HEALTH WEALTH CAREER FOR OFFICIAL USE ONLY HEALTHCARE INNOVATION IMPACTS ON THE DELIVERY AND MANAGEMENT IN HEALTHCARE THROUGH INNOVATION Michael B. Garrett, MS, CCM Principal April 2017
H E A L T H W E A L T H C A R E E R
FOR OFFICIAL USE ONLY
H E ALT H C A R E I N N O VAT I O N
I M P A C T S O N T H E D E L I V E R Y A N D M A N A G E M E N T I N H E A L T H C A R E T H R O U G H I N N O V A T I O N
M i c h a e l B . G a r r e t t , M S , C C M P r i n c i p a l A p r i l 2 0 1 7
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M I C H A E L B . G A R R E T T, M S , C C M P R I N C I PA L
Michael Garrett possesses more than 30 years of experience in managed care, care/case management, utilization management and review, chronic condition management, health information technology, healthcare quality, and population health management services. This has included operational leadership, business development, and consulting roles. His experience includes developing and implementing new care delivery models, such as patient centered medical homes and accountable care organizations (ACOs). Michael has experience working in a range of benefit programs, including self-funded health plans, workers’ compensation, Medicaid, and Medicare. He currently serves on URAC’s health standards committee and the editorial board of Professional Case Management. He has served as an author, editor, and contributor on six case/care management books as well as the author of numerous journal articles in the field.
Michael holds a Master’s degree in clinical psychology from the University of Idaho and a Bachelor’s degree in psychology from Gonzaga University. He is also a Certified Case Manager and a Nationally Certified Psychologist.
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P R E S E N TAT I O N O B J E C T I V E S
• Provide an introduction and background on healthcare innovation
• Identify the risks and opportunities of healthcare innovation
• Describe the explosion of innovations on the healthcare market by segment/domain
• Discuss the impact of healthcare innovation by stakeholder, including consumer, providers, administrators and plan sponsors
• Identify how the innovation adoption cycle impacts plan sponsors in embracing innovation
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27%
17%25%
14%
7%10% Unnecessary Services
Inefficient Care DeliveryExcess Admin. CostsInflated PricesPrevention FailuresFraud
$750 billion; 1/3 of total cost
…WITH GAPS IN QUALITY
T H E C A S E F O R I N N O VAT I O N
PERSISTENT COST PRESSURE
Preventive Health
Acute Care
Chronic Care
Patient Compliance 50% 70% 60%
Care Delivery 99% 70% 80%
Efficiency 50% 49% 48% B E F O R E P L AN
C H AN G E S AF T E R P L AN
C H AN G E S
I N F L AT I O N E AR N I N G S
…AND SYSTEM WASTE
Institute of Medicine – Best Care at Lower Cost: The Path to Continuously Learning Health Care in America
ADVANCEMENTS IN TECHNOLOGY
Everyday use of mobile apps
Emergence of cloud technology
“Big Data” deployment
Memorable experience
Immediate gratification
Desire for personalization
CHANGES IN CONSUMER PREFERENCE = DISRUPTIVE
INNOVATION
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Digital Health Venture Funding:
2012 2015
$1.1B
$4.5B
$1.5B
$2.0B
2013 2011 2014
$4.3B $4.5B
1 Rock Health
D I G I TA L H E A LT H R I S I N G 1
• $4.5B in 2015, and over 2x higher than 2013
• Digital health accounts for 7% of total venture funding
• In 2015, 247 digital health companies each raised more than $2M
• Healthcare consumer engagement and personal health tools and tracking categories accounted for 23%
• 40% of activity is taking place in California’s Bay Area, followed by Boston and NYC
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H E A LT H I N N O VAT I O N O F F I C I A L LY A “ B U Z Z W O R D ? ”
“Innovation means never having to say you are sorry.” — Eric Grossman, Mercer (2012)
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H E A LT H I N N O VAT I O N C U R R E N T S TAT E O F E M P L O Y E R ( A N D C O N S U LTA N T ? ) I N N O VAT I O N
TRAILBLAZERS, at the leading edge of
health benef its innovation and driving the direct ion
of the road…
Trai lb lazer
T r a i l b l a z e r
…while many are EVALUATING from the
sidel ines, and looking for solut ions that are ful ly
tested/tr ied/true.
Evaluator
E v a l u a t o r E v a l u a t o r
E v a l u a t o r
Evaluator
E v a l u a t o r E v a l u a t o r
Evaluator Evaluator
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M A R K E T T R E N D S “ E X P L O S I O N ” O F I N N O VAT I O N
E M P O W E R E D C O N S U M E R
T O TA L W E L L - B E I N G
C O S T D R I V E R S
P E R K S
Emerging Innovation Trends
• Digital navigation & gamification • Advocacy/concierge • Quality provider navigation • Expert medical opinion
E N G AG E M E N T
• Mental and emotional health • Resiliency • Financial wellness • Family health, fertility
H E ALT H I M P R O V EM E N T
• Chronic disease • Musculoskeletal • Oncology • Centers of Excellence
M AN AG E C O S T
• Onsite services • Child care • Personal pampering/relaxation • Entertainment
AT T R AC T I O N & R E T E N T I O N
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The r isks of innovat ion
Will this fit my company culture?
So many new options – where do I start?
How do I fit it within my broader strategy?
Will this cost me a lot to implement?
What if it fails?
How will this impact my career?
H E A L T H I N N O V A T I O N W E I G H I N G T H E R I S K S A N D O P P O R T U N I T I E S
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Broad regulatory changes 1
Dramatic changes to payor/ provider roles 2
Multi-generational behaviors and needs 4
Industry consolidation (carriers and beyond) 5
Growing consumer accountability / expectations 3
Perhaps…not innovating is riskier than innovation itself
Unprecedented Industry Change New Players And New Options
H E A LT H I N N O VAT I O N W E I G H I N G T H E R I S K S A N D O P P O R T U N I T I E S
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…versus innovation portfolio diversification
Putting all of your eggs into one basket… (Strategy, vendor, etc.)
Low/Medium
Medium/High
High
High
Low/Medium
Low
Long-term risk
Return potential
Flexibility
Innovation is a Way of Diversifying Your Healthcare Portfolio
H E A LT H I N N O VAT I O N W E I G H I N G T H E R I S K S A N D O P P O R T U N I T I E S
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I N N O VAT I V E A P P R O A C H E S P R O V I D E A C T I O N A B L E C O S T C O N TA I N M E N T L E V E R S F O R E M P L O Y E R S A P L AT F O R M F O R A C T I O N
Condition Focus Emerging Core Components Across Programs
Navigation
• Directing members to the right solution at the right time
Type of Program
Advocacy
• Concierge level assistance to streamline the member experience
Delivery Infrastructure
• Delivery either through an employer-sponsored plan or an exchange
Incentives/Challenges
• Intrinsic or extrinsic motivators to promote program engagement
Communications
• Broad-based or personalized marketing materials to promote programs
Physical Activity/Wellness
Financial Wellbeing
Sleep
Weight/Nutrition
Resiliency/Mental Health
Condition-specific (e.g., Diabetes)
Pregnancy/Family
Smoking
Pharmacy
Transparency
Telehealth
2nd Opinion
Care Coordination
Onsite/Near-site
Narrow Networks
Centers of Excellence
Nar
row
Bro
ad
Nar
row
Bro
ad
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H E A LT H I N N O VAT I O N W E I G H I N G T H E R I S K S A N D O P P O R T U N I T I E S
NEW PLAYERS AND NEW OPTIONS
M E M B E R Smok
ing
Advocacy
Employer-Sponsored/Exchange
Communications
Incentives/Challenges
Navigation
Assessments/Testing
Broad
Big Data Analytics
Provider- Focused
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P L A N N I N G TO I N N O VAT E — “ T H E H O W- TO ” F O C U S I N G Y O U R I N N O VAT I O N E F F O R T S
RISK
COST
Low Risk 62% of members
Low Cost 12% of cost
Medium Risk 34% of members
Medium Cost 47% of cost
High Risk 4% of members
High Cost 41% of cost
WHAT PARTS OF YOUR POPULATION? WHAT ELEMENTS OF THE PROGRAM DESIGN AND DELIVERY?
Targeted point solutions (specific condition or mode of service delivery)
Provider network contracting/ administration
Member portal / engagement tools
Care management
Customer service / advocacy
Claims administration
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P L A N N I N G TO I N N O VAT E — “ T H E H O W- TO ” H E A LT H I N N O VAT I O N E M P L O Y E R P R O TO T Y P E S
Organizations at the leading edge of health benefits
innovation; actively disrupting traditional roles with an
interest in driving industry-wide change
A S P E C T R U M O F AP P R O AC H E S TO I N N O VAT I O N
“The Disrupter” “The Tester” “The Concentrator”
Organizations that are focusing their innovation efforts around
specific elements of the healthcare ecosystem (e.g., value based care,
transparency). Focus may be driven by philosophical or bandwidth considerations.
Organizations that are generally maintaining underlying program infrastructure, but are testing/
implementing one or more targeted point solutions to
address specific workforce or cost issues.
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I N N O VAT I O N A N D I N F O R M AT I O N
• Innovation and technologies are impacting the four kinds of information that matter in healthcare – Information about the state of your internal systems (from your imaging and
lab-test results, your genome sequencing) – The state of your living conditions (your housing, community, economic and
environmental circumstances) – The state of the care you receive (what your practitioners have done and how
well they did it, what medication and other treatments they have provided) – The state of your behaviors (your patterns of sleep, exercise, stress, eating,
drinking, sexual activity, adherence to treatments)
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HOME WORK/RETAIL PROVIDERS HEALTH PLAN
Biometric Testing
Provider House Calls
Onsite/ Near-site
Pharmacy
COE Narrow Networks
EMR Pharmacy Benefit Mgmt.
Mental Health
Nurseline
Disease Mgmt.
Care Mgmt.
Doctors Hospital ACOs
Retail Clinic
EAP Dental
Non
-clin
ical
C
linic
al
Telemed
Apps Nutrition/ Meal Prep
Wearables/ Trackers
Exercise Equipment
Social Support
Gyms Consumer Ratings
Grocery/ Farmer’s Markets
Spas
Workplace Challenges
Community Resources
Education/ Awareness
Wellness Cost Transparency
Concierge/ Navigation
Incubators, Accelerators, Investors, Entrepreneurs, NGOs, Associations
T H E C O N N E C T E D H E A LT H C A R E N E I G H B O R H O O D
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S E N S O R Y E N H A N C E M E N T I N N O V E G A ( V I S I O N ) S O U N D H A W K S C O O P , R E S O U N D ( H E A R I N G )
P H Y S I C A L M E A S U R E M E N T F I T G U A R D ( S M A R T C O N C U S S I O N M O U T H G U A R D ) S P I R E ( B R E A T H I N G , S T R E S S ) L U M O L I F T ( P O S T U R E , A C T I V I T Y ) A L I V E C O R ( E C G H E A R T M O N I T O R ) H E D D O K O , H E X O S K I N , C I T Y Z E N , O M S I G N A L , A T H O S a m o n g m a n y o t h e r s ( E M B E D D E D C L O T H I N G ) L ’ O R E A L M Y U V P A T C H ( M E A S U R E U V E X P O S U R E ) O M R O N ( 2 4 / 7 R E A L T I M E B P M O N I T O R )
F I T B I T , J A W B O N E , G A R M I N , M I S F I T a m o n g m a n y o t h e r s ( A C T I V I T Y , S L E E P ) O U R A ( S L E E P ) S E N S O R I A ( F I T N E S S , R U N N I N G )
P S Y C H O L O G I C A L M E A S U R E M E N T S M A R T C A P ( F A T I G U E ) M U S E ( B R A I N F I T N E S S ) E Q U I V I T A L ( S T R E S S ) H U M A N Y Z E ( B E H A V I O R ; E E B A D G E )
I N G E S T I B L E S P R O T E U S ( D R U G A D H E R E N C E ) P I L L C A M ( P H O T O G R A P H I C C O L O N O S C O P Y )
P H Y S I C A L R E H A B I L I T A T I O N L U M I W A V E ( I N F R A R E D H E A T T H E R A P Y ) H I N G E H E A L T H ( P H Y S I C A L T H E R A P Y )
S M A R T W A T C H E S A P P L E , S A M S U N G , P E B B L E , M O T O R O L A , a m o n g m a n y o t h e r s ( C E L L P H O N E E X T E N D E R S , A C T I V I T Y )
A P P S M Y F I T N E S S P A L , N I K E + , O V U L I N E , M A P M Y F I T N E S S , C A L M , S L E E P I O , a m o n g m a n y o t h e r s ( A C T I V I T Y , D I E T , W O M E N ’ S H E A L T H , R E S I L I E N C Y , S L E E P )
C H E M I C A L M E A S U R E M E N T G O O G L E / N O V A R T I S C O N T A C T L E N S ( B L O O D G L U C O S E , C A T A R A C T S ) S A N O ( M E T A B O L I C A C T I V I T Y )
L A B - I N - A - B O X C U E ( P O R T A B L E L A B T E S T S F O R I N F L A M M A T I O N , V I T A M I N D , F E R T I L I T Y , F L U , T E S T O S T E R O N E ) L I V O N G O ( S M A R T G L U C O M E T E R )
T H E C O N N E C T E D H U M A N B O D Y 2 . 0
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I N N O VAT I O N P H I L O S O P H I E S Al
pha
Gee
ks
• Venturesome • High risk
tolerance
Early
Ado
pter
s
• Opinion leaders
• Judicious and restless
Fast
Fol
low
ers • Value
shoppers • Focused on
usefulness Late
Maj
ority
• Skeptics • Slower to
adopt
Lagg
ards
• Resistors and traditional
• Averse to change
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ESTABLISHING • DPP, Telemedicine • Transparency • Concierge advocacy
EMERGING • Genetic, molecular
profile • Physician home visits • Personalized benefits
STANDARDIZED • Care management • Utilization
management
DEVELOPING • Metabolic syndrome • Wearables • Narrow networks
TESTED • Consumer driven
health • Health screenings • Incentives/
surcharges
T H E I N N O VAT I O N A D O P T I O N C Y C L E I N N O VAT I O N P H I L O S O P H I E S
CU
MU
LA
TIV
E
RE
PR
ES
EN
TAT
ION
“LATE MAJORITY”
Skeptics; slower to adopt
“LAGGARDS”
Resistors and traditionalists; averse
to change
“EARLY ADOPTERS”
Opinion leaders; judicious and restless
“ALPHA GEEKS”
Venturesome; high risk tolerance
“FAST FOLLOWERS”
Value shoppers; focused on usefulness
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P R E D I C T I O N S F O R TO M O R R O W I T ’ S A B O U T TO G E T M O R E C O M P L I C AT E D
Carriers’ desire for consolidation + new tech entrants disrupt the integrated health plan service model
Diverse workforce preferences means one size cannot fit all
Value-based care acceleration increase new care delivery options
Boom in personalized medicine, but the savings not yet realized
As a new healthcare market emerges, employers must capitalize on this formative period to redefine their role and shape the market to meet their strategic objectives
Payers Evolution
Provider Transformation
Consumer Diversification
Bio-medical Explosion
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F I V E K E Y I M P E R AT I V E S F O R H E A LT H C A R E I N N O VAT I O N
1 Making Value the Central Objective In isolation, efforts to either reduce costs or improve outcomes are insufficient; we need to do both through care coordination and shared information.
2 Promoting Novel Approaches to Process Improvement Instead of largely focusing on product innovation, we also must create an environment that encourages process improvement and acknowledges that “failure” represents an important component of experimentation and learning.
3 Making Consumerism Really Work Today, consumerism remains a strong idea with weak means of execution. We will achieve greater success when provides organize efforts around patient needs and when patients become more active agents in managing their own health.
4 Decentralizing Approaches to Problem Solving We should facilitate the movement of care delivery and healthcare innovation from centralized center of expertise out to the periphery, where more provides, innovations and patients can engage in collaborative improvement efforts.
5 Integrating New Approaches into Established Organizations Our future must build on past successes. Existing healthcare institutions must be reinforced with efforts to integrate new knowledge into established organizations and the communities they serve.
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P R E S E N TAT I O N S U M M A RY
• Provided an introduction and background on healthcare innovation
• Identified the risks and opportunities of healthcare innovation
• Described the explosion of innovations on the healthcare market by segment/domain
• Discussed the impact of healthcare innovation by stakeholder, including consumer, providers, administrators and plan sponsors
• Identified how the innovation adoption cycle impacts plan sponsors in embracing innovation
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PA R T I N G C O M M E N TA RY O N H E A LT H C A R E I N N O VAT I O N
Success is not delivering a project or product; success is learning how to make
your customers great at what your customers care about
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