Disease Management Megatrends: State-of-the-Industry 2008 and Beyond Delivering on promises... January 2008 Vince Kuraitis JD, MBA Better Health Technologies, LLC www.e-CareManagement.com blog (208) 395-1197
Disease Management Megatrends: State-of-the-Industry 2008 and Beyond
Delivering on promises...
January 2008
Vince Kuraitis JD, MBA
Better Health Technologies, LLCwww.e-CareManagement.com blog (208) 395-1197
2© www.bhtinfo.com
9 Chronic Disease Management Megatrends
MAGNITUDE: We are just scratching the surface of chronic disease challenges.
INTEGRATION: The 50 year tide is shifting toward integration, away from specialization.
MEDICARE: While Medicare has endorsed the need for chronic disease management, disappointing results from recent demo projects make future direction unclear.
PROVIDERS: Care providers have woken up to DM opportunities and threats; they are promoting the Chronic Care Model and the medical home.
MAKE, ASSEMBLE, BUY? Fewer are buying as health management becomes increasingly strategic.
TECHNOLOGY: DM in your home and your pocket. BEHAVIOR CHANGE: DM is moving from a medical to a
social model; behavior change has become the Holy Grail. CLINICAL AND ECONOMIC ROI: Round one is over, DM
wins; Round 2 has just begun. WILDCARDS!
3© www.bhtinfo.com
This presentation...
• ...is a synthesis of major trends affecting disease/care management
• ...is continually updated. Look for in the upper left corner as a guide to significant changes since the January 2007 version.
• ...reflects the evolution of trends. Since early 2007 the wording of the megatrends relating to Medicare and Providers has changed significantly
• Note: items with blue outlining are hyperlinked to original sources, e.g.,
4© www.bhtinfo.com
MAGNITUDE: We are just scratching the surface of
chronic disease challenges.
5© www.bhtinfo.com
The Big Picture
Partnership for SolutionsPartnership for Solutions
Changing NeedsChanging Needs
1900-1950 Infectious Diseases
1950-2000 Episodic Care
2000-2050 Chronic Care
6© www.bhtinfo.com
Despite Efforts to Date, the Chronic Care Challenge is Growing
• Over the next 10 years, the global incidence of chronic disease is predicted to increase by 17%, further fueling the global burden of disease. Several factors account for this driving force:– The success of modern healthcare in transforming formerly
lethal diseases, injuries, and conditions (e.g., HIV, spinal cord injuries, diabetes, tuberculosis, and multiple sclerosis) into chronic conditions that require continuous treatment;
– Reductions in premature mortality and increasing longevity resulting in longer-lived chronic conditions and health-related dependencies; and
– Increases in the behaviors (e.g., unhealthy diet, physical inactivity, and tobacco use) that significantly contribute to many prevalent chronic diseases.
Chronic disease is gaining increasing global attention....
The $30 Billion Potential DM Market is Barely Penetrated
Disease Management Market Penetration(millions)
$0$5,000
$10,000$15,000$20,000$25,000$30,000$35,000$40,000
Available Market Industry Revenues
Medicaid Market Opens with FL
Healthplans and Self Funded Employers
FEHBP Plans Start Adding DM
CCIP Phase 1
CCIP Expansion
Source: Chris Selecky, President of DMAA and Chair, Lifemasters, 2005
Available Market based on Wachovia Capital Markets Formula
9© www.bhtinfo.com
• Is a $30+ Billion DM market projection realistic???
• DM’s primary economic value proposition comes from avoiding hospital and ER costs.– CMS projects that U.S. hospital costs in 2015 will be
$1.1 Trillion (not a typo).– Q. What’s $30 B as a percentage of $1.1 T? – A. 2.7%
• You decide.
10© www.bhtinfo.com
INTEGRATION: The 50 year tide is shifting toward integration, away from
specialization.
11© www.bhtinfo.com
There are Multiple Dimensions to “Integration”
• Information and communication technologies (ICT)– Interoperability– Transportability– Convergence of devices
• Local care provider integration (especially physicians)
• Physical health and mental health• Etc.
12© www.bhtinfo.com
To Date DM Clinical/Business Models Have Emphasized Specialization
• Specialized companies providing services• Specialized contracting/financing model -- guaranteed savings• Specialized focus on individual diseases (migrating toward
multiple comorbid conditions)• Specialized technologies: predictive modeling, call centers,
medical management workflow software, etc.• Specialized delivery models are developing for unique customers
– Managed Care Organizations• HMOs• PPOs• other
– Medicaid (in various flavors)
– Medicare
– Employers
– Special Needs Plans– Specialty pharma– State high-risk pools– Multiple diseases– Comorbid patients– Highest cost/risk patients– etc., etc.
13© www.bhtinfo.com
14© www.bhtinfo.com
Future Care Delivery Models Will Be Integrated Around Patients’ Homes & Communities
15© www.bhtinfo.com
MEDICARE: While Medicare has endorsed the need for
chronic disease management, disappointing results from recent demo projects make
future direction unclear.
The Event-of-the-Decade for DM
16
© www.bhtinfo.com
Medicare Understands the Problem:Chronic = Disproportionately Expensive
Source: Johns Hopkins, Partnership for Solutions, 2004
17© www.bhtinfo.com
Medicare DM Demos: Little Evidence of Success
• Medicare Health Support (MHS) appeared to be the favorite son demo to expand DM into Medicare– MHS has attracted worldwide attention– Legislation requires roll out if successful
• Elements of MHS model– Focus on highest cost/risk population (frail elderly)– Disease management -- carve out to private companies &
health plans ( vs. CCM)– Guaranteed 5% savings business model– Short term ROI – Randomized control trial
• Results to-date: little evidence of success. See First “Official” Report on Medicare Health Support DM Pilot Finds Virtually No Evidence of Success, Disease Management and the Medicare Health Support (MHS) Project: “Houston, we have a problem.”
18
© www.bhtinfo.com
Early MHS Results Are Not Encouraging
• First, although the intervention and comparison groups are similar at randomization, our analyses reveal that an unexpected pattern in PBPM differences between intervention and comparison groups emerges between the time of randomization and the start of the MHS pilots.
• Second, participating beneficiaries tend to be a healthier and less costly subset of the intervention group. Thus, high participation rates will likely be a factor in the ability of the MHSOs to impact their assigned intervention populations. And,
• Third, fees paid to date far exceed any savings produced. The negotiated MHSO monthly fees are a much higher percentage of the comparison groups’ PBPMs than the percentage savings on payments through the first 6-month pilot period. Fees negotiated by the MHSOs with CMS have not been covered by reductions in Medicare expenditures, let alone an additional 5% savings in Medicare payments. Without a substantial reduction in each MHSO’s monthly fee, budget neutrality after the first year is questionable.
Source: RTI International Report to Congress: Evaluation of Phase I of Medicare Health Support (Formerly Voluntary Chronic Care Improvement) Pilot Program Under Traditional Fee-for-Service Medicare, June 2007
19
© www.bhtinfo.com
Findings from Four Demonstrations
• No effects on adherence or self-care• Only 3 of the 20 programs reduced hospitalizations
or gross costs (4.5% reduction in MCC admissions)– Another had effects for CHF subgroup in urban counties
• No effects on mortality• Scattered modest effects on quality indicators:
– CHF: MCC reduced preventable hospitalizations– Diabetes: Telemedicine improved HbA1c, cholesterol, blood
pressure; MCC reduced preventable hospitalizations
• Patients love the programs
Does Disease Management/Care Coordination Work for Medicare?Does Disease Management/Care Coordination Work for Medicare?
Randall BrownArnold Chen
Deborah PeikesJennifer Schore
Dominick EspositoPresented at Academy Health Research
Meeting, June 2007
Randall BrownArnold Chen
Deborah PeikesJennifer Schore
Dominick EspositoPresented at Academy Health Research
Meeting, June 2007
20
© www.bhtinfo.com
Why Doesn’t DM Work Better?
• Changing patient and provider behavior is HARD:– Limited use of behavior change models– No incentive for physicians to communicate
• Some patients too ill, others not at short-run risk:– But targeting is not the major problem
• Programs don’t collect timely hospitalization and Rx info
• Usual care providers are minimally engaged
Does Disease Management/Care Coordination Work for Medicare?Does Disease Management/Care Coordination Work for Medicare?
Randall BrownArnold Chen
Deborah PeikesJennifer Schore
Dominick EspositoPresented at Academy Health Research
Meeting, June 2007
Randall BrownArnold Chen
Deborah PeikesJennifer Schore
Dominick EspositoPresented at Academy Health Research
Meeting, June 2007
21
© www.bhtinfo.com
Why Doesn’t DM Work Better?
• Programs led by marketers, not clinical experts:– Ineffective use of available data – Unfamiliar with unique needs of the elderly
• Contact info poor in population-based models • Improvements in quality of care don’t guarantee
better patient outcomes in short run
Does Disease Management/Care Coordination Work for Medicare?Does Disease Management/Care Coordination Work for Medicare?
Randall BrownArnold Chen
Deborah PeikesJennifer Schore
Dominick EspositoPresented at Academy Health Research
Meeting, June 2007
Randall BrownArnold Chen
Deborah PeikesJennifer Schore
Dominick EspositoPresented at Academy Health Research
Meeting, June 2007
22© www.bhtinfo.com
CMS’ Take on Medicare DM Demos
Source: Linda Magno, CMS, presenting at the Patient Centered Primary Care Collaborative Summit, November 2007
23© www.bhtinfo.com
Many Other CMS Demo/Pilot Projects Involve Patients With Chronic Diseases
• Medicare is undertaking a wide range of demonstration/pilot projects
• Many directly involve patients with chronic conditions– Physician Group Practice (PGP) – Care Management for High Cost Beneficiaries (CMHCB) – Special Needs Plans (SNP)– Medicare Medical Home demonstration (discussed later)– and others
What are some of Medicare’s other options toward an optimal chronic care management program?
• From: a guaranteed 5% savings business model• To: considering many alternative payment mechanisms: capitation, shared savings, pay-
for-performance, and/or fee-for-service DM.
• From: focusing on short-term ROI• To: focusing on medium-long term ROI, quality improvement & compression of
morbidity
• From: DM carve outs to private companies & health plans• To: exploring options to re-integrate care providers into care management processes,
e.g., the Chronic Care Model, the Medical Home model or a managed care model (e.g. utilization review, case management, pre-certification, etc.).
• From: focusing on high-risk, chronic, co-morbid patients• To: including programs to address mainstream Medicare patients with prevention and
population health approaches
• From: rigid implementation of inflexible program structures• To: Rapid Learning Models. Open up the data, while protecting for personal
identification, to all “qualified” people to learn what can be learned in a timely fashion. The process should be transparent and open and available to the taxpayers who have funded these demonstrations.
• From: is MHS working as originally designed?• To: what’s the optimal chronic care management program, financing structure, and
evaluation model for Medicare?
25© www.bhtinfo.com
PROVIDERS: Care providers have woken up to DM
opportunities and threats; they are promoting the Chronic
Care Model and the medical home.
26© www.bhtinfo.com
Model #1: Disease Management Model• Medium sized, privately & publicly held companies• $2 billion revenues in 2007 (Source: DMPC) • Payers are increasingly assembling DM components• Key elements
– Telephonic services, centralized call centers• Support patient life style change• Promote evidence based practice
– Started as carve-out model– Guaranteed savings promoted by DMPC– Focusing on highest cost, highest risk patients
• Challenges: physician buy-in, proprietary IT• Major players:
Model #2: Chronic Care Model
• Pioneered at Group Health Cooperative• Key elements
– Community based– Transformation of health care– Restructuring of physician practice
• Challenges: no reimbursement, academic/research focus
• Protagonists:
23 Aspects of the Chronic Care Model
Delivery System
Design
DecisionSupport
Clinical Information
Systems
Self-Management Support
Health System Organization
Links to Community Resources
Leadership support
Provider participation
Coherent system QI
Guidelines
Provider education
Expert support
Registry
Info for care man.
Performance data
Care man. roles
Practice team
Care coordination
Proactive follow-up
Planned visit
Visit system changes
Patient education
Patient activation
Self-man assessment
Self-man resources
Collaboration on decisions
Guidelines to patients
For patients
For community
Source: Pearson, M. et. al. Chronic Care Model Implementation Emphases, Rand Health Presentation to Academy Health Meeting, 2004
29© www.bhtinfo.com
Who Wrote This Statement?
“The literature has correctly indicated that the term ‘care coordination’, which is often used interchangeably with the term ‘care management,’ refers to a variety of activities. – managing the transition of care across settings– use of patient registries to allow for population-based
care protocols, the – use of frequent follow-up with patients to promote
treatment plan compliance and to obtain healthcare data – use of clinical practice guidelines, including feedback to
the physician regarding their degree of compliance with the guidelines
– teaching of disease self-management skills to patients....”
30© www.bhtinfo.com
• Was it written by a DM company? a home health agency? a health plan?
• No, it was written by...doctors!– Source: American College of Physicians Position Paper,
Reform of the Dysfunctional Healthcare Payment and Delivery System, April 2006
• ...and here's the punch line: “These care coordination activities are at the
core of what defines a primary care physician.”
31© www.bhtinfo.com
The Cats are Herding: the Medical Home Model is Gaining Momentum With Physicians...
32© www.bhtinfo.com
...and Congress...
• December 2006 – Congresses passed the Medicare Medical Home Demonstration (MMHD)
• MMHD similarity to MHS: high cost, chronic patients; multiple comorbidities
• MMHD differences from MHS– No requirement of 5% guaranteed savings– Physicians can keep 80% of savings
• An RFP for the MMHD will be issued early in 2008
33© www.bhtinfo.com
...and payers....
34© www.bhtinfo.com
...but there are many details to work out and questions to address.
• How will a MH be defined, recognized (e.g., see NCQA’s program), and measured?
• What should payment levels be for the MH?• Will physicians invest time and $$ to participate?• Will physicians change behavior and workflow?• Will physicians want to collaborate with payers?• Will the Medicare Medical Home Demo be
successful?• Will other pilot projects prove successful?
35© www.bhtinfo.com
The Medical Home Model – Paying for Technology and Process Improvement
• Proposed payment framework for the medical home model includes $$ for:– coordination of care – health information technology – secure e-mail and telephone consultation;– remote monitoring of clinical data using technology.
36© www.bhtinfo.com
MAKE, ASSEMBLE, BUY? Fewer are buying as health
management becomes increasingly strategic.
37© www.bhtinfo.com
Health Plan Views Of the DM Make/Buy/Assemble Decision Have Evolved
• 7 years ago– "DM is really complicated"– "It will take us 18 months to get started"– "Start up cost are significant“– “Let’s buy”
• Today– "DM isn't rocket science; we've learned from the
vendors"– "Care management is increasingly strategic; it is a core
competency that we need to do ourselves"– "We'll get better integration if we do it ourselves;
medical management workflow software is key”– “We need to assemble DM components and make sure
that we keep control over key leverage points”
38© www.bhtinfo.com
39© www.bhtinfo.com
Health Plans Moving From ‘Buy’ to ‘Build’ DM Model
Disease Management News, September 25, 2006
40© www.bhtinfo.com
Is the Trend Toward “Assembling” a Major Threat to DM Companies?
• Not really.• Remember...the market potential for DM is $30+
Billion. There’s a lot of growth to go around.
41© www.bhtinfo.com
TECHNOLOGY: DM in your home and your pocket.
Health care anywhere.
42© www.bhtinfo.com
Tech Megatrends
A. The Full Rollout of DM Technology Will Take TimeB. Technologies are ConvergingC. The Healthcare Unbound Market Opportunity Is Huge (Forrester)D. 2008 Could Be A Breakout Year for Remote Patient MonitoringE. Watch for New Platforms Facilitating Interoperability &
Transportability• Personal Health Records (PHRs)• Corporate efforts – Microsoft HealthVault, Google Health, Dossia• Mobile/wireless apps• Hospital At Home
F. Next Generation Technology – “You Ain’t Seen Nothing Yet”G. Will The DM Community Be Leaders Or Laggards In the March
toward Interoperability?
43
© www.bhtinfo.com
A) The Full Rollout of DM Technology Will Take Time
Diseases/conditions
x
Value propositions
x
Technologies
x
User environments
=
Thousands of Potential Applications
Do the Math.
44© www.bhtinfo.com
B) Technologies are Converging
CONSUMER TECH
INFRASTRUCTURE
Internet
Smart houses
Personal communications devices -- PDAs, cell phones, etc.
Broadband -- cable, DSL, satellite
Digital cameras, video
Wireless -- 802.11, Bluetooth, RFID, etc.
Voice recognition
etc.
eHEALTH APPLICATIONS Electronic Health Records (EHRs)
Personal Health Records (PHRs)
Remote patient monitoring
Fitness/wellness/prevention
Self care support
Physician/patient secure messaging
Home telehealth/telecare
Decision support systems
e-Prescribing
e-Disease Management
e-Clinical Trials
Predictive modeling
Computerized Physician Order Entry
Quality evaluation web sites
Patient reminder systems
etc.
45© www.bhtinfo.com
Focal Points for ConvergenceHome Networks, Smart Phones, EHRs
PHR/EHRSmart
Phone
HomeNetwork
CONSUMER eHEALTH
Role of IT in Disease Management
Patient Facing
DM Provider Facing
Patient-provider communication tools (IVR, email)
MonitorEngage Intervene
Educate, Coordinate, TreatIdentify, Validate, Stratify, Enroll
Call center
Personal Health Record
Predictive modeling
Remote monitoring (biometric, tele-monitoring)
Personal assessment tools
(HRA)
Educational tools (websites, audio library)
Electronic Medical Record
Decision support tools (CDSS)
Outcomes, Feedback, Follow-up
Clinical integration tools
Disease registry
C) Forrester says “$34 B Market for Healthcare Unbound Technologies by 2015”80% is Chronic Care
$0
$10
$20
$30
$40
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
ADL/elder Chronic Acute
Total
Acute
Chronic
ADL/elder $0.35
$US(billions)
$0.37 $0.47 $0.59 $0.73 $0.98 $1.2 $1.6 $2.0 $2.4 $3.0 $3.7
$0.10 $0.13 $0.22 $0.38 $0.65 $1.2 $3.8 $12.1 $23.1 $26.3 $25.7 $26.7
$0.00 $0.00 $0.00 $0.00 $0.01 $0.02 $0.65 $2.0 $3.6 $3.5 $3.0 $3.2
$0.45 $0.50 $0.69 $0.97 $1.4 $2.1 $5.7 $15.7 $28.7 $32.3 $31.7 $33.6
(Numbers have been rounded)
48© www.bhtinfo.com
D) 2008 Could Be A Breakthrough Year For RPM
• Continua begins to address major challenges– Interoperability of devices– Pricing (indirectly)
• But other challenges remain– IT/integration– Reimbursement/business model– Licensure/regulatory issues
49
Promoters
50© www.bhtinfo.com
The Multiparameter Remote Patient Monitoring (RPM) Market is Migrating...
• From– High unit prices rooted in the industry's early focus on medical
device markets and business models
– Proprietary devices, proprietary IT, non-interoperable data
– Low unit volume, moderate margins per unit
– Competition based on vendor lock-in through high switching costs
• To:– Low unit prices as the technology evolves toward consumer
markets and consumer business models
– Intereroperable devices, common IT platforms, and interoperable data
– High unit volume, low margins per unit
– Competition based on value-adds and service
51
© www.bhtinfo.com
...but Consider the Systemic Barriers
• Reimbursement• HIPAA: Privacy/confidentiality issues• Physician workflow• Technology maturity
– Infrastructure– Bandwidth– Interoperability/Standards– Friendly user interfaces
52© www.bhtinfo.com
E) Watch for New Platforms and Networks Facilitating Interoperability & Transportability of
Personal Health Information
“The sine qua non is sharing data” Adam Bosworth, former director of Google Health
• Personal Health Records• Corporate efforts – Microsoft Health Vault,
Google Health, Dossia• Mobile/Wireless Applications• Hospital at Home
53© www.bhtinfo.com
PHR Background
• 2 models of PHRs– Stand alone– Tethered: typically to a health plan, provider, employer
• Each has challenges• The “populating the PHR with data” problem• 200 PHRs on the market• Generations of PHRs
– 1st generation: PHR as “APPLICATION” -- an online repository of personal health information (PHI)
– Next generation – PHR as PLATFORM
54© www.bhtinfo.com
Source: Markle Foundaton A Common Framework for Networked Personal Health Information, 2006. See also: RWJF Project HealthDesign A New Vision for Personal Health Records, May 2007
55© www.bhtinfo.com
Microsoft HealthVault – Launched October 2007
More info: Microsoft’s HealthVault: User Manual = C-, Strategy to Create a New Ecosystem = A
56© www.bhtinfo.com
Watch for Google Health in 2008
More info: Connecting the Dots…Google Health Promises to Create AND Dominate Next Generation PHRs
57© www.bhtinfo.com
Watch for QUALCOMM’s Mobile Platform (LifeComm) in 2008
More info: Disease Management Going Mobile & Retail: QUALCOMM’s Health Care MVNO
58© www.bhtinfo.com
The Value Proposition of Mobile Technology for DM is Huge!
Chronic Disease/Condition Management is migrating– From a clinical based model – Toward a behavior change model
How can you optimize behavior change without 24x7x365
connectivity to the patient?
Hospital at Home (HAH) Dates Back to the 1960s – Almost Completely Outside the U.S.
60© www.bhtinfo.com
The Most Significant U.S. HAH Initiative is at Johns Hopkins
61© www.bhtinfo.com
Current Tech & Apps are a Collective Platform to Support HAH
• EHRs• Telemedicine• Niche apps • Remote Patient Monitoring
• Disease Management• Personal Health Records• Mobile telehealth• Health 2.0• Etc
Hospital At Home
62© www.bhtinfo.com
F) The Next Generation of DM TechnologyWhen the Technology is Just “There”
“Ubiquitous Health”
“Sense and Simplicity”
“Pervasive Computing”
63© www.bhtinfo.com
G) Will the DM community be leaders or laggards in the movement for health information technology
interoperability?
64© www.bhtinfo.com
BEHAVIOR CHANGE: DM is moving from a medical to a
social model; behavior change has become the Holy Grail.
The Holy Grail: Changing behavior to prevent disease
Behavioral Risk Factors
ChronicCHF
Clinical Risk Factors
Our Future1994-98 1998-2002 Current
Interactive Data Systems
• All of the above plus more real time two way remote interaction between pts., disease managers, and MDs (e.g. interactive TV, implantable devices, PDAs, cell phones, other wireless technologies)
Copyright © LifeMasters Supported SelfCare Inc. 2004 All Rights Reserved.
66© www.bhtinfo.com
Behavior Change in a Nutshell
• More than 50 years of research on health behavior change has not provided us with easy answers in understanding patient nonadherence.
• Despite the renewed interest in adherence research, we have a long road ahead in translating behavior change principles into practical application.
• Actionable messages are critical to success. – When physicians and other health care professionals use their
referent power they can be influential in patient adherence....higher patient adherence is associated with physicians who create warm personal relationships with their patients, and work with them to address adherence and lifestyle issues.
– Expanding referent power beyond physicians to patient-affiliated reference groups may be challenging to DM, but it may increase the influence of adherence messages exponentially.
Source: Turpin, R. et. al. “Patient Adherence: Present State and Future Directions”
Disease Management, December 2007
67© www.bhtinfo.com
CLINICAL AND ECONOMIC ROI: Round one is over, DM wins;
Round 2 has just begun.
68© www.bhtinfo.com
The DM/ROI Debate Of the Past 10 Years Has Not Always Been Framed Constructively
“DM has ROI”
“No it doesn’t”
“Yes it does”
“No it doesn’t”
“Jane, you ignorant slut”
69© www.bhtinfo.com
Reframing the DM/ROI Debate:2 Seemingly Contradictory Statements
#1: Whether DM provides ROI has become irrelevant
#2: The DM/ROI debate will continue to be scientifically evaluated for the next decade
70© www.bhtinfo.com
#1: The DM/ROI Debate Has Become Irrelevant DM Has Gone Mainstream
71© www.bhtinfo.com
#2: The DM/ROI Debate Will Continue To Be Scientifically Evaluated For The Next Decade
• #1 = DM today• #2 = Continuing DM ROI and outcome measurement for the
future
No evidence
Preponderanceof
Evidence
Beyond AReasonable
Doubt
Clear andConvincingEvidence
AbsoluteCertainty
0 100
Level of Proof
•Source: With attribution to Gordon Norman, MD, MBA, Chief Medical Officer of Alere
#1 #2
72© www.bhtinfo.com
Will We Ever “Get Along” and Measure Outcomes and ROI Consistently?
• In 2006, DMAA released the first volume of its long-awaited Outcomes Guidelines Report, which described industry consensus approaches to measuring financial outcomes in disease management.
• In 2007, a follow-up document, the Outcomes Guidelines Report Volume II, added clinical measures.
• In 2008, a third volume of the report is planned for publication.
• These are significant steps...but don’t expect the debate AND controversy about ROI to end soon.
73© www.bhtinfo.com
WILDCARDS!
74© www.bhtinfo.com
Watchful Waiting....
• Will employers stay the course in supporting DM?• Can pay-for-performance P4P initiatives align
incentives?• Will retail clinics start doing DM in a big way?• Can U.S. style DM be exported to international
markets?• Will Consumer Driven Health Plans (CDHPs) be
the spark to ignite a consumer model of chronic disease management?
• How will the 2008 elections affect health policy? While DM has received bi-partisan support, dramatic system reforms (e.g. physician reimbursement) are possible.
75© www.bhtinfo.com
APPENDIX ABetter Health
Technologies, LLC
76© www.bhtinfo.com
Better Health Technologies, LLC
• Technology and health care delivery are shifting: – From: Acute and episodic care delivered in hospitals
and doctors’ offices– To: Chronic disease and condition management
delivered in homes, workplaces, and communities
• BHT provides consulting, business development, and speaking services to assist companies in: 1) Understanding the shift 2) Positioning – what’s the right strategy, tactics, and business model? 3) Integrating your offering into the value chain – what are the right partnerships?
77© www.bhtinfo.com
BHT ClientsPre-IPO CompaniesPharos InnovationsHealthPostCardiobeat EZWebSensitronLife NavigatorMedical Peace Stress Less DiabetesManager.com CogniMed Caresoft Benchmark Oncology SOS Wireless Click4Care eCare Technologies The Healan GroupFitsenseElite Care Technologies
Established organizationsIntel Digital Health GroupSamsung Electronics, South Korea -- Global Research Group -- Samsung Advanced Institute of Technology -- Digital Solution CenterAmedisysMedtronic -- Neurological Disease Management -- Cardiac Rhythm Patient ManagementSiemens Medical SolutionsPhilips ElectronicsJoslin Diabetes CenterGSKDisease Management Association of America PCS Health SystemsVarian Medical SystemsVRIWashoe Health SystemS2 SystemsCorpHealthPhysician IPACentocor