Patient-Centered Collaborative Care: Enabling New Healthcare Delivery Models

Patient Centered Collaborative Care: New Healthcare Delivery Models Enabled by Information Technology Dr. Joseph M. Jasinski Distinguished Engineer and Program Director Healthcare and Life Sciences IBM Research

Today’s Discussion • What does Accessibility mean in the Context of Healthcare? • A New Healthcare Delivery Model • Technologies to Enable Improved Healthcare Delivery IBM Research |

Healthcare Environment – More Spending Does Not Guarantee Better Health as Measured by Longevity • World spends about $4.5Trillion, U.S. spends about $2Trillion • US ranked 37th by WHO in Healthcare effectiveness (btw Costa Rica and Slovenia) • In the U.S 42% of spend is Centers for Medicare and Medicade Services, much of the rest is large employers • Large Corporations spend significant amounts on healthcare through self insurance • 47 million Americans have no health insurance • Approximately 100K deaths in US every year from preventable medical error. Source: IBM Global Business Services and IBM Institute for Business Value IBM Research |

A proactive, value-based health system should help move people from right to left – and keep them there. IT is a natural way to improve efficiency, safety and reduce costs Health care spending Health Status Active Disease Early Symptoms At-Risk High Risk Healthy/ Low Risk 20% of people generate 80% of costs A value-based health care system Source: IBM Global Business Services and IBM Institute for Business Value IBM Research |

What Does Accessibility Mean in the Context of Healthcare? • Accessibility Challenges • Availability: Shortage of Primary Care Physicians; Needs of Rural/Developing Economies • Cost: Universal Access to Health Insurance; Chronic Disease; Genetic Predisposition • Physical Access: Elderly, Home Bound, Limited Mobility • Cognitive Access: Literacy, Language, Cognitive Impairment IBM Research |

Why is the healthcare system broken? “ We don't have a health care delivery system in this country. We have an expensive plethora of uncoordinated, unlinked, economically segregated, operationally limited micro systems, each performing in ways that too often create suboptimal performance both for the overall health care infrastructure and for individual patients." George Halvorson We believe…. • Collaboration across the full care team is missing • Taking a longitudinal view of the whole person’s health from wellness and prevention to at risk to chronic care to end of life is missing • Technology is insufficient and not helping the care team do their jobs, thus not being adopted • Accountability and incentives are not in place to encourage delivery of quality cost effective care • Care is not centered on patient needs IBM Research |

Healthcare Team Physicians Healthcare Team Care Givers Medicaid Client Patients Medicaid Staff Employers What do we want our healthcare to be? I want my healthcare to be IBM Research |

The political pressure for healthcare reform has never been greater • “…the cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year.” - President Barack Obama Tools to Rebuild and Restructure Health Care Source: Obama, Barack. “Remarks of President Barack Obama -- Address to Joint Session of Congress” http://www.whitehouse.gov/the_press_office/Remarks-of-President-Barack-Obama-Address-to-Joint-Session-of-Congress/ IBM Research |

Patient Centric/Personal Physician Physician directed medical “team” Whole person orientation Care is coordinated and/or integrated Emphasis on quality and safety Enhanced access Appropriate reimbursement Patient-Centered Medical Home (PCMH) is an approach to deliver comprehensive care, coordinated by a physician-led care team (not your house with a lot of technology) Brief history of the evolution of the PCMH: 1967: American Academy of Pediatrics defined medical home concepts related to children with special needs 2000-present: AAFP and ACP developed and extended the concept to include care for all patients with chronic illness and patient centeredness 2006-07: AAFP, AAP, ACP and AOA develop a common definition of “patient-centered medical home” and link PCMH to reform of payment for physicians Technology, Services & Applications to Support the New Collaborative Care Model Personal Relationship with a Physician and Care Team Proactive Focus on Health, Care Intervention and Chronic Disease Management + + Principles of PCMH “The Patient-Centered Medical Home (PCMH) provides care that is “accessible, continuous, comprehensive and coordinated and delivered in the context of family and community.”1 Source: 1) www.medicalhomeinfo.org/join%20statementpdf IBM Research |

Medical Home in the Current National Debate on HC Reform • Current House Legislation • Medical Home Pilot Program --An expansion of the medical home demo in Medicare. Establishes a medical home pilot program to asses the feasibility of reimbursing for qualified patient-centered medical homes. There are two models in the program: 1) the independent patient-centered medical home structured around a provider, targeted at the top half of high need Medicare beneficiaries with multiple chronic diseases, or 2) the community based medical home, targeted at a broader population of Medicare beneficiaries with chronic diseases and allows state-based or nonprofits to provide care management. Provides approximately $1.6 billion from the Trust Fund for the 5 year pilot programs • Medicaid medical home pilot program -- A 5-year medical home pilot program for high-need Medicaid beneficiaries. The federal government would match costs of community care workers at 90% for the first 2 years and 75% for the next 3, up to a total of $1.235 billion. IBM Research |

Working Definitions for Today’s Discussion • Electronic Medical Record – EMR. An electronic collection of patient documents specific to one physician, clinic, hospital. (Also Electronic Patient Record – EPR) • Institution or physician centric • Episodic • Many versions and types exist • Electronic Health Record – EHR. An electronic collection of all healthcare documents for an individual • Patient Centric • Longitudinal • ‘Gold Standard’ – physician and institution maintained • Very few exist in reality • Personal Health Record – PHR. An electronic collection of all healthcare documents that an individual chooses to maintain • Patient Centric • Longitudinal • Patient Controlled and Editable • Emerging area for healthcare in some countries IBM Research |

http://www.accenture.com/NR/rdonlyres/15D767DA-7F3F-4AE6-ABDD-8260DA7BFFC5/0/eHRbrochureJune06.pdfhttp://www.accenture.com/NR/rdonlyres/15D767DA-7F3F-4AE6-ABDD-8260DA7BFFC5/0/eHRbrochureJune06.pdf IBM Research |

Denmark IBM Research |

Sundhed.dk • General information • Information from hospitals all around Denmark • Yellow-pages for the entire Danish health sector • Waiting-list information • Information about medicine • E-booking calendar • Secure communication (“e-mail”) • Personal Medicine Profile • Citizens event log • Registration as Donor Services for Citizens IBM Research |

Mobile Health – Robust Monitoring for Outpatient Population Initial application for pharmaceutical industry drug trials Real-time feedback improves patient safety Enables monitoring and dosage adjustments based on results Accuracy & compliance documented Sensor equipped Bubble Pack Compliance monitoring Real-time Feedback Health Monitoring Data Server Bluetooth Enabled IBM Research |

PlugFest November 2008 PAN Interface XHR Interface Device Manager Sender Receiver PHM Report • Glucose Wired Glucose Meter (canned) Telehealth Service PHR Wired Glucose Meter (canned) PHM Report • Weight Wired AHD EHR Telehealth Service Wired Weighing Scale Wired Independent Living Activity Hub IBM Research | Continua Health Alliance 18

Online Analytics using a stream optimized system CENTURY’S FOCUS PROACTIVE OUTBREAK DETECTION REALTIME HEALTH CENSUS VERY LARGE NUMBER OF STREAMS Census, CDC HIGH SPEED STREAMS MONITORING SERVICES Biometric Sensor Data SLOW SPEED STREAMS TRENDING ANALYSIS + Contextual Data Sources CLINICAL DECISION Clinical, Insurance WELLNESS SERVICES THIRD PARTY CONSULTING SELF MANAGEMENT Wellness, Citizen IBM System-S IBM Research |

Medical Information Hub Source: Andre Elisseeff Zurich Rsch and Nhumi Corp http://www.youtube.com/watch?v=VAwYdmUd59A IBM Research |

Real time speech to speech language translation IBM Research |

Patient-Centered Collaborative Care: Enabling New Healthcare Delivery Models