This was my first year attending the Forum 2012 conference created by the Care Continuum Alliance. I’ve always enjoyed their journal publications and found them to be substantial in providing new and cutting edge information on population health. The sessions were informative and following were the common themes:
- Customers (not patients) are the main drivers of healthcare. Patients are only a subset of the larger consumers. The consumers include parents, caretakers, employers etc.
- Technologists are the 2nd largest drivers of Healthcare. 98% of the time spent by consumers is in their life compared to the 2% spent in taking care of their health. Technology is making many innovations in the 98% life space more so than the actual point where healthcare happens.
- There are 6 customer segments in the US Healthcare market:
1. Content and Compliant 29%. This group is satisfied, passive and they trust their doctors.
2. Casual and Cautious 28%. This group is disengaged.
3. Sick and Saavy 24%. This is the largest users of healthcare services. They are proactive, preventative and they partner with their doctors.
4. Online and Onboard 8%. This group in primarily interested in quality and perform a lot of research, especially online.
5. Shop and Save 2%. This is the price sensitive group who is interested in a good buy.
6. Out and About 9%. Interested in alternative medicine, homeopathy, yoga, vitamins, supplements etc.- Groups 1 and 3 make up 53% of the market which can be lumped as the Traditional Approach group.
– Groups 4, 5 and 6 make up the alternative group and group 2 makes up the disengaged population
The characteristics of the NEW Health Consumer are:
- Older, reaching about 100 years (it is expected that the average person will live to be 100 years of age).
- Better informed. They are interested in a smart buy.
- Smarter. They look for how their needs are met.
- They care more about being functional rather that fully disease free.
- Caregivers of the aging population.
- Busy women. Family CEO, makes 80-90% of the healthcare decisions for the household.
- In complex situations and thus demand SOLUTIONS not DATA.
- Does not trust large systems and large institutions. I trust people like me is the key rule here. This leads to online communities and magazines.
- Biometric Screenings are only the starting point of wellness. Biometric screenings constitute the front end of data collection and care for wellness, but they are only the starting point. Many wellness vendors do not know what the next steps are after fulfilling this step. In fact, much of the wellness vendors are essentially a phlebotomist scheduling service.
- Worksite wellness primarily aims to increase productivity and lower cost. Employers are in a unique position to own the overall preventative health of employees and are primarily driven by internal productivity factors which include absenteeism, presenteeism and retention. Financial ROI is only important to get the initial buy off – the employers seem driven more by the productivity gains rather than ROI savings.
- Industry is moving from ROI to VOI. The industry is not only interested in the hard dollar savings, which are important to get started, but Value on Investment, which is broad and difficult to define. There is a difference between participation and engagement of a population and VOI drives towards meaningful engagement. The actual metrics for VOI depend on the organization and its strategic objectives when it comes to health.
- Coordinated care and delivery is key to quality and cost. Our healthcare systems today center around the systems themselves, around providers and around the science rather than the person receiving the services. As a result, much care is not coordinated or simply not occurring. IDN’s are emerging as the new organization, more so than ACO’s, to be the glue that integrates detection, care delivery, post care delivery, social services and care coordination among multiple providers for the same patient.
Hospital Readmissions in Medicare Population
Hospital Readmissions predictive models are mediocre at best. 20% of Medicare folks are readmitted to hospitals in 30 days and 49% are readmitted in 7 days. There is $15 billion in potential savings.
The C-Stat of over 26 predictive models for readmissions hovers around 0.7. The greatest contributing factor to predictability is social factor data such as:
- Needing help around the house
- Needing transportation
- Needing same day follow up
- Needing meal support
Factors leading to hospital readmissions
- Social Factors
- Inpatient Care Quality
- Post Discharge Care
- Bed Supply (if there are lots of beds available, there tends to be more readmissions)
A 3-staged approach can reduce hospital readmissions
1. Day 1-2: reach out to entire population within 48 hours to triage appropriately. This should be done during post hospital discharge.
2. Day 3: Inform PCP that their patient was in the hospital so that PCP can touch base and ensure proper care is occurring
3. Day 7+: Post program check-in should occur within 30 days.
It seems that the old world of disease management (managing chronic conditions) is in the midst of transforming as we speak towards population health management (managing health of everyone from sick to healthy). The above topics will be key factors to help facilitate that transformation. For population health companies to be successful, whether they be a payer, a provider or both, it is critical to understand the new model of consumerism, transform the internal operations of population health and have strong analytical and predictive capabilities to tackle high-cost items such as readmissions.