Blue Cross Blue Shield of Michigan and Blue Care Network of Michigan are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association.

Consumer Centric Healthcare

Leo BarellaVP EIT- Data Intelligence

Blue Cross Blue Shield of Michigan

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“There is nothing more difficult to take in hand …. than to take the lead in the introduction of a new order of things.

Because the innovator has for enemies all those who have done well under the old conditions, and lukewarm defenders in those who may do well under the new. This coolness arises partly from fear of the opponents, who have the laws on their side, and partly from the incredulity of men, who do not readily believe in new things until they have had a long experience of them.“

- Nicolo’ Macchiavelli

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Trial & Error Pattern Recognition Cause & Effect

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Pattern RecognitionTrial & Error Cause & Effect

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Two Thousand Years Ago….

“It is far more important to know what person the disease has than what disease the person has,”- Hippocrates

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The Old Paradigm: Treatment of Disease

Time

Dis

ease

Sev

erity

Reactive Medial Care

Diagnose Disease: Treat Symptoms; Costly, Trial and Error Treatment

Diagnosis

Select Drug

Switch Drug

Switch Drug Again

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How Do We Decide That a Drug “Works”

CURE

NO EFFECT

SIDE EFFECT

SERIOUS SIDE EFFECT

CURE

NO EFFECT

SIDE EFFECT

SERIOUS SIDE EFFECT

A

B

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Major Drugs Ineffective for Many

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Ineffective Therapies Can Cause Harm

Adverse Effects• Estimated 125,000 deaths per year (in 2014)

• 6th leading cause of death in the US

• Experienced by approximately 7% of patients (2.2 million) per year

• Medication-related health problems account for an estimated 3-7% of hospital admissions (Pirmohamed M, et al 2004)

• During their hospital stay, 15% of patients experienced adverse drug reactions (Davies, et al 2009)

• Increased patient non-compliance

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Google answers to anything

The Consumerism Megatrend

Implications on Healthcare

Americans Want Control

Control TV programming with TiVo

Seek employment through LinkedIn

Keep personal videos on Facebook

Maintain their music with iTunes

Buy & sell goods through eBay

Purchase stock over the internet

Bank electronically at ATMs

They don’t want limits, restrictions, waiting lines, or other barriers to their health

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Videoconferencing for follow-up visits

Self-monitoring device to check condition & send information to DR. electronically

Videoconferencing for sick visits

App that enable access to medical records & treatment information

App to set & track progress towards health improvement goals

App that reminds you to take medication

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Social Provider

Media Blog

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Social Provider

Media Blog

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$4,000

$79

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$100,000

$5,000

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Personalized Medicine

“Products and Services that leverage the science of genomics and proteomics (directly or indirectly) and capitalize on the trends toward wellness and consumerism to enable tailored approaches to prevention and care.”

PricewaterhouseCoopersThe new science of personalized medicine

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Cost Per Genome

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BENCHTOP GENOME CENTER

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Effective, Efficient Health Management

Time

Dis

ease

Sev

erity

Predisposition Screening

Diagnosis/Prognosis

Right Drug Monitoring

Efficient Medial Care

Health Management; Molecular Screening, Early Detection; Rapid Effective Treatment; Improved Quality of Care

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New Data Streams, Including Those Direct From Patients, AreBeginning to be Used by Companies for Predictive AnalyticsSO MUCH DATA

Percentage of venture-backed predictive analytics companies using various types of data (2011-Q3 2014)

SAM HO, M.D.Chief Medical Officer, UnitedHealthcare

“Current data sets generally revolve around claims but that’s going to be changing with lots of clinical data and transactional information with lifestyle becoming more readily accessible”

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Personalizing Care Through Predictive Analytics Represents a Significant Opportunity to Reduce Costs in the Healthcare System

$192B

OVERTREATMENT

• Eliminating care that cannot help patients – care that outmoded, supply-drive, and eschews science

• Restricting treatment and intervention to the patients who will benefit based on the individual and the context

$128B

FAILURES OF CARE DELIVERY

• Continuously studying care to identify what works for whom and in what context

• Scaling best practices including preventive care and early warning systems that demonstrate effectiveness

$35B

LACK OF CARE COORDINATION

• Ensuring those at the highest risk of costly medical episodes are

identified, monitored, and cared for between

visits and following hospitalization

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Actionable lifestyle prescription for reducing risk of disease

Greater control & patient-centered access to medical records

Treatment decisions will be improved by patient education

Greater knowledge of one’s genetic risks

Changing Role of the Consumer (Patient)

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New ethical & legal issues/quandaries

Greater reliance on HIT for decision support

Improved care through use of aggregate patient data

Highly networked, team based care

Physician as manager, rather than repository of medical knowledge

Changing Role of the Health Care Provider

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Regulatory mandates could disrupt development budgets & market plans

“Personalization” of drugs will require partnering with diagnostics companies

Uncertain economics of drug development & commercialization

New Business Strategies for Pharma

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Increased need to demonstrate cost efficiencies

Proactive strategies to limit reimbursement

Increased pressure to change paradigm towards preventive medicine

Greater emphasis on clinical validity & utility of diagnostic tests

New Demands On and From Payers

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The Consumerism Grid

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IT Evolution Compared Healthcare

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The Evolution of Healthcare Consumerism Generations of Consumerism

HIGH IMPACT

Traditional Plans

Traditional Plans With Consumer Information

1st Generation

High Deductible

Plans

2nd Generation

Focus on Behavior Changes

3rd Generation

Health & Performance

4th Generation

Personalized Health &

Healthcare

5th Generation

Community Health &

Healthcare

LOW IMPACT

Behavioral Change, Improved Health, & Lower Cost Potential

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The Promises of Consumerism Major Building Blocks of Consumerism

Personal Care Accounts

Health Management

Condition Management

Health Literacy

Incentives & Rewards

The Promise of Demand Control & Savings

The Promise of Wellness

The Promise of Health

The Promise of Transparency

The Promise of Shared Savings

It is the creative development, efficient delivery, efficacy, and successful integration of these elements that will prove the success or failure of consumerism.

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The Consumerism Grid

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Personalized Medicine: Impacts Care

~ 38 types of Leukemia

~ 51 types of Lymphomas

“Disease of the Blood”

Lymphoma

Leukemia

Aggressive Lymphoma

Indolent Lymphoma

Chronic Leukemia

Acute Leukemia

Preleukemia

5 Year Survival ~0% 70%

Ries LAG, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L, Mariotto A, Feuer EJ, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2002, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2002/ Based on November 2004 SEER data submission, posted to SEER web site 2005

Source: Mara G. Aspinall, former President, Genzyme Genetics

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It Will Largely Fall Onto the Healthcare Industry to Recognize the Value of Predictive Analytics and Implement Critical Use Cases

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Beyond Regulation, the Biggest Risk to Predictive Analytics Being Used in Healthcare is Adoption as Power Dynamics Shift

Our question: Can user experience and design influence decision making so deeply as to be regulated?