patient 13Patient 14Observation/Hypothesis:Physicians implicitly leverage experience to create patterns or “Care Archetypes ”Opportunity:Leverage “Care Archetypes” as an organizational framework for improving cost/outcomesSharing and communication of “Care Archetypes” across the Ecosystem
  7. 7. Interactions at the Point of Care: Populations Medication/Therapy compliance Discuss Alternatives, Activation and Engagement Cost Effective? Affordable? Good Outcomes? Alternate Treatments? Risk? Engagement/Outreach? Behavioral Archetype? Compliance? Incentivized?Continuous Learning Ecosystem: Roadblock partially addressedTransition to Pay for Performance has begun!However: Improving Performance requires research – and sharing of insights and resultsPay for Insight/Pay for Research is not yet on the agenda!
  8. 8. Interactions at the Point of Care: Research Comparative Effectiveness Research Clinical Trials Clinical StudiesNew Interventions (Therapeutic, Incentives, Engagement)?Impact of new ongoing research? Patient Participation?Contribution of Insights:New Cost Effective approach, Drug Side Effects, New Behavioral IncentivesGranular Care Delivery contexts where Interventions are effective?Genomic correlates of behavioral/activation characteristics?
  9. 9. Aligning Research and Practice Do physicians have the orientation to do research in the context of clinical practice? Opportunity Analysis Hypothesis Ideation Generation Clinical Trials/ Populations/ Studies Segments Outcomes Measurement Differential Diagnosis/ Possible Likelihood Estimation Diagnoses Therapeutic Intervention Care Archetypes History Lab Tests/ & Physical Longitudinal Follow UpPhysicians continue as usual – Automated Infrastructure pulls data and performs “Research Analytics”
  10. 10. Data, Analytics and KnowledgePopulation Clinical Care Genome Toxicity/ Cost Risk Quality Behavioral/ Therapeutic Engagement/ Payment Patient Dimensions* Efficacy Activation Intervention Outreach Incentives IncentivesPopltn 1Patient 1 Interventions that needPatient 2 to be studied/evaluatedPatient 3Patient 4 Activation Segments Care Archetypes Patient StratificationPatient 5 PopulationsPopltn 2Patient 6Patient 7Patient 8Patient 9Patient 10Popltn 3Patient 11Patient 12Patient 13Patient 14AlignmentPatient Care Archetypes  Cost/Quality Populations  Behavioral/Activation Segments Patient Stratification
  11. 11. Coordinated Healthcare Intervention Therapeutic Intervention Informational - Drugs, Procedures - Outreach - Devices - Wellness Apps Coordinated Health Intervention Motivational Cost and Risk Sharing - Engagement - Provider Incentive - Personal Incentive• Optimal Health Interventions will require collaborations between stakeholders across the ecosystem• Optimizes a set of criteria: outcomes, cost, toxicity, efficacy, utilization, economic benefit
  12. 12. Scenario: Emergence of the Third Party RO/A Engagement Protocols Medication Incentives, Compliance Infrastructure Investment Insights Research/ Behavioral Validation Data/Insights Licensing ModelPrescribing/Administration Medication Adherence Licensing ModelProtocols Insights• The Healthcare Ecosystem as a “Continuous Learning System” – Driven by Research• Reduce barriers to participation: Provide common infrastructure and a set of incentives• Need to incentivize sharing data generated from on going observations and measurement• Need for a trusted “Third Party Research Organization/Aggregator”
  13. 13. Towards an Economic Decision Model U = R – (Ic + Ir) U = R – (Ip + Ir) Ir consists of one time and incremental Ir consists of investments in utilization investments: ui = ri + d – Ii and incentives Um/2 = (Uprovider + Upayor + Upharma) U = utility, R = Revenue Ui = U + (ri) – (Ic + Ir) I: Investment in Care (Ic), Ir consists of investments in compliance Research (Clinical, Utilization, Incentives) (Ir), and incentives Payment (Ip)• Utilization Model for Research drives investment in research to address the information gap• Providers will rationally consume results to drive cost/outcomes improvement in clinical care• Payors and Pharma will drive investments in infrastructure and incentives to drive research• Optimization curve for market based on marginal gains for various components
  14. 14. Conclusions• The Health Ecosystem needs to evolve into a Continuous Learning Ecosystem to achieve cost/outcome objectives• Need for Deep Collaborations & Information Sharing to close the Information Gap Care Archetypes  Populations Activation/Behavioral Segmentations  Toxicity/Efficacy Stratifications• Need to invest in infrastructure and incentivize research and knowledge sharing – Reducing Information Gap creates value (in terms of cost/outcomes) which is consumed by different stakeholders in the ecosystem – Information Gap always exists (due to new knowledge and information)  new economic incentives market evolution/continuous learning• Trust – a key roadblock – may lead to the emergence of third party research organizations/aggregators• Next steps: Develop Economic Decision Model and Work on a Roadmap of Incentives to achieve a Continuous Learning Ecosystem!
  15. 15. Bloghttp://continuouslearningecosystem.blogspot.comLook forward to comments, feedback, critique, suggestions!

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