is hindsight 2020?

Presented by

Is hindsight 20/20?

2020 State of the Industry Update

Health Care Industry Committee

How we can learn from the past to change

the future of care delivery

© 2019 Advisory Board • All rights reserved • advisory.com

‹#›

Road mapRoadmap6

Four trends poised to reshape care delivery1

2 Challenges and next steps for the industry to move forward

• “Everywhere” care

• Physician independence

• Artificial intelligence

• Clinical innovation

http://www.advisory.com/



7

1. Affordable Care Act.

Ten years later, we start to see unraveling of those efforts

ACA1 helped catalyze health system consolidation

Three goals of the ACA

Replace fee-for-service (FFS)

incentive structure via:

• Hospital payment cuts

• New Medicare payment

models intended to catalyze

broader change

Improve health care quality via:

• IT mandates

• Pay-for-performance

programs

• Market-facing transparency

Achieve universal, affordable

coverage via:

• Insurance market regulation

• Expanded public coverage

• Market-based exchanges

IMPACT

Health system consolidation and integration

Advisory Board interviews and analysis.




8

Individually and together, trends will impact all health care organizations

Four trends with potential to change care delivery


Payers, technology companies, and consumers are converging on “everywhere” care, changing the locus

of control for health care services.1

Eyes are on independent physicians as agents of change, but independence alone won’t drive down costs.2

Clinical care will be impacted by artificial intelligence, though applications will be limited by the quality of

data used to train the systems.3

Clinical innovations will only be valuable if purchasers and end users can and will adopt them.4




9

To understand impact, we must go beyond the headlines


Suppliers and service firms should consider four aspects of each trend

• What problem is the industry trying

to address?

• What activity or patterns have we

seen in this space to date?

• What organizational or market factors

could impede future progress?

• What mistakes are legacy or new

actors on track to repeat?

• Which case studies encapsulate the

current state?

• How has this trend impacted

organizations to date?

• If the trend plays out, what impact will

it have on care delivery organizations?

• What should suppliers or service firms

do differently?

Current state

Barriers to progress

Implications for future state

Context behind trend




10

Trend #1: Payers, technology companies, and

consumers are converging on virtual care, changing

the locus of control for health care services





11

Sources: “Explaining The Fall (And Possible Rebirth) of Doctors’ House Call,” Forbes,

Dec 9, 2015; “A History of the House-Call,” Throughout History, Oct 1, 2014; “How the

Modern-Day House Call is Evolving Healthcare,” Dispatch Health, May 17, 2018.

Move away from house calls represents the first site of care shift

Care at home was once the norm


1940s

40%of visits occurred at

patient’s home

Today

<1% of visits occur at

patient’s home

Drivers of the first “site of care shift”

House calls deemed an inefficient use of

clinician time

More clinician specialization meant that more

doctors are needed to manage patient health

New medical equipment only available in care

facilities

Emergence and rise of health insurance limited

patient control over where care is delivered

Rise and fall of house calls




12

Technology is accelerating resurgence of virtual care


Technological advances allow patients to get care where and when they want it

Home infusionsAt home genetic tests

TECHNOLOGY

CARE DELIVERY

Video consultations Remote patient monitoringDirect to consumer

pharmaceuticals




13

1. Centers for Medicare and Medicaid Services.

Sources: ”CMS finalizes policies to bring innovative telehealth benefit to Medicare Advantage,” CMS, April 5, 2019; “Amazon pilots virtual health clinic for

employees,” Modern Healthcare, Sept 24, 2019; “Tampa General, OnMed launch telehealth station that can diagnose patients,” Fierce Healthcare, Oct 16, 2019;

“Telemedicine startups Roman, Hims, and Keeps show enormous growth,” SecondMeasure, Dec 13, 2018; Advisory Board Virtual Visits Consumer Choice Survey.

Purchasers and patients converge on virtual care


Pressure from purchasers and

consumers to adopt virtual care

Resulting landscape

Purchaser pressure

on affordability

Amazon launched virtual clinic with in-home follow-ups

Tampa General Hospital created on-campus telehealth pods

for employee use

Men’s telehealth companies Hims, Roman, and Keeps all saw

more than 15x growth in new subscribers in first 9 months

CMS1 expanded

telehealth benefits

available in Medicare

Advantage plans

77% of consumers would

consider seeing a

provider virtually

Consumer pressure on

convenience




14

Virtual care holds promise, but can’t gloss over limitations

But how far should the pendulum swing?


Rise of virtual care may expose industry to new challenges

Access to, and

comfort with,

technology

• Patient does

not have device

that facilitates

virtual care

• Patient has low

IT literacy

Risks

Ability to

understand and act

on information

• Patient

misinterprets care

instructions

• Patient acts upon

incorrect

information

Risks

Ability to self-manage

• Patients’ condition

deteriorates as

they cannot

independently

shoulder burden

of care

Risks

Fragmentation

of care

• No single

provider has

complete view of

patient health

Risks

Reliability of

technology

• Device

malfunctions

without patient

or provider

knowledge

Risks




15

1. Primary care physician.

Evolution in where care takes place and how it’s directed


Initial evaluation Visit Follow-upProcedure

Comparison of one traditional and one virtual care pathway

Traditional care

pathway

PCP1 assesses patient

status

PCP instructs patient to

visit specialist

Care team tells patient when

to return for follow-up visit

Specialist recommends and

performs procedure at hospital

One emerging care

pathwayPatient researches

symptoms online

Patient starts a virtual

visit with specialist

Patient schedules procedure

at optimal site of care

Care team monitors patient’s

status remotely




16

Implications for suppliers and service firms


1Hospital outpatient departments

are at risk of losing volumes to

virtual and home settings

While hospitals’ inpatient business is already threatened by the outpatient shift

of services, their outpatient departments are now going to be in fierce

competition with virtual and at-home care. To retain share, traditional outpatient

service providers will by hyper-focused on convenience and price.

2With the emergence of “everywhere

care,” suppliers and service firms’

primary customer is going to evolve

In some cases, supplier or service firms’ primary customer will become the

patient, who will value ease of comprehension and use. In other cases, the

primary customer may be a care provider, but will demand products and

services that can flex across settings.

3Care fragmentation makes it

increasingly difficult for providers to

track patients across the continuum

Providers, patients, and other individuals involved in care decision-making must

have a comprehensive view of a patients’ health at any given time. Platforms that

enable information sharing will be crucial to maintaining care continuity, but

workspaces, staff training, and other IT systems must consider the importance of

interoperability.




17

Trend #2: Eyes are on independent physicians as

agents of change, but independence alone won’t

drive down costs





18

Pathways to Success ACO1

Model

MSSP2 overhaul includes

distinction between high- and

low revenue ACOs to create

lower-risk participation option

for physician groups

1. Accountable care organization.

2. Medicare Shared Savings Program.

Sources: Cigna Collaborative Care, Cigna; “Reigniting the physicians arms race, insurers are buying practices,” Modern Healthcare,

June 2, 2018; “Why PepsiCo is paying D-FW employees to go to the doctor's office,” The Dallas Morning News, Dec 2, 2018.

Both public and private payers are betting with these entities

Independent groups praised for their ability to reduce costs


Cigna

Cigna launched 230

Collaborative Care

arrangements, in which they

reward physicians when they

meet quality and cost targets

Primary Care First

CMS program increases

rewards and reduces

administrative burden for

independent physicians

PepsiCo

PepsiCo waives premiums if

employees use an independent

physician. Employees receive

a $100 gift card if visit the

provider for a meet & greet

PR

IVA

TE

P

UB

LIC




19

The space between physician- and health system-owned practices is expanding

Physicians now have more funding and management options

Physician-owned Health system ownedThe space between

Virtual care networks

For-profit care delivery organizations that do not

have in-person locations but partner with payers

and employers to offer virtual visits to patients

Example: AmericanWell, 98.6

National medical group franchises

For-profit care delivery

organizations not owned by a

hospital or heath system

Example: ChenMed, Iora

MSO1 aggregators

Multi-state private entities that invest in a

physician group’s MSO and provide centralized,

scalable business resources

Example: Privia, Alledade


Retail clinics

Care delivery organizations affiliated with a

large retail chain that provide low-acuity care

Example: Walmart HealthCenters, CVS

Minute Clinics/HealthHubs

1. Managed service organizations.




20

Source: “Physician Practice Management – A New Chapter,” L.E.K. Consulting, Sept 19, 2013.

Not the first time we poured money into independents


“If you don’t integrate, you are slapping s*** on

top of s***. There are still people in the market

who have that mentality of the ’90s, and we’ll

have circumstances that don’t work out.”

Nader Naini, Managing Partner

FRAZIER HEALTHCARE PARTNERS

WAS THE LESSON LEARNED?

80%DECLARED

BANKRUPTCY

By 2002, eight out of the ten

largest publicly traded physician

groups declared bankruptcy

1300% ESTIMATED

INCREASE

Change in the combined market

cap of top 20 publicly traded

PPMs between September of

1994 and 1997

Reasons for practice group failure

• Purchase price for physician practices became

unsustainable as competition increased

• Practice management companies could not command

sufficient payer leverage

• Practices overall more focused on growth than integration

The 1990s’ rise and fall of physician practice management

(PPM) companies




21

Four factors differentiate today from the 1990s


PolicyTechnology

Investment goalsConsumerism

Historical investment was based on the premise that

scale would generate returns; current investment

goes beyond increasing valuation through back-

office efficiency.

Consumers’ health care decisions no longer driven

solely by physician loyalty; independent groups are

now equipped with better marketing and

engagement platforms to acquire and retain patients.

Technological advances help manage

administrative burden and complex care contracts.

Examples:

• Cloud-based EHRs1

• Revenue-cycle management systems

New regulations may loosen practice restrictions

and create more favorable reimbursement

environment. Regulations include:

• Stark reform

• Expansion of site neutral payments

1. Electronic health record.




22

Is there infrastructure to facilitate smooth

communication between leadership constituencies?

To what extent are administrative leaders prepared to

drive change or cede decision-making authority to

physician leadership?

While environment is favorable, what really matters is on the inside

Physicians’ success is still not guaranteed


Regardless of environmental factors, two “mission critical” aspects of a physician group

A strong sense of business purpose and vision

• Focused on high-level strategy, and committed

to constant self-improvement

• Aware of their intended niche, business

specialty

Adept governance and non-clinical leadership that

can organize and mobilize change

• Governance and management—two distinct

functions—are performed by two different bodies

Is the physicians groups’ unique value in their

respective market identified and demonstrated?

Do both executive leadership and front line staff have

an understanding of the group’s mission and

purpose?

Questions that may help you gauge physician groups’ sense of vision and leadership




23



1The independent physician

market is diversifying

Independent groups are diversifying along multiple vectors, including ownership,

governance, services, and patient market segments. Each of these

differentiators affect providers’ priorities and preferences when working with

supplier partners.

2As groups get larger, they may

start behaving more like health

systems

While there may be marked differences across any given group’s ability to

inflect meaningful cost savings, the focus on independents as “agents of

change” – and the roll out of value-based care programs specifically for that

group - will put downward pressure on product/service pricing and upward

pressure on accountability for outcomes.

3Private equity investment in physician

practices is focused on specialties that

are in direct competition with traditional

health systems

Private equity is targeting gastroenterology, urology, orthopedics, and women’s

health services, with the intention of pulling services from hospitals to outpatient

settings. Both these new practices – and the legacy organizations that will fight to

retain these services – may require unique space, staff, and product support.




24

Trend #3: Clinical care will be impacted by AI,

though applications will be limited by the quality of

data used to train the systems





25

Sources: “Why Google’s Artificial Intelligence Confused a Turtle for a Rifle,” Fortune, Nov 8, 2017; “IBM's Watson

recommended 'unsafe and incorrect' cancer treatments, STAT report finds,” Becker’s Hospital Review, July 25, 2018.

Turtles are rifles? AI can outperform humans, still fails at seemingly simple tasks

All that glitters is not gold


Examples of AI advancing health care Current headlines reveal critical shortcomings

Automates patient registration

Collects patient history

Determines likely diagnosis

Generates evidence-based care plan

Performs clinical documentation

Recommends specialists

Creates follow-up care plan

“Google’s Artificial Intelligence Confused a

Turtle for a Rifle”

- Fortune

“IBM’s Watson recommended ‘unsafe and

incorrect’ cancer treatments…”

- Becker’s Hospital Review




26

1. Registered nurse.

2. Length of stay.

Sources: “Process Improvements for Gwinnett Pulmonary Group After

3 Months on QueueDr,” QueueDr; “Hospital System Uses AI to Boost

Surgery Outcomes, Cut Costs,” Wall Street Journal, Nov 18, 2019.

AI today supports decision-making, automates tedious tasks


Workforce hiring Schedule management Supply standardization

• MultiCare Health System

integrates Arena machine learning

algorithm into hiring process

• Algorithm predicts the likelihood

that candidate will be retained in

their role

• Reduced 180 day RN1 turnover by

40% and overall turnover by 28%

• Gwinnett Pulmonary Group

uses QueueDr to maximize

appointment slot use

• Technology monitors cancellations

and offers slot to patients likely

to want the appointment

• Increased physician utilization by

15%, resulted in 582 fewer calls

made by staff per provider

• Intermountain leverages homegrown

AI to standardize supply use

• Technology evaluates large

volumes of clinical data; data is

displayed on dashboard allowing

physicians to compare costs and

outcomes against peers

• Reduced supply costs by 4%,

readmissions by 43%, complication

rates by 50%, and LoS2 by 35%

AI complements providers’ management of people, processes, and products




27

Current AI efforts focused on narrow, administrative tasks


Narrow,

tunnel-

vision

decisions

Clinical applications

Administrative applications

Flexible,

human-like

intelligence

Adaptive user

interfaces

INEVITABLE WITH TIME

TODAY’S OPPORTUNITY

SCIENCE FICTION

DISTANT FUTURE

An AI application landscape

Automated diagnosis

and treatment planClinical

chatbots

Radiology

interpretation

Recruiting

Smart

monitoring

Real-time medication

dosing adjustments

Administrative

chatbots (concierge)

Ambient

documentation

Worklist

prioritization

Capacity/staffing

management

Population health

risk predictions

The self-driving

hospitalInformation

security

Targeted

marketing

Revenue cycle

task automation

Precision

engagement

Predicting

terminal illness

Tumor DNA

diagnostics

Medical record

mining and extraction




28

1. Advisory Board is a subsidiary of Optum. All Advisory Board research,

expert perspectives, and recommendations remain independent.

2. Protected health information.

Sources: “Optum algorithm used to flag high-risk patients is found to have unintentional racial bias,” Modern

Healthcare, Oct 25, 2019; “Resistance to Medical Artificial Intelligence,” Journal of Consumer Research,

Dec 2019; “Google's 'Project Nightingale' center of federal inquiry,” CNN Business, Nov 15, 2019.

Barriers to AI implementation exacerbated in clinical setting


Regulatory landscape

• Google’s “Project Nightingale” revealed disconnect between current use

of medical data in AI and patient comfort with how their PHI2 is used

Patient trust

• Recent study of consumer receptivity to AI found patients are less likely to

use health care when the provider is automated rather than human

Data bias and quality

• Optum’s1 care prioritization algorithm was designed with an unintentional

bias, underestimating the health needs of black patients

Reimbursement status

• Payers have not determined how to reimburse the use of AI that

performs clinical tasks at a rapid pace

Common barriers to AI Barriers that significantly restrict adoption of AI in the clinical setting

• Workflow integration

• Data bias and quality

• Cost of technology

• Regulatory landscape

• Job displacement fears

• Reimbursement status

• Patient trust

• Competing provider priorities




29

Sources: “Meet Sophie: MDLive’s New Chatbot Powered by Artificial Intelligence,”

MDLive, Nov 29, 2017; “Robin Healthcare Raises $15 Million to Build Digital Assistant

for Doctors, Launches Partnerships with Leading Health Systems, and Adds Siri Co-

Founder Tom Gruber as Advisor,” PR Newswire, Sept 18, 2019; “AI Medical Gets

Breakthrough Device Designation for Endoscopic AI System,” FDANews, Nov 13, 2019.

Still, AI has potential to radically alter clinical care


Examples of AI used in the clinical setting today

1. Documentation acronym for subjective, objective, assessment and plan; predictive SOAP note uses evidence-

based medicine to suggest diagnoses and medications to improve efficiency and increase clinical quality.

Robin Assistant uses

ambient listening to

draft clinical

documentation

MDLive’s Sophie

chatbox frontloads

and automates

information gathering

including detailed

patient history and

SOAP1 note

AI Medical

Service’s algorithm

examines radiology

images to help

providers diagnose

gastric cancer

Livongo monitors

glucose data to

analyze, predict, and

prevent escalation

of diabetes




30



1At this point, AI’s success will be

primarily driven by non-

technological factors

To produce quality results, algorithms must be fed quality that accounts for clinical and

non-clinical factors that drive patient outcomes. Moreover, suppliers must be able to

articulate how these applications can be integrated into existing workflow and the

degree of interoperability across systems.

2Clinical and non-clinical staff must

brace for the impact that AI

In the shorter term, AI’s administrative applications will reshape the role of non-clinical

staff. In the longer term, as AI seeps into clinical care, clinical staff must develop new

skills and competencies so they’re able to integrate AI-related processes and outputs

into their individual workflow

3Digital health systems must

integrate technology with the

physical space and environment

Legacy facilities – and emerging care delivery spaces – must be designed to

accommodate more behind-the-scenes and point of care technologies.

4AI enables collection of more

patient health data, raising new

ethical and legal questions

More extensive collection of patient data has the potential to improve care

management; however, third party involvement in the space may continue to heighten

legal and ethical concerns about data privacy and ownership.




31

Trend #4: Clinical innovations will only be

valuable if purchasers and end users can and will

adopt them





32

1. Clustered Regularly Interspaced Short Palindromic Repeats.

Sources: Shaer, Matthew, “Soon, Your Doctor Could Print a Human Organ on Demand,” Smithsonian,

May 2015; Chatsko, Maxx, “Here’s Why CRISPR Therapeutics Jumped 42.2% in November,” The Motley

Fool, Dec 2019; Park, Alice, “Why It’s Time to Take Electrified Medicine Seriously,” TIME, Nov 2019.

Clinical innovation is pushing the bounds of science


3D-printed medical products

Immunotherapy

Manufacturing techniques

Examples of current and emerging manufacturing techniques and treatment modalities

New treatment modalities

“Bioprinted” organs

In use today On the horizon

CRISPR1 technology Bioelectric therapies

Benefits to patients and society

More personalized medical

devices and products1 More personalized and

targeted disease treatment2 Ability to treat previously

un-manageable diseases3




33

Health systems take a much broader view of “innovation”


Invention of a

novel product

or service

Iteration and

application of

best practices

Three primary goals of innovation

Enhance brand prestige Diversify revenue Improve core business

• R&D investments into new

clinical treatments

• Incubator for sourcing

ideas from within and

outside the organization

• Technology transfer for

commercialization of

intellectual property and

business development

• Venture fund for

investment returns

• Process improvements

to streamline

operational efficiency

• Clinical pathways that

make meaningful

improvements to

patient outcomes




34

Source: “The Biopharmaceutical Pipeline Innovative Therapies in Clinical Development,” Analysis Group, June 17,2017, https://www.ajmc.com/newsroom/new-report-

examines-the-biopharmaceutical-pipeline-and-innovation-in-clinical-development, Brady, Michael, “Verma: Drug ‘innovation doesn’t mean anything’ if it’s too costly,”

Modern Healthcare, Oct 2019; Martinez, Gina, “GoFundMe CEO: One-Third of Site's Donations Are to Cover Medical Costs,” TIME, January 2019.

Current system not set up for large upfront costs of new therapies

Innovations face affordability scrutiny


Public and payers looking for

affordability of clinical innovations

New payment models emerging to address

affordability challenges

Direct to patient subscription sales

Patients pay a subscription to drug

manufacturers each month for medication

“Netflix” model

Payer (typically state) pays fixed annual amount

to pharmaceutical company in exchange for an

unlimited supply of medication

Spread payments/mortgage pricing

Payer pays for expensive treatment over time,

continually assessing benefits to patient

Innovation doesn’t mean anything if people can’t

afford and access new drugs and therapies.

Seema Verma, CMS Administrator

Portion of all donations on GoFundMe

site that go towards health care costs

1/3

Of clinical innovations in development are potentially

first in class medicines, representing a possible new

class for treating a medical condition

74%



https://www.ajmc.com/newsroom/new-report-examines-the-biopharmaceutical-pipeline-and-innovation-in-clinical-development


35

1. Food and Drug Administration.

Adoption challenges are more than what meets the eye


• Determine alignment with organizational mission

• Estimate volumes and demands

• Run cost-benefit analysis, including audit of required staff

• Identify eligible patients

• Determine method for integrating with clinical workflows

• Develop a data management strategy

• And on…

Sticker price

Affordability is just the tip of the iceberg

FDA1 approval

Revenue cycle and billing

Staff support

Target population

Outcomes tracking

Patient education

Before investing in gene therapy, a provider must:

Gene therapy illustrates complexity of workflow integration




36

1. Return on investment.

Implications for suppliers and service providers


1Defining appropriate use may be

a powerful way to sharpen the

ROI1 argument for innovation

It’s crucial that suppliers assess whether and how a given partner defines the

problem that any innovation is trying to solve. Moreover, it may behoove

suppliers to assess the relative value of narrowly defined appropriate use with

higher potential to show clear ROI versus more broadly defined appropriate use

that may be more challenging to demonstrate ROI.

2Buyers and end users want

comprehensive support around

product roll-out

Investing in new clinical innovations is not without risks for health care

providers. As such, providers want support when addressing challenges related

to workflow, finances, and clinical outcomes. Suppliers can explore new

financing strategies, provide product-specific information to develop clinical

decision support tools, and may even leverage trials as a means of learning

about other adoption challenges that may be addressed with future customers.




37

Additional Advisory Board resources on each trend


“Anywhere” care

Physician independence

Artificial intelligence

Clinical innovation

• Cheat sheet: Telehealth

• Webinar: Telehealth market trends on

April 14 at 1:00 PM ET

• Resource: Physician archetypes

series Coming soon!

• Report: Innovative disruptors in

care delivery

• Resource: Artificial intelligence

resource library

• Report: How to understand and

address bias in AI Coming soon!

• Report: New innovation agenda

• Presentation: Unlocking

innovation at scale



https://www.advisory.com/research/health-care-industry-committee/members/resources/cheat-sheets/telehealth

https://www.advisory.com/research/service-line-strategy-advisor/events/webconferences/2020/2020-market-trends/telehealth-market-trends

https://www.advisory.com/research/market-innovation-center/research-reports/2018/innovative-disruptors-in-care-delivery

https://www.advisory.com/research/health-care-it-advisor/resources/2019/artificial-intelligence-resource-library

https://www.advisory.com/research/health-care-advisory-board/research-reports/2018/the-new-innovation-agenda

https://www.advisory.com/-/media/Advisory-com/Microsite/Research/2019/2019-20%20Health%20Care%20Advisory%20Board%20National%20Meeting/Presentation%20PDFs/Speech-E.pdf


38

Will the economic shock of “shelter in place” mandates leave millions more Americans unable to afford

basic care, let alone elective procedures?2

Will the lowered barriers to telemedicine use and reimbursement finally push virtual care services

toward a tipping point in terms of broader adoption?1

Pandemic likely to change health care; we just don’t know how or for how long

COVID-19 the emerging fifth trend


Will the unprecedented surge in demand for certain medical and protective supplies change how provider

organizations manage inventories and vendor relationships?3

Will the clinical and economic shocks to the system force the closure of more facilities and a new wave of

industry consolidation? 4

Will consumers and policymakers emerge from the crisis with different expectations for government’s

role in health care? 5

Five questions all health care leaders should consider




‹#›

Road mapRoadmap39

Four trends poised to reshape care delivery1

2 Challenges and next steps for the industry to move forward

• “Everywhere” care

• Physician independence

• Artificial intelligence

• Clinical innovation




40

How can we ensure that hindsight is 20/20?

WORST CASE

SCENARIO

BEST CASE

SCENARIO

Site of care shift

• Patients are empowered to

get clinically and cost

effective care wherever

and whenever they want it

• Disparities in health care

increase; some patients gain

access to care at the expense

of others

Rise of independent

physicians

• Independent groups bend

the cost curve by creating

market competition among

large health systems

• Independent groups seek

scale without integration

and fail to reduce costs

Proliferation of AI

solutions

• Technologies perpetuate

inherent biases and sow

distrust across parties

• AI enhances operational

efficiency and improves

patient experience

Exponential

innovation

• Life enhancing innovations

are not adopted

• Technologies and

therapies cure previously

untreatable diseases

Behind each trend is a cautionary tale





41

Not yet clear how different industry pieces will fit together


Clinicians

Patients

Decentralization heightens the importance of cross-industry collaboration




42

Care fragmentation complicates information ownership


How can groups across the industry work together to ensure decision-makers have accurate and complete

information at the point of decision?

Information no longer centered on single EHR




43

Source: “Start Here: Getting Real About Social Determinants of Health,” IHI, December 21, 2018; “Social Determinants, Children, And More,” Health Affairs, May 6, 2019; Ansell D, The Death Gap – How

Inequality Kills, Chicago, IL: The University of Chicago Press, 2017; “Incorporating Patients’ Social Determinants of Health into Hypertension and Depression Care: A Pilot Randomized Controlled Trial,”

Community Mental Health Journal, April 4, 2017; “Assessing the Social Determinants of Health Care Costs for Medicaid-Enrolled Adolescents in Washington State Using Administrative Data,” Health Services

Research, September 16, 2018; “Inpatient Health Care Utilization Among Patients Who Require Interpreter Services,” BioMed Central, 15, no. 214 (2015); Social Risk Factors and Performance Under

Medicare’s Value-Based Purchasing Programs,” US DHS Report to Congress (2016); “Estimating the Health-Related Costs of Food Insecurity and Hunger,” Bread for the World Institute, November, 2016.

Undeniable impact on health outcomes and spending

Growing awareness and interest in SDOH1


2XIncreased risk of

developing coronary

artery disease due to

social isolation

16 yearsDecrease in life

expectancy across six

mile stretch in Chicago

neighborhoods

2XHigher death rate for

individuals

unemployed for

more than six years

Higher risk of

developing mental

health conditions due

to exposure to violence

and feeling unsafe

during childhood

5X

Impact on patients Impact on system

$155BAnnual cost to the U.S.

health system due to

food insecurity

24-67%Higher likelihood of

readmission for patients

dually enrolled in

Medicare and Medicaid

$2,320Per capita annual

health system

expenses due to

housing instability

60%Higher risk of ED

utilization for patients

requiring language

services

1. Social Determinants of Health.




44

Suppliers must evolve in lock step with provider strategy


Case study

University of Vermont

devotes a minimum of

$464K annually to fund

affordable housing units

University of

Pennsylvania leads three

RCTs¹ to create a

community health worker

standard

Methodist Le Bonheur

convenes 500+ churches

to create a medical

liaison network

Texas Health Resources

deploys team to advocate

for local, state, and

federal policies

Rush University

Medical Center hires

locally, purchases

locally, and offers

impact investing loans

1. Randomized Controlled Trials.

Examples of provider organizations driving community impact at scale

ADVANCEDTRADITIONAL

Role Funder Convener Expert Advocate Anchor

How can you support provider partners’ efforts to address social determinants of health?




45

Providing a solution is not enough to drive change


Where are efforts to evolve the industry bumping up against existing behaviors and how can we enable more

seamless change?

What one payer sees What providers are dealing with

• Use of fax machine slows down

information sharing

• Online portal can improve process

efficiency

Real life example shows disconnect between the surface and what lays beneath

• Other payer partners will still send reports

via fax

• While payers offer online portals, each

requires unique log-on, offers different

information, and different navigation




46

Suppliers can create connections across fragmented system


Health plans Health systems

Clinicians

Patients

Employers

Life Science

Health IT

Facility planners

Service providers

Ideal state of the industry Recap of the guiding questions that can help get us there

Where are efforts to evolve the industry bumping up

against existing behaviors and how can you enable

more seamless change?

How can you support provider partners’ efforts to

address social determinants of health?

How can groups across the industry work together to

ensure decision-makers have accurate and complete

information at the point of decision?




47

1. Private Equity.

2. Ambulatory Surgery Center.

Some of the questions we’re tackling this year

Continuing the conversation in 2020


CUSTOMER INSIGHT

• How are aggregators, PE1 investors,

retail giants and innovative start-ups

disrupting primary care?

• Are IDNs losing their position as the

physician employer of choice?

• What factors influence medical groups’

adoption of new technologies,

appetite for risk, and patient

engagement strategies?

• What segmentation models can help

suppliers and services firms align

solutions with different medical groups’

priorities?

COMMERCIAL ENABLEMENT

• How are value analysis programs

changing in light of IDNs’ continued

consolidation and integration?

• How can suppliers best diagnose a

value analysis committee’s maturity

and sophistication?

• How can suppliers best engage and

coach clinician champions?

• How can account teams facilitate more

meaningful conversations about

product value internally and with IDN

or ASC2 customers?

• Which clinical and IT innovations – including AI,

genomics, digital therapeutics, and precision

medicine – are most poised to disrupt care

delivery in the next 5-7 years?

• How might such innovations reshape the

staffing, IT, workflow, and space requirements

for delivering low cost, high quality care?

• How will provider, payer, and patient

organizations look to incubate, integrate, or

hinder such innovations?

• How can supplier organizations partner with

providers to help them capitalize on change?

FUTURE PLANNING

The changing physician

landscape

The value analysis playbook The likely and unlikely impacts of

disruptive innovation

Comments? Reach out to your Dedicated Advisor.




48

Coming soon! Your chance to brush up on our IDN insights

Advisory Board

research reportsNew and updated market

trends and cheat sheets

Recorded and live

webinars

Look out for an email from your Dedicated Advisor

with more information




Credits

50

Lindsay Conway, Managing Director

Brandi Greenberg, Managing Director

Program Leadership

Nick Hula, Analyst

Sydney Moondra, Analyst

Jessica Preston, Analyst

Miriam Sznycer-Taub, Senior Consultant

Research Team

202-266-6454

[email protected]

Jessie Goldman

Project Director

Health Care Industry Committee



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