2013-07-17: Health Innovation, A General Dynamics IT Perspective

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Property of General Dynamics Information Technology do not distribute or re-use content without permission

Health Innovation –A GDIT Perspective

Craig MillerVice President, Health Strategy and Innovation

2Property of General Dynamics Information Technology do not distribute or re-use content without permissionGeneral Dynamics Proprietary Information

PROBLEMS


1: The UnsustainableCost Curve

• Healthcare accounts for nearly 18% of US GDP (Health Affairs 31(1): 208-219)

• $2.6 trillion in total spending in 2010, over 10x spending 25 years ago (Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, National Healthcare Expenditures Data, January 2012.)

• Insurance premiums have risen 113% in last decade (Kaiser Family Foundation and Health Research and Educational Trust. Employer Health Benefits 2011 Annual Survey. September 2011.)


Cost growth comparison with other countries

Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database)


Overall cost comparison with other countries (2009)

Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database)


2: Waste

Almost one third of the US spending on healthcare ($750 billion) is unnecessary, according to the 2012 Institute of Medicine study Best Care at Lower Cost


3. Unacceptable Outcomes

• According to the recently release IOM report “U.S. Health in International Perspective: Shorter Lives, Poorer Health”, compared to 16 other peer industrialized countries:

• America ranks last in probable life expectancy for males <50, second to last for females <50

• Americans as a group fare worse in at least nine health areas: infant mortality and low birth weight injuries and homicides adolescent pregnancy and sexually transmitted infections HIV and AIDS drug-related deaths obesity and diabetes heart disease chronic lung disease disability


INSIGHTS


4: The Chronic DiseaseEpidemic

• According to the CDC: 7 out of 10 deaths among Americans each year are from chronic

diseases. Heart disease, cancer and stroke account for more than 50% of all deaths each year.

In 2005, 133 million Americans – almost 1 out of every 2 adults – had at least one chronic illness.

Obesity has become a major health concern. 1 in every 3 adults is obese and almost 1 in 5youth between the ages of 6 and 19 is obese

If current trends continue 1 in 3 Americans will havediabetes by 2050

US Adult Type II Diabetes Incidence, 2008


5: The Five Percent

• According to AHRQ study The High Concentration of U.S. Health Care Expenditures: Five percent of the

population accounts for almost half (49 percent) of total health care expenses.

The 15 most expensive health conditions account for 44 percent of total health care expenses


OPPORTUNITIES


6: Coordinated Care

• The “5 Percent” typically exhibit complex comorbidities and extensive chronic disease

• Often characterized by frequent hospital readmissions and extensive end-of-life care

• At-risk populations need to move from isolated, reactive models of care to coordinated, proactive models of care


Coordinated Care Enablers

• Health Information Exchange• Open Source HIE solutions, such as HIEOS• Patient Centered Medical Homes• Care coordination teams• Accountable care organizations


7. Disruptive Care Models

• Move to value-based purchasing for healthcare presents unique opportunities for disruptive innovation

• “Winners” in ACO-like environments will do the best job of aggressively managing chronic disease, incenting better patient self-care, and moving care to less expensive providers and settings

Hospital Outpatient Home

High cost of care Low cost of care

Care provider

Care setting

Physician Nurse / NP PA Self-Care


Disruption Enablers

• Remote monitoring• Remote consultation• Mobile platforms• Social networks• Increased autonomy/privileges for NP/PA and other

non-physician clinicians


8: Solutions for Three Types of Fraud

• Identity: one or more participants in the transaction is a false identity (provider, patient, processor, etc.)

• Transactional: real patient and provider, but fictitious or inappropriate/unnecessary service or product (also includes waste and abuse)

• Collusive: Larger pattern of transactions indicates organized conspiracy to defraud, such as pill mills and rent-a-patient schemes

• Each type of fraud needs a different solution


FWA Solution Enablers

• Move to prepayment detection of potential fraud and claim denial

• Integrate data from clinical sources and public/financial records in addition to traditional claims data

• Create a longitudinal view of true patient health status to evaluate claims for waste and abuse


9: The Analytics Revolution

• Widespread EHR and HIE adoption will provide a rich stream of computable clinical data that can significantly enhance the utility of analytic applications

• “Big data” tools will enable analytics on unstructured data (e.g. clinical notes, social media, etc.) to augment the traditional structured data analysis

• Significant challenges remain in reconciling inconsistent data from multiple sources and in de-identifying personal health data for public use


Analytics Enabler: Data Fusion

Clinical Encounters

ClaimsQuality

ReportingResearch

DataPublic

Records

Analytics

Comparative Effectiveness FWA

Population Health

Chronic Disease

Management

Clinical Decision Support


10: Create a Learning Health System

• Past studies have shown it may take a decade or more for new clinical knowledge to make its way into routine practice

• A learning health system is one that collects digital evidence from clinical experience, analyzes it to gain new insights and then rapidly applies them to front-line care to lower cost and improve quality


LHS Enabler: The Circle of Health Data

• Meaningful Use provisions and health economics are driving the industry towards the creation of “learning health systems”

• EHR adoption and HIE alone are insufficient to achieve this

• Real value comes from identifying populations at risk and moving from reactive to proactive, coordinated models of care that integrate analytic insights into practice

• Follow example of integrated delivery network systems

Collect and manage

health data

Exchange health data

Analyze health data

Integrate insights

into practice


For More Information

HIMSS Innovation Community

http://66.77.252.5/asp/innovation_community_home.asp

HIEOS http://sourceforge.net/projects/hieos/

GDIT Health Solutions http://www.gdit.com/Capabilities/Health/

Learning Health Community

http://healthinformatics.umich.edu/initiatives/lhs/national-summit



http://sourceforge.net/projects/hieos/

http://www.gdit.com/Capabilities/Health/




Contact Information

Email [email protected]

Website www.gdit.com

Twitter @HealthITCraig

Phone 703.405.1408

mailto:[email protected]

http://www.gdit.com/


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