Disruption, Reinvention & Growth

Transcription

1 Disruption, Reinvention & Growth IT Opportunities in Healthcare Transformation TAG Market Insights Analyst Conference April 29, 2015

2 Focus Points Overview of Healthcare Transformation Top Health IT Trends for 2015 Discussion with Justin Barnes SGR Interoperability Telehealth mhealth 2

3 Overview of Healthcare Transformation 3

4 Disruption, Reinvention & Growth End-to-End Disruption All Stakeholders will be Impacted and the Future Healthcare System Will Be Unrecognizable Reinvention Efforts Mostly Focused on Reimbursement, New Care Delivery Models, and Changing Stakeholder Roles Growth Opportunities Born of Reinvention Will Be Tremendous, Particularly for IT 4

5 Why is this Happening? High Cost of Catastrophic Care Can Bankrupt Individuals and Health Systems Hospitals Face Insolvency: Need To Change Processes of Care Delivery & Discover New Business Models Traditional Approach to Health Information Systems and Management Does Not Deliver Value to Clinicians and Patients 5

6 5 Transformations Driving Opportunities in Healthcare Wellness, Prevention and Reducing the Impact of Chronic Disease Re-imagining Care Delivery Changing Customer Roles Moving From Product To Platform Value Rediscovered and Redefined 6

7 Wellness, Prevention and Reducing the Impact of Chronic Disease Improve Outcomes, Lower System + PMPM Cost Cost of care innovations Outcomes-based incentives in vendor contracts? Extending Outside of the Hospital Extending into primary care and home-based interactions IT solutions to identify and track at-risk individuals Better Use of Staff Chronic disease management requires more interaction with patients, at lower cost, requiring use of technology and lower cost clinical personnel Going Digital Preventive care and remote diagnostic models require the use of technology solutions to enable scalability Chronic Disease Management Strategies Rigorous processes for patient management and care protocols Role of New Participants Proactive patient interaction strategies New tools, processes New vendor and stakeholder partners 7

8 Re-Imagining Care Delivery Scalability Financial viability in accountable care and capitated care models requires scale Decision Support Automating non-critical decisions and documentation that are a currently significant time and resource burden Process Change Care coordination and collaboration Utilizing AI and automation to speed processes, digest information and reduce labor costs and human error Department Management New approaches to improve efficiency in surgical suite, cath lab, imaging services, infant / pediatric care, ER, etc. Building the Ecosystem Forming partnerships with a range of stakeholders Vendors, patients and families, analytics service providers, supply chain New Revenue Focus Wellness services Direct contracting with employers Tech innovation codevelopment with vendors 8

9 Changing Customer Roles Rethink Your Customer Beware not only of disruptions to your business, but also to your customers business Who Is Your Target? Rethink and expand target audience, even within same provider organization Use case must be adaptable and holistic Value to Individuals Patients no longer passive participants Patient may not be buyer, but may still be the key user Consolidation Consolidation among payers and providers is changing the volume and scale of relationships Larger entities will likely look to scale back on number of vendors Role of New Participants New competitors, partners as the value of analytics, CRM, patient interaction, stakeholder collaboration and service delivery models increase Viability of as-a-service Solutions and Smaller Customers Small and mid-size providers will increasingly by X-as-aservice as vendors move toward service/solution models 9

10 Moving From Product to Platform Data vs Information Value not derived from collecting data, but in the conversion into insights and change in process or behavior Building the Ecosystem Forming partnerships with key stakeholders is critical to establishing a functional platform Monetization Strategies Failure to define monetization models key factor behind the majority of market exits Security Apprehension over data security is one of the major impediments to large scale deployment of analytics and connected platforms. Decision Support Automating non-critical decisions and documentation Providing AI support to make sense of increased volume of lower value data Integration is King Institutions and consumers will increasingly value integrative solutions that reduce fragmentation of information and processes Source: Frost & Sullivan analysis. 10

11 Stakeholder Roles Are Changing, Creating Opportunity and Challenges in Customer and Partner Interactions Source: Frost & Sullivan analysis. 11

12 Value Rediscovered and Redefined Value-based / Patient-centered / Outcome-based Models Driving Incremental and Disruptive Innovation Success in a valuebased reimbursement environment requires a new alignment of care delivery processes that place a strong focus on collaboration to ensure optimal patient outcomes. 12

13 Monetizing Results, NOT Goods & Services Fee Per Use Model Fee for Value Model Transactions PAYMENTS Quality and Cost Metrics Treatment Volume INCENTIVES Treatment Outcomes Short-term, Utilization SUCCESS Longer-term, Prevention Each Tech Evaluated Separately TECH ADOPTION Tech Value Higher If Integrated Misaligned Incentives Raise Costs INCENTIVES Risk Sharing Drives Partners Treating Sickness OBJECTIVE Preventing Sickness High Use Cost Causes Avoidance PRIMARY CARE Early Detection + Intervention 13

14 Many Needs, Many Models Goodbye one size fits all; hello unique customer segments Payers and providers must differentiate customer needs, expectations, and means to participate Solution developers must consider which customer segments are the greatest fit for their offerings 14

15 Top Health IT Trends for

16 Conquering the Cloud Adoption of HIPAA-compliant cloud solutions for data storage, archiving, and hosting of healthcare IT applications will continue to increase. Niche healthcare cloud service providers will emerge as top contenders in the market. 16

17 Monetization of Chronic Care Management & Care Coordination IT solutions that enable care coordination for chronic disease management accelerate in 2015 due to the CMS Chronic Care Management (CCM) program. CMS will pay separately for nonface-to-face care coordination services for Medicare beneficiaries with two or more chronic conditions. IT solutions for care coordination likely to grow YoY by 26%. 17

18 Payer IT Comes Into Focus Payer IT rises in focus as health plans build out capabilities to engage with members, and improve IT functions. The greatest areas of IT interest will be in new analytics to manage financial risk including more robust member profiling, new solutions to directly engage individual members, and tightening cybersecurity. BPO solutions for payers will also grow significant. 18

19 Integrating Telehealth with Enterprise IT Health IT vendors will continue to heavily promote capabilities for seamless telehealth integration with enterprise platforms, as well as consumer devices and wearable tracking systems. 19

20 Launch of Clinical mhealth Apps Healthcare apps launched for smart devices is expected to include a much higher percentage with clinical grade functions/support (requiring FDA approval). This market is likely to grow 30% YoY. 20

21 Employers Incentivize Use of mhealth Employers are looking at reducing the cost of care burden for chronic diseases, by encouraging healthy and preventative behavior. By the end of 2015, 70-80% of large employers are likely to offer some form of telemedicine services to their employees as a part of health plans. 21

22 Wearables Move Beyond the Wrist An over saturation of me-too products with similar functionalities in the wrist will lead to a contraction of hardware developers in that space. Smart clothing and wearables elsewhere in the body will take a significant leap forward from a virtually non existent market in 2014 to upwards of several hundred millions in sales over the next couple of years. 22

23 New Focus on Cybersecurity Healthcare payers and providers will pay closer addition to cybersecurity risks beyond device theft. High profile hacks at Premara and Anthem are wake up call. Current protocols and security measures are significantly lacking in healthcare and many stakeholders are unaware of vulnerabilities. Numerous vendors will rush to compete in this space. 23

24 Growth of Private Health Insurance Exchanges (HIX) Private insurance exchange platforms had ~2.5 M enrollees in The advent of HIX represents a significant shift in private insurance from defined benefits to defined contribution models. The number of enrollees who will select their insurance through private exchange platforms is expected to grow by nearly 300% in 2015 and will continue to gain in prominence in coming years. 24

25 Telecoms Launch Home Health Platforms With established telecom companies serving as integrators, the market is able to gain greater traction with consumers. By end of 2015 nearly 6 million homes worldwide will have some form telehealth set up in place, facilitated by newly launched services from major telecom providers 25

26 For Additional Information Nancy Fabozzi Principal Analyst Connected 26

27 Discussion with Justin Barnes 27