TAG Luncheon: Center for Innovation

TECHNOLOGY ALLIANCE GROUP

MARC PIERSON, MDPEACEHEALTH

Where we are going today:• CONTEX & CHANGES IN HEALTHCARE LANDSCAPE

– Changing financial incentives—How big an effect?• HISTORY OF HEALTH CARE INNOVATION WHATCOM

– CHR, HInet, Shared Care Plan, HIE– PURSUING PERFECTION

• Patient voice: Nav-Coach, SCP, Education & Training• Systems Dynamics Model

• INSIGHTS & OPPORTUNITIES for INNOVATION– Whatcom Alliance for Healthcare Advancement– P4Mi (Innovations in Biology & Behavior)

• Innovations in Systems Biology– Predictive and Preventive

• Innovations in Social Psychology– Personalization & Participation

– Innovation Ecosystems and SW Platforms--for Commercialization• On open opportunity

TAKEAWAYS

• Whatcom County is uniquely positioned today.• Medical business model is changing—creating

new technical opportunities• Technology needs &opportunities:

– Support individual behavior change• Use gamification: PERMA• Work for health both outside medicine and with the

medical system

– Support rebirth of vibrant neighborhoods

THE PROBLEM• COSTS are the highest in the world

– 2X Europe, Canada, Australia– Taking public funding from education– Putting US businesses at a severe disadvantage globally– Unsustainable

• POPULATION HEALTH has not been a major focus– 37th in the World– 5% of the money directed at 85% of the opportunity

• NOTE: NW US is more cost effective and higher quality than rest of the US but works under the same perverse incentives.

OURFUTURE

How to get upstream of illness?

WHATCOM--THE IDEAL PLACE & TIME forSYSTEMS INNOVATION

• Technology• Organization of healthcare delivery system

– With aligned incentives!• Public Health & Government• Systems Biology• Systems Medicine• Resilient Schools• Resilient Workplaces• Neighborhoods?

The Good News—A Technology Opening

• Historical focus on Consolidated-Monolithic organizations– Enterprise level transactional and analytical software

• Widening of focus -- include individual customers• New Opportunity for Application Development

– Congral’s Shared Care Plan Platform• Collection of personal data• Connection of all relevant actors• Coordination of action• Integrated with MS HealthVault (home monitoring, labs, meds, etc.)

– Supported Behavior Change (“compliance”)• “Games”, Gamification, PERMA, Jane McGonigal, SuperBetter

– Big Data• Todd Park, HealthData.gov & Overview Presentation

– Mobile health

http://www.healthdata.gov/

http://www.slideshare.net/fullscreen/HHS-HealthData/health-data-initiative-starter-kit/3

THE KEY--Activated “Patients”

• The Critical Missing Players are:– Activated students– Activated workers– Activated patients– Activated citizens & families?

• What applications will help these actors be more successful?– SUPERBETTER?

http://www.superbetter.com/

The Bad News—Uncertainty about:

• Timing and location of the openings?– Innovation ecosystem matchmaker?

• Business relationships?• Access to healthcare delivery system?

• Interoperability with enterprise systems?– HealthVault certainly helps

• Customers for the applications?– Who benefits?– Who pays?

3 Big Changes

1. Baby boomers + Financial Crisis + Global Competition for Labor– ->Payment Reform

• From visits and procedures toward “Accountable Care”, Triple Aim

• 1) Population health, 2) Per Capita Cost, 3) Experience of Care

2. Networked & Activated Consumers– Global digital communication & information

3. Bioscience promise– Massive amounts of personal biologic data– Affordable, personal, trended data (4Ps)

TURNING POINT

(2001-2006)

--Accidentally through the eyes of “Patients”

• RWJF & IHI for 5 Years, @ $30M X 2• Europeans joined• Voice of Patients / Clients / Citizens changed the

possibilities dramatically• Three big ideas:

1. Navigator-coaches2. Web based personal health management platform3. On-going education and training of clients, often by

clients• Show stopper: Non-alignment of financial incentives

(winners and losers)

Redesign US Health Care System

SOURCE: We Can Do Better — Improving the Health of the American People,” Steven A. Schroeder, M.D., New England Journal of Medicine, 2007, page 1222.

The Case For More Active Policy Attention To Health Promotion, Health Affairs, 2002;21:78-93McGinnis

Proportional Contribution to Premature Death in USMORE THAN

MEDICINE IS NEEDED

http://www.nejm.org/doi/full/10.1056/NEJMsa073350







http://content.healthaffairs.org/content/21/2/78.full.html

Health & Wellness Require Social AND Technological Innovation

Peop

le in

Rel

ation

ship

Tec

hPractices (habits)

New Behaviors

Commitments

Conversations

Communication

Information

Data/ToolsPr

edic

tion

Prev

entio

n

Pers

onal

ized

Parti

cipa

tion

Resilience Training & Coaching

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Supporting the Communitythrough

Health Information Technology

17

Shared Care Plan, Transitions of Care Module, Care Manager Workstation

A suite of tools for patients, their family caregivers,

and health professionals

The Shared Care Plan, a PHR connected to MS Health Vault, the State Immunization Registry , PH -SJMC EMR and more.

www.sharedcareplan.org

The Transition of Care Module – patient facing, interactive content designed to facilitate what should be happening post discharge, for chronic disease management and prevention.

The Care Manager Workstation – enter discharge or home care instructions, track a panel of patients, see

who needs encouragement and intervention

Transforming Healthcare in Whatcom County

W H ATC O M A L L I A N C E F O R H EA LT H C A R E A C C E S S

L A R R Y T H O M P S O N , E X E C U T I V E D I R E C T O R

T E R E S A L I T T O N , A C O D E V E L O P M E N T M A N A G E R

Health Advancement

Health Advancement

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A community-wide, level 4 ACO

Rippel Foundation: ReThink Health Simulation model of Whatcom County

http://rippelfoundation.org/rethink-health/

Bridge Project Pilot

Dual Eligible Pilot

Dental/Primary Care Integration

Pilot

Advanced Care Planning Initiative

Project Impact: Care Coordination

Phase IIDevelopment Committees

Phase II & IIIPilots and Projects

Transforming Healthcare

Project

Whatcom Community

Health Association/

Steering Committee

Accountable Care

Organization Task Group

Health Home Collaborative

Behavioral Health &

Primary Care Integration Specialty

Provider Task Force

Whatcom Care

Coordination Advisory

Committee

Community Organizing Group for

Health

Health Information

Exchange Task Force

Integrated Health System

Whatcom Community Health Association

Accountable Care OrganizationPerson-Centered Wellness

Transforming Healthcare in Whatcom County

Whatcom Today

HInet: Hardware, Connective Wiring, and Communication/E-mail Platformand

Shared Care Plan: A Portable Community-Wide Personal Health Record

Pharmacies Physician Offices Hospital Systems Other ProvidersMental health, long term

care, Imaging, labs

Other ProvidersPublic Health, Social

Services, EMS

Practice Management Systems


EMR systems (~20)and

Practice Management Systems (~20)



EMR systemsand


EMR systemsand


EMR systemsand


EMR systemsand


Enterprise Information Systems


Care Coordinators

Care Management Systems

Whatcom Community / WCHA

Satisfaction Improvement

Quality Improvement

Cost PerformanceImprovement

ACO—Achieving the Triple Aim


Shared Care Plan: A Portable, Community-Wide Personal Health Record


care, Imaging, labs


Services, EMS







EMR systemsand


EMR systemsand


EMR systemsand


EMR systemsand




Care Coordinators


Health Information Exchange



Quality Improvement






care, Imaging, labs


Services, EMS







EMR systemsand


EMR systemsand


EMR systemsand


EMR systemsand




Care Coordinators



Data Repository: Clinical and Claims DataReceipt and storage of data for look up and analysis



Quality Improvement






care, Imaging, labs


Services, EMS







EMR systemsand


EMR systemsand


EMR systemsand


EMR systemsand




Care Coordinators



Data Repository: Clinical and Claims DataReceipt and storage of data for look up and analysis



Quality Improvement



Analytic Systems: Software and personnel


Shared Care Plan: A Portable, Community-Wide Personal Health Record


care, Imaging, labs


Services, EMS







EMR systemsand


EMR systemsand


EMR systemsand


EMR systemsand




Care Coordinators


P4 Medicine

1.Prediction2.Prevention3.Personalization4.Participation

p4mi.org

http://p4mi.org/

P4Medicine InstituteISB, PeaceHealth, Ohio State University, others to be added

• Applied Genomics• Applied Proteomics• Personal data clouds• Resilience support

– Training– Coaching– Support applications (SUPERBETTER,

positivityratio.com,

TEDxRainier - Leroy Hood - Future of MedicineDanny Hillis talks Proteomics & Personalized Medicine

http://www.superbetter.com/

http://www.youtube.com/watch?v=ZRHcTlCZXrE

http://www.youtube.com/watch?v=r1XrophhA_k%23!

The Network of Networks

Scientists use network paradigms to organize, integrate and model data and enormously increase the signal to noise

Kristin Brogaard

This statement still doesn't make sense to me. Scientist's use networks to organize and integrate...

Kristin Brogaard

There are two different font sizes in the title - need to make them all the same

• Unprecedented levels of education and access to information through the Internet

• Able to self-organize using new social networking tools

• Determined to better understand their own personal health situation / issues

• Able to find innovative solutions for better managing their own health and that of the people they care about

Networked and Activated Consumers

PersonalizedData Clouds

Genomics,Proteomics, etc

Medical history

Demographic

Environmental

Psycho/Social

Data analysis

Systems biology

Social science

Cultural expertise

ActionableInformation

New products

More cost-effectiveuse of existingproducts

Useful information not bundled with product

HealthcareStakeholders

Clinical service Physicians Coaches

Patients/consumers

Discovery scienceInstitutions

Actionable Information

Input Value Added Digital Product Used By

The P4 Innovation Cycle

Advances in Discovery Research

Comprehensive personalized data cloud

Personalized actionable information

New Data re Health outcomes

Improved healthcare

Intellectual Property

• Only a community can– Build a new value network based on monetizing

improved health (WAHA)– Implement new business models– Activate self-sustaining cycle of accelerating

innovation• The early community microcosms

– Whatcom County + P4Medicine Institute– Other NW communities and beyond

It Takes a Communityto integrate technological and social innovation

“PeaceHealth Center for Innovation”

• We have been exploring the possibilities for stimulating or creating a Health Innovation Network or Ecosystem

Big Idea—For LaterA Connected Health (Innovation) Ecosystem

(CHE)

• Components• Locale• Organizers• Funding• Mechanisms

THANK YOU

(360) 739-2728

IDEAS FOR A Connected Health Ecosystem

(CHE)

March 2011

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Connecting Health ventures and regional Health Communities

• The Vision is the Northwest as a leader in Connected Health innovation and commercialization for health and healthcare improvement across all populations

• The Mission is to develop and cultivate an ecosystem to accelerate the development and value of early stage companies

• Complementary goals are regional economic development, job creation, and return on investment

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Opportunity to bring needed Connected Health technology to market faster

• Aging population needs and wants– Doubling of 65+ population; aging in place and independently

• Regional representative demography & health conditions– WA and OR together are representative of the nation’s demographic and health

condition

• Demand from health communities (ACOs)– RWJF “Pursuing Perfection Grant” “Remaking American Medicine” patients as

teachers; Tech4Impact Grants

• Demand from government (ACOs)– Reform; Readmission Penalties; Accountable Care (ACO); CMS, VA and HHS innovation

initiatives

• Regional expertise– Microsoft, Intel, Philips, Healthcare Providers, Universities, Venture Community,

Technologists, Senior Care Companies

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Connected Health is Patient- and Consumer-Centric Approach to health & wellness

• Tech-Enabled tracking, communicating and managing of health data outside of traditional care venues

• Sharing care management information & support among networks-care providers, caregivers and peers

• Outcome oriented-drive preventive, promotive & curative outcomes

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CHE

Test Bed

B

Test Bed A

VCs

Connected Health

Solutions & Features

SOURCE MATCHM

ATCH

MAT

CH

CHEC sources from candidate pool

To meet the need we should assembled a unique resource – a health community test bed

PeaceHealth is initial health communityTRIAGE

Vetted solutions are piloted in the test

bed

CHE presents solutions based on needs

assessed for each test bed

CHE refers non-match but worthy deal flow

to capital sources

VET60-70% from

PNW

CHEC’s sweet spot is tech-enabled solutions that improve care delivery and quality, access and engagement

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VENTURELIFECYCLE Idea

Post Revenue

Consumer/Patient

SOLUTIONS FOCUS

HC Institution

CONNECTED HEALTH

MEDICATION ADHERENCE

ANALYTICS

REMOTE MONITORING

CARE NETWORKS

DISTRIBUTED CARE

DECISION SUPPORT

Congral, a healthcare applications development start-up, is proof of concept for CHEC’s process

Input from patients, practitioners and hospitals define initial needs and interest (PeaceHealth community)

Congral solution selected and test launched

Test launch yields 2nd level of user input:• Rules engine and care manager cockpit integrated with Shared Care Plan• Mobile access to online data added to roadmap

Acquisition of new clients following pilot illustrates viability of solution in other health communities

Congral primed for funding & partner development based on successful test and new customer interest

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Congral powers a personal health record (Shared Care Plan) and care management workflow system for 5,000 patients in Whatcom County, WA

11

15

12

13

14

NEEDS ASSESSMENT

PILOT LAUNCH

SOLUTION ENHANCEMENT

CUSTOMER DEVELOPMENT

FUNDING READINESS

TIMELIN

E

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CHE leverages partner contributions at multiple levels of commitment

INVESTOR

GOVERNANCE

PHILANTHROPIST

CONSORTIUM MEMBER

ADVISORY COMMITTEE

REFERRAL SOURCE

FOLLOW-UP SUGGESTION

• Local Seminar– Focus on intersections of

• Seed money• Health system access• Rapid cycle development and deployment

PERSON-CENTRIC RADICAL REORIENTATION FOR OUTCOMES

1. Coach and coordinate health care2. Improve routine preventive and chronic physical

illness care3. Provide adherence support for routine care4. Improve care for chronic mental illness5. Enable healthier behaviors6. Improve post-discharge care to reduce hospital

readmissions7. Extend the use of hospice care (end of life choice)

From ReThink Health, Fannie E. Rippel Foundation

Best Possible Outcomes at 2040

Best Possible Savings in Whatcom