Embed Size (px)
Citation preview
Harnessing Population Health
Management to Promote Quality
Improvement in Healthcare
Judy Murphy, RN, FACMI, FHIMSS, FAAN
Chief Nursing Officer
IBM Global Healthcare & Life Sciences
Slide 2
What we will cover:
– Evolving healthcare landscape – what is changing and why
we need to change too
– Population Health Management
– Reimagining Health and Healthcare with Mobile
– Population Health Management requires Patient Engagement
– Emerging Consumerism and eCommerce
– The Need for Analytics
– The Era of Cognitive Computing (Watson)
Healthcare transformation is happening, driven by
fundamental shifts in expectations and critical drivers
Expectations for better
quality, value and
outcomes
Escalating incidence and
cost of chronic disease
Changing demographics
and lifestyles
Globalization of health
care
Critical resource
shortages
Increased competition
and new entrants
Advances in
technologies
and treatments
Slide 3
Old Healthcare New Healthcare
Fee for service Pay for performance
Volume Value
Delivery Quality Outcome
Employer-centric Consumer-centric
Prices unknown Cost transparency
One way dialogue Engaged & mobile
Transactional Brand loyal
Data poor & disconnected Integrated rich “big” data
Reactive Predictive & prescriptive
Standards Personalized & optimized
This transformation is an evolution … to a new model for healthcare
Slide 4
Healthcare is moving to a system focused on value,
coordinated around the individual,
and integrated into our communities
Focus is on value,
coordinated around the
individual and integrated
into communities
Emphasis is on proactive
care to meet health needs
Payment will be based on
value and outcomes
Care is standardized
according to evidence-
based guidelines
We measure quality and
make rapid changes to
improve it
Data and Information
Understand and
influence their
populations
Evidence-based and standardized care planning
Coordination across boundaries -- share care, accountability and risk
Individual engagement and empower- ment
Quality measurement and performance reporting
Social Worker
Behavioural Health
Family
Community
Pallative Care/
Hospice
Rehabilitation
Home Care
Specialists Intensivist
Physical Therapist
Dietician
Case Manager
Caregivers
Transportation
Housing
Medications
Funding and
Payment
Primary
Care
Slide 5
The new model is Value Based Care –
centered around the patient
Value = Experience Cost
Taking steps to achieve better results, and improve customer (patient) satisfaction
Reducing waste, reducing errors, managing risk, improving efficiency and quality
Organizations are on a journey to improve value
Slide 6
Population Health Management
HEALTHY / LOW RISK
CHRONIC
AT RISK
ACTIVE DISEASE
No or very-low touch
Medium to high touch
Low touch High
touch
40-60% 5-15% 20-25% 2-3%
60+
5-10% 30-40% 15-20% 40-50%
RISK
STRATIFICA
TION
POPULATION
RELATIVE
COST
ENGAGE
MENT
Fully automated
Validate from data
Blended -
retail outlet,
care mgt,
automated
Mostly automated
with email, call,
text, mobile app
Active
Case
Mgmt OUTREACH
Capability Needs
• Data (internal-external)
• Scalable platform/data
management
• Risk analytics &
management
• Insight analytics
• Similarity analytics
• Cost of care analytics
• Actuarial analytics
• Marketing analytics
• Marketing management
• Predictive modeling /
next best action
• CRM
• Campaign management
• Outreach advisor
• Remote data capture
• Mobile apps
• Network analytics
• Care coordination tool/
clinical integration ~20% of population
drives ~80% of cost
ENTIRE
POPULATION
Slide 7
Reimagining Health &
Healthcare with Mobile
Slide 8
Mobile is being exploited to:
Facilitate anytime anywhere access to data and extend services beyond traditional settings
Develop new engagement techniques and health strategies with patients and consumers
Gain insights to provide more personalized, proactive interventions; bring analytics to the point of care
Slide 9
Imagining Care Anywhere
https://www.youtube.com/watch?v=UOMtWFeyscg
Slide 10
The Power of Patient Engagement:
Population Health Management requires Patient Engagement
Capture and incorporate
preferences
Personalize offerings
and services
Innovate to deliver quality,
convenience and total
experience
“Know me”
“Engage me”
“Empower me”
• What’s my history?
• What are my preferences?
• How will I respond?
• What will motivate me?
• Respect my privacy
• Engage in the preferred dialog
• Be relevant (“right information”)
• Be consistent across touch points
• Show sincerity -- “you care”
• Give me the information I need
• Connect me with relevant communities
• Simplify control and access
• Enable action and convenience
Slide 11
Trends Supporting Greater Patient Engagement
The way we pay for and deliver care is changing.
Health IT adoption has reached a tipping point.
Technology is getting better, cheaper, faster and more ubiquitous.
Consumers increasingly expect online engagement, in all aspects of their lives.
Slide 12
Integration of health in our lives
https://www.youtube.com/watch?v=-zh9fibMaEk
Slide 13
So what is driving “Consumerism” in healthcare?
Source: Healthcare Payer News, May 2014
• Cost shifting – “out of
pocket” costs are
increasing for individual
healthcare consumers
• There is an increase in
the use of High
Deductible plans and
Health Savings Accounts
(HSAs), leading to more
consumer price sensitivity
Slide 14
New business models for delivering care are emerging, providing people with more “choice”
Slide 15
Health Plan Engagement App Demo
https://www.youtube.com/watch?v=brtucoXRbTA
Consumer “Shop & Buy” activities
Slide 16
Successful healthcare organizations thrive by using analytics
as a core strategic foundation
Early and accurate insights on member
health risk and utilization to inform
Financial / Actuarial decisions
Patient-360 insights to inform Medical Management in
chronic disease & episode
management
Insights into referral patterns and
provider quality to support Network
Design and Management
Inform program design & operations for Marketing &
Sales and Customer Service with insights on consumer preferences &
triggers
Population Health
Risk Management
Consumer Engagement
Provider Relations
Su
pp
ort
B
usin
ess
F
un
cti
on
s
Imp
act
Co
nti
nu
um
of
Care
Sample Analytics Applications
Facilitate insights exchange &
messaging across care team members. Inform
incentives design.
Enabling analytics to empower ACOs and
providers to succeed in value-based payment transformation
Next best action analytics leveraging
real-time data to optimize omni-
channel consumer engagement
Provide tools to providers to enhance risk
stratification and clinical decision
making
Care Path Mining
Network Optimization
Personality Insights
Consumer Segmentation
Risk Stratification
Utilization Prediction
Cost Patten Detection
Channel Optimization
Resource Allocation
17
Slide 17
What is the optimal
treatment based on the
latest literature for my
patient’s clinical profile?
Why is this the best
protocol?
Basic
Reporting
What happened?
When and
where?
How much?
Foundational
Analytics
Who is at risk? What is happening? How can we improve? What is the Right
Data? What actions to take?
Enterprise –Wide Data Insights Retrospectiv
e Reporting
Proactive Interventions and Improved Outcomes
Data Governance
Centralize Data
Structured and Unstructured
Data Sharing
Cost of Care Intelligence
High latency reporting
Spreadsheets
Limited view reports
Dept data marts
Population Health
Analytics
Evidence-based
medicine
Streaming Analytics
Similarity Analytics
Natural language
understanding
Guided consumer
experience
Watson Applications
Clinical Content Analysis
Personalized Healthcare
Dynamic Learning for Optimal Care Guidance
Predictive &
Prescriptive
What will happen? How can we pre-empt? What is the likely outcome? Who
would be best at managing this
patient?
What is the expected response
to potential medications?
Cognitive The Healthcare Analytics
Journey
18 Slide 18
Published
Knowledge
WATSON
Patient Care
and Insights
Knowledge-Driven Methods Data-Driven Methods
Observational
Data
Longitudinal health records
Claims data
Patient reported data
Scientific papers
Books
Guidelines
Patient Similarity Analytics
Identification
of evidence-
based best
practice
From population averages … To insights for individual patients
Analytics strategy must span both knowledge & data-driven methods
19 Slide 19
Trusted Information Platform
Predictive
Dashboards
Natural Language
Cognitive Computing
‘Big Data’ Volume, Velocity, Variety…
Patient Similarity
Healthcare Analytics Progression
Slide 20
Watson is ushering in a new era of computing
1900 1950 2011
Slide 21
Cognitive Systems Era
Discover and Decide
Interact Naturally
Learn and Reason
Slide 22
Watson May Help Beat Cancer
Slide 23
https://www.youtube.com/watch?v=E7wpFfEqE1k
