HIMSS CEO Addresses Leveraging Information and Technology to Minimize Health s Economic Challenges Session # 96 March 6, 2018 Hal Wolf CEO, HIMSS

Challenges in Most Systems Fastest Ageing Population High Chronic Disease Burden Geographic Displacement Extremely Challenging Funding System Highly Educated and Demanding Consumer Lack of Actionable Information

Total Health Expenditure per Capita, USD, 2014 Source: World Health Organization, Global Health Expenditure Database 2014

Public Share of Total Health Expenditure, USD, 2014 Netherlands Thailand Qatar Norway Denmark Sweden UK New Zealand Estonia France Finland Saudi Arabia Costa Rica UAE Spain Malta Australia Ireland Switzerland China Chile USA Brazil Singapore India 30.0% 87.0% 86.0% 86.0% 85.0% 85.0% 84.0% 75.0% 77.9% 79.0% 82.0% 83.0% 75.0% 73.0% 72.0% 71.0% 69.0% 67.0% 66.0% 49.0% 56.0% 66.0% 42.0% 46.0% 48.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Source: World Health Organization, Global Health Expenditure Database 2014

Percentage aged 60 years or over Economics of Healthcare Percentage of the population aged 60 years or over for the world and regions, 1980-2050 35 30 25 20 15 10 World Europe Northern America Oceania Latin America and the Caribbean Asia Africa 0 1980 1990 2000 2010 2020 2030 2040 2050 Source: United Nations (2015). World Population Prospects: The 2015 Revision.

Billions The Silver Tsunami is Approaching 2.5 2 1.5 1 0.5 0 Year: 2015 Year: 2030 Year: 2050 Source: United Nations (2015) World Population Prospects: The 2105 Revision

Age Increases, Demand for Services Increase One Service Delivered to patients under 60 years old Three Services Delivered to patients over 60 years old

Global Average Ratio of Skilled Healthcare Workers to Population 23 skilled health professionals per 10,000 people Source: World Health Organization, A Universal Truth: No Health Without a Workforce, Third Global Forum on Human Resources for Health Report 10,000+

Millions Skilled Healthcare Workers Global Shortage 14 12.9 M 12 10 8 7.2 M 6 4 2 0 Year: 2018 Year: 2035 Source: World Health Organization, A Universal Truth: No Health Without a Workforce, Third Global Forum on Human Resources for Health Report

Economics of Healthcare Number of workers per dependent, Ratio of working-age population (aged 15-64) to dependent population (aged 0-14 and over 65) 3.0 Today Projected 2.5 2.0 1.5 India Less developed economies China Developed economies 1.0 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 Source: United Nations population statistics: McKinsey analysis

National Regional Municipality Acute Facility Provider Group Who Holds the Risk?

Defining the Care Setting

How We Think of Care Delivery and the Medical Model Primary Prevention Secondary Prevention Acute Care Chronic Care The Continuum of Care

What Makes a System Successful Six Attributes of an Ideal Health Care Delivery System Information Continuity Care Coordination and Transitions. System Accountability Peer Review and Teamwork for High- Value Care Continuous Innovation Easy Access to Appropriate Care

Progression of Care Delivery Models Traditional Primary Care Chronic Care Model Primary Care Medical Home Medical Neighborhood Integrated Delivery System

Progression of Care Delivery Models Models of Care Traditional Primary Care Chronic Care Model Primary Care Medical Home Medical Neighborhood Integrated Delivery System Characteristics Participants Relationship, holistic, and access Patient Primary Care Physician (PCP) Use registries and teams to provide proactive care to patients with specific chronic conditions Patient PCP Chronic Care Team Combines traditional primary care with chronic care model, PCP as focus Patient PCP Primary Care Team Brings providers of patient care together in an integrated way (real or virtual) Patient PCP Multiple Care Teams Specialists Hospital/community resources Like medical neighborhood, plus infrastructure, financing and governance KP, Intermountain are exemplar, ACOs trying to recreate this model Same as medical neighborhood ACO requires a central governing body and a medical director Clinical System Roles Minimal use of Clinical Decision Support tools Registries using clinical data to prompt follow-up and outreach Primary care clinical data potentially augmented with claims data from other settings All providers across the continuum can access clinical information and proactively use Clinical Decision Support tools to improve care End-to-end patient view of clinical/care data and financial data

Integrated Delivery System with Coordinated Care More than assembling the pieces of a puzzle To be successful the integrated whole must deliver substantially more value to all within the system than the sum of the parts The right care to the right patient at the right time in the most appropriate setting Shared commitment to eliminating functional, structural, funding impediments to efficiency Aligned incentives across and within entities no one benefits by sub-optimizing partners Rational Technology to support the end to end vision of care

A Patient s View

Meet Bandit and Adam

Who had the First Patient Registry for Prevention?

We Support the Medical Model with the Increased Use of Personalized Information Genomics Personalized Health Population Care/ Mass Production Sub Segmentation (risk & conditionbased) Integrated Medical Conditions Patient Preferences/ Personal Circumstances Medical Model

But There s a Catch

The Consumer is Bringing Their Own Personalized Needs and Data Health Model Patient Preferences Personal Circumstances Personalized Health Medical Model Population Care/ Mass Production Sub Segmentation (risk & conditionbased) Integrated Medical Conditions Genomics

How Do Weave Together the Personalization of the Two Models Health & Medical Model Personalized Health Population Care/ Mass Production Sub Segmentation (risk & conditionbased) Integrated Medical Conditions Patient Preferences/ Personal Circumstances Genomics

The Challenge in Front of Us New opportunities exist to integrate the disparate components of the healthcare ecosystem, create greater connectivity and build 24/7 access to care.

Defining Digital Health

Digital Health By Any Other Name When I use a word, Humpty Dumpty said in rather a scornful tone, it means just what I choose it to mean neither more nor less. Lewis Carroll Telehealth Telemedicine Mobile Health (mhealth) Virtual Health Bio Med Devices (Wearables)

What is Digital Strategy? Consumers, Patients, & Families Payors Digital Strategy is about Health System CONNECTIVITY Digital strategy is the use of technology enabled innovation to extend and deepen connectivity between the health system and its consumers, clinicians, payors and care continuum partners. Physicians & Care Team Providers Other Care Continuum Providers & Partners Source: Chartis Group 2016

Consumer Preferences Driving Changes in the Healthcare Landscape

Searched for INFO. % Acted Upon Information Knowledge Management and Consumer Actions Searching online for health information is the most well-adopted digital health category, with 40% of those who search acting directly upon the information they find. Prescription Drugs Diagnosis Supplements 60% Information about prescription drugs or side effects 57% A diagnosis based on your symptoms 52% 35% 45% Asked his or her physician to prescribe a specific drug or asked to discontinue a specific drug Proposed own diagnosis to his/her physician Treatment Options Information about supplements 49% Treatment options based on your diagnosis 40% Purchased or discontinued use of a supplement Searched for REVIEWS Physician 44% Hospital 33% Nursing Home 10% Caregiver 7% Nearly half of Americans go online to find provider reviews. 36% Proposed a treatment to his/her physician While adoption of searching for health information online is strong, consumers still rank physicians, friends, and family highest when it comes to trustworthiness of sources. Consumer survey data, n=4,017 Source: Rock Health, Digital Health Consumer Adoption: 2015, accessed Feb. 2016

Home Care: Digital Health and Mobile Devices In a survey of 250 home care users (either seniors receiving home care or loved ones arranging it), many saw technology, including wearables and mobile devices, as a way to improve health care management. 88% said they would value access to an online or mobile app providing information about their loved one s home care visits. 75% said they would pay a premium for that access. (34% said they would pay more than $25). 87% said they would be able to answer three to give questions on a tablet after each visit. Respondents were asked about other areas of home care where they predicted wearables playing a role in the future: 52% said they could alert home care providers about unusual changes in activity level, heart rate, or temperature. 50% saw value in reminding providers about things like appointments, prescriptions, and meal times. 40% thought wearables would be impactful by sending real-time alerts from a home care agency to a member or their emergency contact. Source: Comstock, J.,Survey: Half of aging in place seniors believe wearables will improve home care. mobihealthnews, March 2017 40% hoped wearables could diagnose potential ailments in home care recipients.

Telemedicine Usage of telemedicine is highest amongst the 35-54 age bracket across all mediums, with adopters reporting high satisfaction. 18-24 29% E-MAIL TEXT MESSAGE VIDEO 28% 12% 7% overall adoption overall adoption overall adoption 35% 36% 11% 32% 57% 6% 41% 53% 25-34 30% 34% 37% 10% 33% 57% 9% 41% 50% 35-44 31% 37% 33% 13% 31% 56% 9% 40% 50% 45-54 28% 36% 36% 11% 32% 56% 7% 40% 52% 55-64 28% 35% 37% 9% 28% 63% 7% 37% 56% 65+ 25% 38% 37% 8% 31% 61% 4% 36% 60% Used Planning to Use No Plans to Use Consumer survey data, n=4,017 Source: Rock Health, Digital Health Consumer Adoption: 2015, accessed Feb. 2016

The Growth of Consumer Data Generation Expands the Healthcare Business Relationship Traditionally, healthcare data exchange only occurred B2B. Digital health capabilities has expanded these relationships to include B2C, C2B, and C2C.

Digital Transformation Leadership from the C-Suite Digital transformation is expanding the roles and responsibilities of the C-Suite, but most initiatives are being led by the Chief Medical Officer. Question: 15% Chief Digital Officer 5% Chief Experience Officer Which executive is leading the digital transformation initiative? Source: Altimeter, The 2016 State of Digital Transformation, 2016 n=500+ 19% Chief Technology / Information Officer 27% 34% Chief Medical Officer Chief Executive Officer

A Customer Focus

Operationalizing Innovation

Moving Beyond Visit-Centric Medicine Traditional Encounter Based Care One patient at a time Only know about patients who appear in your office No use of IT Limited use of data Accountability for panel/population New Model Elements Transparency Use of EMR, registries, mobile Team care (including patient) Moving care out of doctor s office

The Clinical Ecosystem Impacted Physicians Nurses Other Care Providers Patients Clinical Operations Administration Commissioning Legal Patients Mobile devices Patient / Clinical Clinical Systems IT Infrastructure Facilities

Shelves are Full of Impactful Books on Innovation

Sometimes innovations is seen as significant departures in an industry, capability or medium Innovation Comes In All Sizes

Innovation Comes In All Sizes Sometimes innovations is seen as significant departures in an industry, capability or medium Sometimes innovations are seen as small and rapid improvements and changes to the an existing environment

Innovation as an Emerging Core Competency for Healthcare Providers?

How is Innovation Described?

Innovation Inside a Healthcare System Innovation only succeeds when the interest of diverse stakeholders can be aligned so that trade-offs are sufficiently beneficial to overcome the cost or risk of adopting the new way of working

Innovation Inside a Healthcare System The electric light did not come from the continuous improvement of candles

It s Not Just the Innovation OO + NT = COO

It s Not Just the Innovation OO + NT = COO Old organization + New Technology = Costly Old Organization

Innovation and Change Management as a Focus of Minds is Not New Nothing is more difficult than to introduce a new order. Because the innovator has for enemies all those who have done well under the old conditions and lukewarm defenders in those who may do well under the new. Niccolo Machiavelli (1469 1527)

Thank You!