Bringing Health Care to the World – What Does the Future Hold? Ogden Surgical-Medical Society 74 th Annual CME Conference – Bringing Healthcare to the World 2019 Shepherd Union Building, 3 rd Floor, 3848 Harrison Boulevard, Ogden, Utah Wednesday, 15 May 2019 – 11:00a - 12:n Brent C. James, M.D., M.Stat. Quality Science
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Bringing Health Care to the World –What Does the Future Hold?
Ogden Surgical-Medical Society
74th Annual CME Conference –Bringing Healthcare to the World 2019
Shepherd Union Building, 3rd Floor, 3848 Harrison Boulevard, Ogden, UtahWednesday, 15 May 2019 – 11:00a - 12:n
Brent C. James, M.D., M.Stat.Quality Science
SQ cienceuality
Disclosures
I receive a monthly retainer as a part time
(3 days / month) senior advisor for Health Catalyst.
Other than that, neither I nor any family
members have any relevant financial
relationships to be directly or indirectly
discussed, referred to or illustrated within the
presentation, with or without recognition.
SQ cienceuality
The basis for variation research:
Apply rigorous
clinical research measurement methods(think “statistics”)
to
routine care delivery performance(that is, to quality of care)
SQ cienceuality
The opportunity (care falls short of its theoretic potential)
1. Massive variation in clinical practices (beyond
even the remote possibility that all patients receive good care)
2. High rates of inappropriate care (where the risk of
harm inherent in the treatment outweighs any potential benefit)
3. Unacceptable rates of preventable care-
associated patient injury and death
4. Striking inability to "do what we know works"
5. Huge amounts of waste, leading to spiraling
prices that limit access to care
James, B.C. Testimony to the U.S. Senate Finance Committee, February 2009
SQ cienceuality
The waste opportunity is HUGE
30-50+% of all health care resource
expenditures are
quality-associated waste:
• recovering from preventable foul-ups
• building unusable products
• providing unnecessary treatments
• simple inefficiency
Institute of Medicine Roundtable on Value and Science-Driven Healthcare. The Healthcare Imperative:
Lowering Costs and Improving Outcomes. Yong, Pierre L., Saunders, Robert S., and
Olsen, LeighAnne, editors. Washington, DC: National Academy Press, 2010.
SQ cienceuality
We know why this happens
SQ cienceuality
Why? The collision of 2 forces:
(1) Continued reliance on the "craft of medicine" (clinicians as stand-alone experts; “best care” = “personal excellence”)
encounters
(2) Complexity; a.k.a. clinical uncertainty(the fruits of 100 years of clinical discovery, that changed the
nature of clinical practice – the ground shifted under our feet)
in the context of
(3) Low clinical transparency at a process level
(relatively poor data makes it difficult to causally link
treatment to outcome in routine care delivery)
SQ cienceuality
The craft of medicine
placing her patient's health care needs before any other end or goal,
Drawing on extensive clinical knowledge gained through formal education and experience
An individual physician
can craft a unique diagnostic and treatment regimen
customized for that particular patient.
This approach guarantees the best result possible for each patient.
Note: For green arrows, savings from waste elimination accrue to the care
delivery organization; for red arrows, savings go to payer organizations.
Case-rate utilization(# cases per population)
Within-case utilization(# and type of units per case)
Efficiency(cost per unit of care)
FFS Per
case
Provider
at risk
WASTE REMOVAL
LEVEL
PAYMENT METHOD
1.
2.
3.
% of all
waste
45%
40%
15%
James Brent C and Poulsen Gregory P. The case for capitation: It’s the only way to cut wastewhile improving quality. Harv Bus Rev 2016; 94(7-8):102-11, 134 (Jul-Aug).
SQ cienceuality
What does the future hold?
Walter Gretzky (Wayne Gretzky’s father):
Skate to where the puck is going to be, not where it has been.
SQ cienceuality
“Pay for value” continues to grow
Forward looking indicators:
➢Kaiser Permanente (continued rapid growth within
existing geographic markets, mostly)
➢Medicare Advantage (continued rapid growth)
➢ACOs (Leavitt Group; mostly commercial)
➢ERISA direct to provider contracting(11% of large employers, according to Modern Healthcare)