1 / 29

Learning 2.0: Robust, Rigorous, Relevant, and Rapid

Learning 2.0: Robust, Rigorous, Relevant, and Rapid. Paul Wallace MD Permanente Federation Kaiser Permanente Paul.Wallace@kp.org. “Gray Areas”. The last 115 new technologies examined:. ?. Generally not medically appropriate. Medically appropriate. 7.

felicia-korbin
Download Presentation

Learning 2.0: Robust, Rigorous, Relevant, and Rapid

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Learning 2.0: Robust, Rigorous, Relevant, and Rapid Paul Wallace MD Permanente Federation Kaiser Permanente Paul.Wallace@kp.org

  2. “Gray Areas”... The last 115 new technologies examined: ? Generally not medically appropriate Medically appropriate 7 • Insufficient evidence because the evidence is: • Of insufficient quantity and/or quality • B.Conflicting or inconsistent • C.There isno evidence 38 66 3 1 3

  3. “Gray Areas”... The last 115 new technologies examined: Generally not medically appropriate Medically appropriate 7 • Insufficient evidence because the evidence is: • Of insufficient quantity and/or quality • B.Conflicting or inconsistent • C.There isno evidence 38 66 3 1 4

  4. Comparative Population Effectiveness: The Kaiser Permanente National Joint Replacement Registry [Evaluation] feedback changed practice with respect to: implant selection, minimally invasive procedures, uncemented knees, and surgical indications and preoperative care. Paxton,EW et al; The Permanente Journal 15:12-16, 2008

  5. Predictive Modeling... In patients with diabetes, Aspirin-Lisinopril-Lovastatin (ALL) as a daily combination, has a greater impact on cardiovascular risk than aggressive HbA1c (glucose) control

  6. Sean Tunis, CMTP 8

  7. The Business of Health Care in 2009… chronic health conditions increasingly underlie the bulk of health care costs 1% of people Diabetes Heart Failure Coronary Artery Disease Depression Chronic Pain Cancer Asthma and COPD Dementia Falls Obesity … CO-MORBIDITIES 100% 80% 30 + % of total cost 60% 40%  Premium level 20% 0% total cost 0% 0% 20% 60% 80% 100% 40% 20% of people 70% of people % of People

  8. Is “more care better” for the patient with Multi-Morbidity? Desired Result N Engl J Med 351;27 2870-2874 December 30, 2004 What is the “dose response” for relating the number of things you do to achieving clinical outcomes? # of Interventions

  9. A key challenge FFS Medicare (Not to scale at higher ages – not even close!) Usual Care $ Prevention 20 30 40 50 60 70 80 90 Working Years Working or Not? Age Phil Madvig MD The Permanente Medical Group

  10. A key challenge: Living to utilize... FFS Medicare Usual Care (Not to scale at higher ages – not even close!) $ DM + End-of-Life PalliativeCare Prevention 20 30 40 50 60 70 80 90 Working Years Working or Not? Mortality diff Age Phil Madvig MD The Permanente Medical Group

  11. Care in the last 6 months of life... Non-KP Medical Centers (Same Cities) Non-KP Medical Centers (All US) KP Medical Centers • The Dartmouth Atlas Applied to Kaiser Permanente: Analysis of Variation in Care at the End of Life • By Matt Stiefel, MPA, Paul Feigenbaum, MD, and Elliott S Fisher, MD, MPH • The Permanente Journal/ Winter 2008/ Volume 12/ Number 1

  12. Health 0.0 • “Rules of the Game” model • Coverage policies, prior approval, ‘utilization management’ • ? Evidence Based Medicine

  13. Health 0.0 • “Rules of the Game” model • Coverage policies, prior approval, ‘utilization management’ • ? Evidence Based Medicine • “Skin in the game” model • Co-payment and Deductibles • Financial incentives • High Deductible, Value Based and Consumer Directed Health Plans • (Shared Decision Making)

  14. Health 0.0 • “Rules of the Game” model • Coverage policies, prior approval, ‘utilization management’ • ? Evidence Based Medicine • “Skin in the game” model • Co-payment and Deductibles • Financial incentives • High Deductible, Value Based and Consumer Directed Health Plans • (Shared Decision Making) • “Brain in the game” model • Sustainable behavior change • Motivational interviewing and coaching • Shared Decision Making

  15. Health 1.0...

  16. Health 2.0 • User Generated Content • Patient Networks and Communities • “Dis-intermediation” • Patient-centered Personalized

  17. Health 2.0

  18. Health 2.0 ... Evidence Challenge

  19. Research 2.0 ???

  20. Cross cutting values...Health 0.0 thru 2.0 The Trusted source Knowledge-based Values-based

  21. An Oncology Patient in 2020...

  22. An Oncology Patient in 1996...

  23. An Oncology Patient in 1996... • “Don’t tell me what to do, doc...

  24. An Oncology Patient in 1996... • “Don’t tell me what to do, doc... • Help me understand what all this information means for me.”

More Related