health:further public good from market forces

JoshuaRosenthal,PhD

PublicGoodfromMarketForces:

High-ValueCareforPayers,ProvidersandConsumers

Context

Exit

Exitw/GoodMultiple

Idea

Prototype

Funded

1%*

1%*

1%*

1%*

*HealthCareStartUpsfailatastounding,

disproportionate rates

PublicGoodfromMarketForces

Most‘Successes’,Aren’t

MeasuringValueCreation


UserGuide(ALT)

Consultants/ProfessionalServices,

Providers

SaaS-baseddata/analyticplatforms



Healthcarehasnotdonesowell

“Justwait‘tillnextyearFinancialServices&Energy!”

Inthisracevs.otherverticals


*Direct-to-ConsumerNote:Peopledon’t liketopayoutofpocketforsomethingtheydon’t liketodoordon’twanttoknowabout

Challenge:DirecttoConsumerApps


Speakingatamajorhealthcareconferencenearyou

Challenge:Fluffinnicesuits


Ihavebetterengineering /architecture

Hmm, ‘fixing thepipes’wasnottheanswer

Challenge:NoisefromTech


Ihavebetterdesign&experience

Hmm, theprettycolorsonmysocialappdidn’t stopme

Challenge:Bubbles(design)


Mydataisbigger thanyours Hmm,thisfixationindicates...

Sillyboys

Challenge:Buzz(cf.bigdata)


*Source:DartmouthAtlasforUnwarrantedVariation

*

Challenge:PerverseIncentives


PerverseIncentives:FeeforServicePayersaggregate–butsomehavenothistoricallybeen“healthcare”

“Actually,Imakemoremoneyoffofbaddrivers.”*

(Readw/accent)


SomeHospitals/Providersmayhistoricallygeneratedrevenuebyfillingrooms*

Keeppatientsaway?!?

Iwastryingtobookyouforanextranight!

PerverseIncentives:FeeforService


Challenge:InterpretationofData


Causal?

Thenagain…Maybethere’ssomethingtoit?


Review

HealthCareStartUpsfailatastounding,

disproportionate rates


FAIL


Change:NEWINCENTIVESGovernmentAnnouncesSun-settingofFeeforServices

GovernmentAnnouncesNewPay-for-ValueModels


Change:OPENDATAGovernmentAnnouncesPublicData

GovernmentAnnouncesEntrepreneursDataAccess


So?

PublicGoodfromMarketForcesDoGood…

...butyouareprobablynotprofitable

IfP<EHCxDWS,then501c3

P:Profit;EHC:EmployeeHeadCount;DWS:DogWalker’sSalary;501c3:Non-profit

It’seasytodogood...

PublicGoodfromMarketForces…andCreateValue

...butyouareprobablydoingbadthings

“I’llbillyou.”

It’seasytomakemoney...


It’stoughtodogood&createvalueinHealthCare

Solet’spractice

together

CreatePublicGoodbyCreatingMarketplaceValue…

...Let’slookatanexample


Low-ValueCare:.30/Each$IsWasted

Over$9BinOrangeCounty, CA

$850BillionUnnecessarySpendin2014(InstituteofMedicine)

InstituteofMedicine(IOM)report,“BestCareatLowerCost,”(Sept.2012)estimatesthattheUnitedStateslost$750billionin2012.(Adjustedin2013at$800BB,2014at$850BB.)

Thisisabout3%ofGDPor roughlytheDODbudgetfortheIraqWaroveran8yearspan.

Low-ValueCare(30%)

NecessaryUtilization(70%)

“It’sgenerallyagreedthatabout30percentofwhatwespendonhealthcareisunnecessary.Ifwe

eliminatetheunneededcare,therearemorethanenoughresourcesinoursystemtocovereverybody.”

-Dr.ElliottFisher,DartmouthInstitutefor

HealthPolicy

“Biggerthanhigherprices,administrativeexpenses,and

fraud,however,wastheamountspentonunnecessaryhealthcareservices.”Injustasingleyear,upto42%ofpatientsreceive

“Low-Value”Care.

- Dr.AtulGawande,DepartmentofHealthPolicyand

ManagementattheHarvardSchoolofPublicHealth&DepartmentofSurgeryatHarvardMedicalSchool


2016 World Economic ForumAnnual Meeting in Switzerland

Ontracktosunset50%ofFFS

High-ValueCare:CMSIsPayingonIt


In a series of white papers, HCTTF, following research, recommends that payers, providers and CMS use low-value care as evaluation criteria for success in pay for value modelsand incentivize providers based on it to create sustainable economic models for transition to value-based care.

High-ValueCare:MarketAdvocatingforIt


“Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for

them, and often cause harm.”Dr. Atul Gawande, Professor, Department of Health Policy and Management at the Harvard

School of Public Health & the Department of Surgery at Harvard Medical School.

High-ValueCare:MediaIsReportingonIt


"It'snosecretthatpatientsoftenundergounnecessaryproceduresthatcanbedangerousandcostly."Throughourcollaboration withRowdMap,weareprovidingpatientswithmeaningful informationabouttheseno- orlow-valuetreatments,allowingthemtomakebetter,moreinformeddecisionsabouttheirdoctors,hospitalsandmedicalcare.”

High-ValueCare:ConsumersDemandIt


RowdMaphaslow-valuecareandpopulationhealthbenchmarks for…

everyphysician

everyhospital

everyzipcode

…intheUnitedStates. Whatifyouknewwhichproviderswould

driveyoursuccess?

High-ValueCare:WeHaveIt


Healthplansandproviders in48statesandtheDistrictofColumbiauseRowdMap’sbenchmarkstoreducethedeliveryoflow-valuecare.

RowdMap’sbenchmarkshelpmanagethe$850billionthenationspendsoncarethatleadstonobetteroutcomes.

TheclientsRowdMapservescollectivelycoverthelivesofmorethan100millionAmericans.

PayersinMarketplace/Exchange,MA,Medicaid,Commercial andGovernmentProgramsProviders includingPCP&SpecialtyGroups,CINs&Systems,ACOs,Bundles&other CMMIProgramParticipants.

High-ValueCare:MarketAdoptingIt…


High-ValueCare:MarketChallenge


High-ValueCare:MarketResponseCreatingHigh-ValueNetworks


High-ValueCare:MarketResponse

CompensatingProvidersonValue


High-ValueCare:MarketResponseImprovetheFlowofCare



CreateaVirtuousGrowthCycle


High-ValueCare:MarketResponseEnsuringFinancialViability



AchievingFinancialSustainability


High-ValueCare:Problem

HowMuchOutcomeDoesYourDollarBuy?

Youcanhavegreatoutcomes…Onasurgeryyoudon’tneed

Youcanhavegreatpatientexperience...Onasurgeryyoudon’tneed

Youcanhaverelativelylowcosts...Onasurgeryyoudon’tneed


High-ValueCare:Response


YourTurn!HowtoGuide

for


DIYIt!

bit.ly/OpenDataYourHand

bit.ly/HEBUserGuide

bit.ly/HEBSources

bit.ly/CMSHowToGuide

www.healthdata.gov

Asheldat


YourTurn!HowtoGuide

for


Yes– itispossibletodo.

Someofthemostmeaningfulhealthcareinnovationiscomingoutoftraditionallyoverlookedspacesandareas:seniors,B2B,Medicare,Medicaid,Nashville,I-65,‘fly-over’country,etc.


High-ValueCareforPayers,ProvidersandConsumers

Specialthanksto