Harnessing Population Health Management to Promote Quality Improvement in Healthcare

Transcription

1 Harnessing Population Health Management to Promote Quality Improvement in Healthcare Judy Murphy, RN, FACMI, FHIMSS, FAAN Chief Nursing Officer IBM Global Healthcare & Life Sciences

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) Slide 2

3 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

4 This transformation is an evolution to a new model for healthcare Old Healthcare Fee for service Volume Delivery Employer-centric Prices unknown One way dialogue Transactional Data poor & disconnected Reactive Standards New Healthcare Pay for performance Value Quality Outcome Consumer-centric Cost transparency Engaged & mobile Brand loyal Integrated rich big data Predictive & prescriptive Personalized & optimized Slide 4

5 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 evidencebased guidelines We measure quality and make rapid changes to improve it Understand and influence their populations Pallative Care/ Hospice Rehabilitation Home Care Quality measurement and performance reporting Evidence-based and standardized care planning Social Worker Specialists Medications Housing Transportation Primary Care Funding and Payment Case Manager Intensivist Physical Therapist Community Dietician Behavioural Health Caregivers Family Coordination across boundaries -- share care, accountability and risk Individual engagement and empowerment Data and Information Slide 5

6 The new model is Value Based Care centered around the patient Organizations are on a journey to improve value Taking steps to achieve better results, and improve customer (patient) satisfaction Value = Experience Cost Reducing waste, reducing errors, managing risk, improving efficiency and quality Slide 6

7 Population Health Management ENTIRE POPULATION Capability Needs POPULATION 40-60% 20-25% 5-15% 2-3% Data (internal-external) Scalable platform/data management RISK STRATIFICA TION HEALTHY / LOW RISK AT RISK 60+ CHRONIC ACTIVE DISEASE Risk analytics & management Insight analytics Similarity analytics RELATIVE COST 5-10% 15-20% 30-40% 40-50% Cost of care analytics Actuarial analytics ENGAGE MENT No or very-low touch Low touch Medium to high touch High touch Marketing analytics Marketing management Predictive modeling / next best action OUTREACH Fully automated Validate from data Mostly automated with , call, text, mobile app Blended - retail outlet, care mgt, automated Active Case Mgmt ~20% of population drives ~80% of cost CRM Campaign management Outreach advisor Remote data capture Mobile apps Network analytics Care coordination tool/ clinical integration Slide 7

8 Reimagining Health & Healthcare with Mobile Slide 8

9 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

10 Imagining Care Anywhere Slide 10

11 The Power of Patient Engagement: Population Health Management requires Patient Engagement Know me Capture and incorporate preferences What s my history? What are my preferences? How will I respond? What will motivate me? Respect my privacy Engage me Personalize offerings and services Engage in the preferred dialog Be relevant ( right information ) Be consistent across touch points Show sincerity -- you care Empower me Innovate to deliver quality, convenience and total experience Give me the information I need Connect me with relevant communities Simplify control and access Enable action and convenience Slide 11

12 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

13 Integration of health in our lives Slide 13

14 So what is driving Consumerism in healthcare? 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 Source: Healthcare Payer News, May 2014 Slide 14

15 New business models for delivering care are emerging, providing people with more choice Slide 15

16 Consumer Shop & Buy activities Health Plan Engagement App Demo Slide 16

17 Impact Continuum of Care Support Business Functions Successful healthcare organizations thrive by using analytics as a core strategic foundation Population Health Provider Relations Risk Management Consumer Engagement 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 Early and accurate insights on member health risk and utilization to inform Financial / Actuarial decisions Inform program design & operations for Marketing & Sales and Customer Service with insights on consumer preferences & triggers Provide tools to providers to enhance risk stratification and clinical decision making Facilitate insights exchange & messaging across care team members. Inform incentives design. Enabling analytics to empower ACOs and providers to succeed in valuebased payment transformation Next best action analytics leveraging real-time data to optimize omnichannel consumer engagement Sample Analytics Applications Risk Stratification Care Path Mining Network Optimization Utilization Prediction Cost Patten Detection Personality Insights Consumer Segmentation Resource Allocation Channel Optimization 17 Slide 17

18 The Healthcare Analytics Journey Basic Reporting Foundational Analytics Predictive & Prescriptive Cognitive What happened? When and where? How much? Retrospectiv e Reporting High latency reporting Spreadsheets Limited view reports Dept data marts Who is at risk? What is happening? How can we improve? What is the Right Data? What actions to take? Enterprise Wide Data Insights Data Governance Centralize Data Structured and Unstructured Data Sharing Cost of Care Intelligence 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? Proactive Interventions and Improved Outcomes Population Health Analytics Evidence-based medicine Streaming Analytics Similarity Analytics What is the optimal treatment based on the latest literature for my patient s clinical profile? Why is this the best protocol? Dynamic Learning for Optimal Care Guidance Natural language understanding Guided consumer experience Watson Applications Clinical Content Analysis Personalized Healthcare 18 Slide 18

19 Analytics strategy must span both knowledge & data-driven methods From population averages Knowledge-Driven Methods Scientific papers Books Guidelines Published Knowledge To insights for individual patients Data-Driven Methods Longitudinal health records Claims data Patient reported data Observational Data Identification of evidencebased best practice WATSON Patient Care and Insights Patient Similarity Analytics 19 Slide 19

20 Healthcare Analytics Progression Cognitive Computing Natural Language Predictive Patient Similarity Trusted Information Platform Dashboards Big Data Volume, Velocity, Variety Slide 20

21 Watson is ushering in a new era of computing Slide 21

22 Cognitive Systems Era Interact Naturally Learn and Reason Discover and Decide Slide 22

23 Watson May Help Beat Cancer Slide 23

24 Thanks! Judy Slide 24