衛(wèi)生保健模式的變革：醫(yī)療服務(wù)模式再思考【Kevin Fickenscher】

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KevinFickenscher,MD

Boston,Massachusetts

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StayingAheadofthe

Healthcare

Transformation:

Reconsidering

CareDeliveryModels

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“Youneverchange

thingsbyfighting

againsttheexisting

reality.Tochange

something,builda

newmodelthat

makestheold

modelobsolete.”

F.BuckminsterFuller

TheSession…

1ABriefOverviewoftheForcesPrecipitatingChangeinGlobalHealthcareDelivery

1TechnologyasaTransformationalandDisintermediatingForce

1SixImperativeDirectionsforCareDelivery

1TheImplications

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TheMetaphor...

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TheMetaphor...

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“Therealvoyageof

discoveryconsistsnotoffindingnewlandsbutofseeingtheterritorywithneweyes.”

-MarcelProust

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ThePremise…

1Societyisdemandingforallgoodsandservicesbut–especiallyforhealthcare–thatwe…

-↓Costs

-↑Quality

-↑Service

1Theinherentincentivesofthehealthcareindustryaredisparate,inconsistentanddysfunctional–causingleaderssignificantchallenges

1Societyismovinginextricablytowardsaninformationdemocracyratherthanprofessionallydominatedtheocracy

=Focalpointforhealthcarechange

=Appropriatemanagementofinformationrequired

=Intellectualcapitalofmedicine

=Simultaneouslyempowering(consumers)anddisempowering

(physicians)

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“Changeistheprice

ofsurvival.”

SirWinstonChurchill

HealthCareForces

1Workforceglobalization

1Cross-industryconvergence

1Risingtideoftechnology

1Breakdownoftraditionalboundaries

1Shiftfromvolumetovalue

1Continuouscaredeliverymodels

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So,WhatDoesItAllMean?

And,TheImplications?

1EfficiencyandEffectiveness–thenewwatchwords

1Productivity–theessentialingredient

1Accountability–therequiredcapability

1Globalization–ofcaredelivery

1Virtualization–ofsupportanddelivery

1InformationExchange/DataAnalytics–fosteringopendatasharing,transparencyandinteroperability

Why?

TheMostCritical

Question!

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So,what aretheforces thatare affectinghealthcare?

TheDomainsofChange–inHealthcare…

ReasonsfortheChange…

Incentives

Technology

Communications

Expectations

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TheAnticipation…

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“Helpyourbrother’s

boatacrossand

yourownwillreach

theshore.”

HinduProverb

From

ServiceIntegration

To

ServiceContinuum

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TraditionalFocusofCareDelivery…

Acute

AmbCare

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TheAlternative:

ComprehensiveCoordinatedCare(C2CARE)

AmbCare

Chronic

Transition

SNF

AltLiving

Hospice

Preventive

RemotePatientMonitoring

Acute

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OPPORTUNITYANALYSIS=Super-Utilizers

1Opportunity:reducecostoftop1%by20%ortop5%by20%

1Result:USHealthcaresavingsof$55Bor$128Bperyear

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ChineseDemographics…

1953

1982

2000

2010

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ChinaCausesofDeath

Major

causesofdeath

per100,000

population,basedon2004urban

populationsamples:

1Malignantneoplasms(cancers):119.7

1Cerebrovasculardisease:88.4

1Respiratorydiseases:78.1

1Heartdiseases:74.1

1Accidents,violence,andpoisoning:43.5

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ChinaDistributionofthePopulation

Withthegrowthofthepopulationheavilyweightedtowardthecoastalareas,itislikelythemajorityofthestate’sresourceswillbeallocatedinthoseregions.HowwillChinacontinuetoprovideequitablecareforthoselivinginmoreruralareas?

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“"Youcannever

planthefutureby

thepast."

EdmundBurke

From

VirtualMonitoring

To

VirtualCareDelivery

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The

OldWorld

Volume-Based

Roleofthe

Provider

The

NewWorld

今Value-Based

Payments

Incentives

Focus

Information

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TheTele–Intersection

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Patient

Navi-

gator

Interactive

Call

Center

Support

Remote

Patient

Monitors

Focused

AV

Education

Integrated

Analytics

Sensor

Tracking

Guideline

&

Protocols

Mgmt

Call

Center

Support

Ambient

Assisted

Living

IVR

Onsite&

Remote

Assess

Remote

Lifestyle

Monitors

Triage

&

911

Alerts

Mgmt

eVisits

TelecareTelehealth

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$1K

Home

$9K

Doctor’sOffice

Institutions

Home

TheTeleCareFocus

AvgMedicare

CostperPatient

perAdmission

$20K

Telecare…FocusingOnCareWeIgnore

HospitalReadmissionCosting$26BAnnually

113.6MPatientsOver65DischargedfromHospitaleachyear

12.7M(20%)areReadmittedwithin30daysofleaving

PoorDischargePlanning/CareCoordinationisatFault

1Maincauseofreadmission,especiallyhealthattacksandpneumonia

1$17Bpreventableifpatientsreceivedrightcare

$10K

LocationsHospitals

Source:AHRQ

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TelecareDrivers…

Source:/article/836/971/836971-figure.jpg

Telecarecanreplace…

FINANCIALPRESSURE

RapidlyChangingReimbursementModelsWithFinancialPenaltiesforPoorOutcomes

RISKSHIFTINGFROMPAYERSTOPROVIDERS

MoreAccountabilityforCareDeliveryUtilizationandOutcomes

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Telecare…NotAnOption,ButAnImperative!

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CARE

RefiningTheFocus…

ChangingTheFocusToCaptureTheGreatestValue

FOCUSFORTODAY

AreasofGreatestNeedandImpact

1Ambulatory

1Post-Acute

1Transition

1ChronicIllness

FOCUSFORTOMORROW

1Non-HospitalChronicIllness

1ChronicIllnessPrevention

1SocialInterventions

1Self-CareManagement

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…useofa

Comprehensive

CoordinatedCARE

Frameworktransforms

caredeliverythrough

theappropriate

applicationof

technology…

TelecareSummaryResults…

Outcomesintheliteratureshowresultsacrossmu8ltiple

caredeliveryenvironmentsIFtherequirementsfora

comprehensiveapproachtoCAREaremet…

Reduceall-cause30-dayreadmissions

ReducehospitalALOS

Decreasecosts>35%

Enhancecare

delivery

efficiency

Improvebiometrics+reducerisks

ROIsexceeding3:1

Reducerequired

in-homenurse

visits>50%

Increasepatient

compliance

>80%

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“"Youcannever

planthefutureby

thepast."

EdmundBurke

From

DeploymentofStandards

ToUbiquitousInteroperability

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FromthePrimacyofProprietarySystemstothePriorityofOpenSource…

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“Thosewhohave

knowledgedon’t

predict.Those

whopredictdon’t

haveknowledge.”

LaoTzu

From

DataMining

To

PeripheralIntelligence

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LEVELOFVALUE

InformaticsChangesPractice

AnINFORMATICSSAVVYORGANIZATION

isone

thathasaninformatics-skilledworkforce,a

disciplinedapproachtoinformationsystem

designanduse,andreliablymanagedIT

operation.

PRACTICE

INTELLIGENCE

KNOWLEDGE

INFORMATION

INFORMATICS

impliesadisciplinedapproachtoinformation

systemsdesignandusethat

public

drivesimprovementsinhealthpractice.

DATA

HEALTHIERCOMMUNITIES

PUBLICHEALTHPRACTICE

Source:ModifiedfromworkbyMartyLaVenture,BillBrand,MinnesotaDepartmentofHealth.KarenZeleznak,

BloomingtonMinnesotaDivisionofPublicHealth

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..

CanYouImagine?

LosAngeles

–ACaseStudyinPublicandClinicalHealth

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Imagineifyouwill…

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Tha

“

osewhofallinlovewith

practicewithoutscience

relikepilotswhoboard

ashipwithoutrudderor

compass.”

LeonardodaVinci

FromQualityasOutcome

To

QualityasRequirement

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“"Youmustbethe

changeyouwant

theworldtobe.”

MahatmaGhandi

From

SocialMedia

To

SocialActivation

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UseofHealthAppsforCareDelivery…

1PatientEngagement=enhancedelectroniccollaborationbetweenpatientswithhealthcareorganizationusingmobiledevices

1Administrative/Employee=Reuseexistingsecurityanddatatoimproveoperations–e.g.scheduling,forms,managementreporting,bedmanagement,workforce,RFID/RTLcapabilities,etc.

1HealthDelivery=Newsimplifiedandtargetedaccesstocomplexcontent(e.g.,diabetesmanagement)

1HealthEducation=Integratedcontentmanagementandsecuresocialnetworkingallowsfornewcollaboration,andtracking(e.g,myhealthyworld)

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S

U

M

M

A

R

Y

FromDeploymentofStandards

…ToUbiquitousInteroperability

FromServiceIntegration

…ToServiceContinuum

FromVirtualMonitoring

…ToVirtualCareDelivery

FromDataMining

…ToPeripheralIntelligence

FromQualityasOutcome

…ToQualityasRequirement

FromSocialMedia

…ToSocialActivation

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And,TheImplications?

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AStory:TheWomanandTheMountain

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So,WhatDoesItAllMean?

Thetoolsareclearly

available…but,the

transformationof

healthcareismissingthe

essentialrequirementof

allchangeinitiatives…

Areyoureadytobealeacn

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TheWorldofHealthcareisChanging…

Systems-Centricnot

Professions-Centric

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TheWorldofHealthcareisChanging…

GlobalandAggregated

not

Segmented

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TheWorldofHealthcareisChanging…

NetworkedandVirtual

not

Proprietary

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