MobCon DH 2015 - Adam Darkins - transform healthcare delivery

USING INFORMATION AND TELECOMMUNICATION TECHNOLOGIES TO CHANGE THE LOCATION OF CARE AND TRANSFORM HEALTHCARE DELIVERY

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MOBCONMinneapolis, MNApril 8th , 2015

Adam Darkins, MD, MPHM, FRCSVice President of Medical Affairs and Enterprise Technology SolutionsMedtronic, plc.

Navigating Change

• US healthcare spending hit $3 trillion, or 18% of GDP in 2013, and it has been growing consistently faster than the US economy

• Top 5% healthcare utilizers consumed 50% of healthcare cost, approximately $36,000 for each individual

• Chronic disease treatment accounts for 75% of total healthcare spending and 70% of the mortality in the US

• 9.6 million dual eligible population cost the system over $270 billion annually, and they are more likely to suffer from chronic disease

• With aging population, prevalence of obesity, and growing unhealthy lifestyles, it’s only getting worse without change!

Unprecedented Pressure for Change

Why Change Healthcare Delivery Systems?

Our Current System Does not Work

Obesity (BMI ≥30 kg/m2)

Diabetes

1994

1994

2000

2000

No Data <14.0% 14.0%–17.9% 18.0%–21.9% 22.0%–25.9% 26.0%

No Data <4.5% 4.5%–5.9% 6.0%–7.4% 7.5%–8.9% >9.0%

Source: CDC’s Division of Diabetes Translation. National Diabetes Surveillance http://www.cdc.gov/diabetes/statistics

2010

2010

• Demographics

• Nature of Disease Burden

• Unclear Evidence the Current Configuration is Effective/Cost Effective?

• Health Care Delivery Rooted in Industrial Age

• Changing Lifestyles

• Changing Expectations

Why Change the Location of Care?

# of hospital discharges with diabetes as 1st -listed diagnosis grew from 454,000 to 688,000.

Data sources: Centers for Disease Control http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm

Number (Thousands) of Hospital Discharges with Diabetes as First-Listed

Diagnosis ( US 1988–2009)

Acute Care Systems for Chronic Disease?

“Every System is Perfectly Designed to Achieve Exactly the Results it Gets”

• Legacy of health information/billing systems

• Income/allocation designed to support physical assets

• Financial stability of acute care sector

• Focus on end-stage “salvage” versus prevention

Challenges of Legacy Systems

Post Acute Care in the United States

• Medicare Post Acute Care Spending (short-term skilled nursing and therapy services) on recovery from acute illness $62 billion.

• Post acute care Largest Driver of Geographic Variation.• One in 9 deaths in 2009 included heart failure as contributing

cause.• Traditionally most acute care hospitals and physicians pay little

attention to post acute care.• Medicare Spending Nearly as Much on post-acute care and

readmissions in the First 30 days after Hospital Discharge as it does for the Initial Admission.

• Under fee for service Acute Providers have had little financial incentive to invest in post-acute care resources.

• Medicare readmission penalties, bundled payment and shared-savings programs Change the Landscape.

Data sources: Mechanic, R. New England Journal of Medicine. 370;692-694. 2014.

Care In Home And Non-Hospital Settings

Different than: Delivering care in acute hospital settings.

Has: Other stakeholders, non-medical considerations and needs redefined relationships.

Offers: Opportunities for health care transformation that meld technologies across the continuum of care in new therapeutic relationships.

Requires: Patient centric care that covers preventative, investigative, curative, rehabilitative and palliative; as needed

What will be Different?

Post Acute Care: – A Redundant Term

Access: – Right Care in the Right Place at the Right Time

Variable Process: – Standardized Processes Supply, Chain Principles

Shared Decisions: – Non-Paternalistic

Patient-Centric: – No longer Provider Centric

Outcomes Driven:- Based on Evidence (Patient Centered)

Sharing-Risk When Outcomes are Assured

New Payment Models

Scaled Home Telehealth Program Outcomes

– Growth of Patient Numbers 2003 – 2007 from 2,000 to 31,570.

– Analysis of Cohort of 17,025 Patients.

– 25% Reduction in Bed Days of Care.

– 19% Reduction in Hospital Admissions.

– Mean Patient Satisfaction Score of 86%.

– Cost per Case $1,600 per Patient per Annum.

Reference. Darkins, A., Ryan, P., Kobb, R., Foster, L., Edmonson, E., Wakefield, B., et al. (2008). Care coordination/home telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemedicine and e-Health, 14(10), 1118– 1126.

Implantable Device Diagnostics Can Predict Heart Failure Events Earlier

Heart Failure Exacerbation

Fluid Retention

Decrease in Impedance

Measurement of Interthoracic Impedence

Advanced Device Diagnostic For Heart Failure Management

Device Diagnostics Have Been Shown to be Reasonably Good at Predicting Heart Failure Events

Merging Sensor/Device Data Onto Merged Connected Health Platforms

Earlier And More Effective Interventions

With this approach, we can serve a broader set of HF patients…

…and in the future expand our model to include key comorbidities

HTN

Diabetes

COPD

AfibCKD

Stroke

AMI

Integrated Solutions Can ServeBroader Population, With Multiple Diseases

With this approach, we can serve a broader set of HF patients…

…and can take a similar approach to manage diabetic patients

Integrated Solutions Can ManageLarger Populations and Multiple Diseases