mHealth: Consumerism & Connectivity

Dave Levin, MD

CMIO, Cleveland Clinic

CEO, Tres Rios Group, LLC

Dave@TresRiosGroup.com

@DaveLevinMD

©2014 Tres Rios Group. All Rights Reserved.

The Perfect Storm

• Value-based Care

• The Rise of Consumerism

• Explosion of Mobile Devices

At The Breaking Point ?

• US spends approximately 2.4 Trillion annually.

• US health care expenditures expected to account for 17% of GDP

• Expected to increase 2% above economic growth rate

• Chronic Disease accounts for 70% of health care costs

“Health Spending Projections Through 2019: The recessions impact continues,” Health Affairs. Feb 4, 2010

Health IT: The Story So Far…

• We have $pent a lot of money.

• Adoption has increased substantially for both MD practices and hospitals.

• Mixed results for ROI/VOI

• Rising Financial challenges

• Increased scrutiny of HIT expenditures

• Users and HIT Professionals are frustrated

No one is giving us 10’s …

Rx: From Volume to Value

• Volume: Today we get

paid to do stuff. Do more

stuff; get paid more

regardless of results.

• Value: Tomorrow we will

be paid based on the

actual results, not for

just doing stuff.

“If you can’t explain it to

your mom and dad, you

don’t really understand it.”

Volume Based Value Based

Provider Incentive Activity Clinical Results & Cost

Provider Payment Fee for Service Outcomes

Patient Role Passive ; Dependent Active; Engaged

Partnership

Care Model Acute; Episodic; Individual

Patients.

Continuous; Chronic

Disease; Prevention;

Individuals and Populations

Provider Role Silos of individual providers

or groups

Collaboration; Medical

Home; Teams; ACO’s

Analytics Retrospective; Fragmented;

Administrative

Real Time & Predictive;

Integrated; Clinical,

Operational & Administrative

Technology Stand-alone EMR; Enables

existing care models (cow

paths)

EMR-HIE; Enables new

care models; Virtual care

The Challenge: Living in Two Worlds

Fee for

Service

Pay for

Performance

Bundled

Payments

Full Risk

Models

Less than 11% of payments to hospitals and providers are Value based. The Catalyst for

Payment Reform has set a goal of 20% of payments to be value based by 2020

Source: Catalyst for Payment Reform

Delivery of Clinical Services: The Three “P’s”

Personalized (Zoom In)

•Highly customized for each individual

•“Omics”, Real Time Info, Individual Needs &

Tastes

Population-based (Zoom Out)

•Systems designed to care for large groups of

similar patients

Pervasive (Zoom Everywhere)

•Ubiquitous; Everything connected

“Every day I work in healthcare and then I go home

and live in the 21st Century.”- Dave Levin, MD

Keynote Address, Healthbeat 2013

D

mHealth is the use of mobile and wireless devices to

improve health outcomes, healthcare services and

health research.

- National Institutes of Health Consensus Group

mHealth: Bringing Healthcare To People

www.mhealthbook.info

C

Global mHealth market estimated value at

6.6 billion in 2013. Expected to reach 20.7

billion by 2018 at a healthy CAGR of

25.5%.

Consumerism & Patient Engagement

Patient or Consumer?

• Transparency

• Transactions

• Trust

Should Patients Contribute

Data to their Record?

• Types of Data

- Demographic/Financial

- Status

- Clinical Outcomes

• Potential Benefits

- Engagement

- Efficiency

- Enhanced research

• What’s the down side?

Caregivers Are Consumers Too!

• ~40% of Adults are

Caregivers

• The “Panini

Generation”

• Caregivers affect

patient outcomes.

• Patient outcomes

affect Caregivers

too!

Case Study

A. Don’t forget

your

appointment

on Tuesday

with Dr. Smith

B. Did you have

any side effect

with your

meds

Patient’s

DaughterPatient

Healthcare

Professional

All sharing

the same

view!

As ExperiencedAs Observed

Barriers

Privacy & Security

Infrastructure

Shifting Reimbursement Models

Culture

Design

Delivering REAL VALUE

EMR Integration

Apps or CrApps ?

Secure and private

Interactive

Intuitive to use

Portable across platforms

Integrated into EHR /PHR

Transmit data wirelessly

User perspective

Tested with intended audience

Designed to meet personal need

Designed to become part of

ecosystem (like Facebook)

©2014 Tres Rios Group, LLC. All Rights Reserved.

Implementation

• New • Replacement• Deeper Clinical Impact

Transformation

• New Delivery Models• Physical• Virtual

• IT Enabled• Analytics• Transactional• Mobile

Optimization

• Benefits Realization• Planned?• Measured?

• User (Dis)satisfaction

Skill / Demand

Tech IQ Hi Med Low

Operations IQ Low Med High

Strategic IQ Low Med High

Leadership Challenge Low Med High

Emotional Intelligence (EQ)

Low Med High

Overall Benefit (ROI/VOI)

Low Med High

Frustration Level High Med Low

Typical Path Towards HIT Benefits

©2014 Tres Rios Group, LLC. All Rights Reserved.

©2014 Tres Rios Group, LLC. All Rights Reserved.

Implementation

• New • Replacement• Deeper Clinical Impact

Transformation

• New Delivery Models• Physical• Virtual

• IT Enabled• Analytics• Transactional• Mobile

Optimization

• Benefits Realization• Planned?• Measured?

• User (Dis)satisfaction

Skill / Demand

Tech IQ Hi Med Low

Operations IQ Low Med High

Strategic IQ Low Med High

Leadership Challenge Low Med High

Emotional Intelligence (EQ)

Low Med High

Overall Benefit (ROI/VOI)

Low Med High

Frustration Level High Med Low

Typical Path Towards HIT Benefits

©2014 Tres Rios Group, LLC. All Rights Reserved.

Great Technology is Not Enough… We Need Great Leadership!

Case Study

http://www.healthcare-informatics.com/blogs/david-levin/can-propeller-health-propel-us-future

Discussion

Dave Levin, MD

CMIO, Cleveland Clinic

CEO, Tres Rios Group, LLC

Dave@TresRiosGroup.com

@DaveLevinMD