Quantum Care Leadership in BioBusiness USC Marshall School of Business Spring 2006 Keith Strier, JD

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Quantum CareLeadership in BioBusinessUSC
Marshall School of BusinessSpring 2006Keith
Strier, JD Innovation LeaderDeloitte Touche
LLP
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Quantum Care
Transparent
Patient-Friendly
Molecular-Based
Information-Driven
Evidence-Based
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Agenda

• Introductions
• Uncertain Medicine Current State of Care
  Delivery
• Artful
• Opinion-Based
• Cost-Driven / Reactive
• Facilities-Based
• Towards Certainty Quantum Care
• Transparent / Patient-Friendly
• Information-Driven / Evidence-Based
• Molecular-Based
• Barriers
• Infrastructure
• Incentives
• Closing Thoughts

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Who is Keith Strier?

• Deloitte Touche LLP
• Practice Leader, Innovation Emerging
  Technologies, Health Industry Practice
• National Provider Alliances Leader
• Strategy Lead, Innovation Growth Practice
• CapGemini
• Co-Founder, Public Sector Health Practice
• Leader, Military Health Practice
• Affiliations
• Guest Faculty, Harvard Medical School MIT Joint
  Health Science Technology Program
• Visiting Lecturer, UC, Irvine Healthcare MBA
  Program
• Strategic Advisor, eHealth, The World Bank
• Member, Industry Advisory Boards TETHICS, NMHCC,
  SoCal HIMSS.
• Education
• BSILR, Cornell University
• JD, New York Univ. Law School

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Agenda

• Introductions
• Uncertain Medicine Current State of Care
  Delivery
• Artful
• Opinion-Based
• Cost-Driven / Reactive
• Facilities-Based
• Towards Certainty Quantum Care
• Transparent / Patient-Friendly
• Information-Driven / Evidence-Based
• Phenotype Molecular-Based
• Barriers
• Infrastructure
• Incentives
• Closing Thoughts

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The Artistry of an Uncertain Discipline

• Uncertainty influences virtually all of medical
  decision making.
• McNeil BJ. Hidden barriers to improvement in the
  quality of care. N Engl J Med 2001345 1612-20.
• I doubt very much whether Corvisart in 1800 was
  any more skilful in recognizing a case of
  pneumonia than was Aretaeus in the second century
  A. D.
• The Evolution of Modern Medicine, Sir William
  Osler
• A 2003 New England Journal of Medicine study of
  over 400 indicators of quality care for 30 common
  conditions determined that, on average, patients
  received recommended care only about half the
  time.
• The Quality of Health Care Delivery to Adults in
  the United States, McGlynn, et al, New England
  Journal of Medicine 3482635-2645. June 26, 2003.

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Opinion-Based Medicine

• Geography is indeed destiny.
• 1999 Dartmouth Atlas of Healthcare
• to a large extent, your ZIP code determines
  what kind of care you receive..
• Putting EBM to Work, Ricardo Guggenheim, MD

Source Putting EBM to Work, Ricardo Guggenheim,
MD
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Cost-based / Reactive Care

• The average patient needs 25 preventive services
  that have been recommended by the U.S. Preventive
  Services Task Force, but routine medical care is
  focused today mostly on treating chronic disease
  after it occurs.
• A large portion of individuals in the U.S. fail
  to receive even an early-stage diagnosis for many
  diseases.
• "We know that prevention is very important for
  the health of our nationbut it is simply not
  possible for physicians to deliver all those
  services to their patients."
• Kimberly Yarnall, M.D., lead author of a new
  study published in the April 2003 issue of the
  American Journal of Public Health
• "The current American health care system is
  driven more by tradition than by scientific
  principles and is inherently wasteful."
• R. Sanders Williams, M.D., dean of the Duke
  University School of Medicine.

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Facilities-based

• telemedicine can reduce health care costs,
  eliminate or shorten hospitalizations, increase
  efficiency and reduce travel times..
• "Surgery is what drives hospital finances and
  telemedicine might result in less hospital
  patient volume, which is good for the patient and
  who's paying for treatment but doesn't help a
  hospital's bottom line,"
• Jonathan Linkous, Exec. Dir, American
  Telemedicine Association,
• While there is growth in telemedicine,
  reimbursement and business models based on remote
  care remains limited.
• The American Telemedicine Association estimated
  that the total amount of federal grants and
  contracts for telehealth in 2003 was about 270
  million (in contrast to 2 trillion healthcare
  economy
• In 2006, Congress approved 3 million for
  telehealth funding in the HHS, Labor and
  Education spending bill.

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Agenda

• Introductions
• Uncertain Medicine Current State of Care
  Delivery
• Artful
• Opinion-Based
• Cost-Driven / Reactive
• Facilities-Based
• Towards Certainty Quantum Care
• Transparent / Patient-Friendly
• Information-Driven / Evidence-Based
• Phenotype Molecular-Based
• Barriers
• Infrastructure
• Incentives
• Closing Thoughts

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What is Quantum Care?

• Quantum Care is a theory of medicine that holds
  that the optimal practice model is
• Transparent
• Patient-Friendly
• Information-Driven
• Evidence Based
• Molecular-Based

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What does Quantum Care require?

• The optimal model of care is one premised on a
  universe of clinical information that, like the
  physical universe, is always expanding
• Volume of clinical information
• Sources of information
• Two corollaries
• Systems must scale to support growing universe of
  information
• Systems include infrastructure and applications
  as well as incentives and training
• Parity of clinical information holds constant
• There is so much new information, how do
  prioritize and distinguish between what is more
  scientifically rigorous/relevant to your patient?

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Expanding Volumes
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How should clinicians stay current?

• More than 150,000 articles published in some
  20,000 physician-focused journals every month
• More than 400,000 new entries in 4,000
  nursing-focused journals per year (Leipzig, 1999)

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Expanding Sources of Information
Source Institute for the Future
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Transparent
Insurer Reveals What Doctors Really Charge To
Help People Compare Fees, Aetna Posts Some
Online August 18,2005

• As consumer-driven plans rise in popularity,
  competition will be less on premiums and more
  on the financial and information services
  consumers will need to use them effectively.

What is the impact for providers?
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Information-Driven
Source IBM, Deloitte
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Patient Friendly

• Did you know that pleasant smells can reduce
  blood pressure and heart rate?

The Art of Good Health
Creating Healing Environments

• Hospital Art Music Programs

• Did you know the color blue can subdue aggressive
  patients in emergency departments.

A Process of Service Delivery Innovation
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Evidence-Based

• The practice of EBM includes the judicious
  integration of current best scientific
  literature, clinical experience and patient
  understanding and values.
• Adapted from Guyatt et al. and Sackett et al.
• Systematically developed statements to assist
  practitioner and patient decisions about
  appropriate health care for specific clinical
  circumstances
• Institute of Medicine, 1992
• The backbone of EBM is
• Judicious Review of Science
• What works best given what we know today
• Population-based peer reviewed research
• Clinician training and experience
• Academic training, CME and credentialing
• Practice setting, locality
• Patient understanding and values
• History, symptoms, and genetic typing
• Preferences

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Molecular-Based
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Molecular-Based
Cancer1 in 3 Afflicted

• Breast, Prostate, Lung
• Programmed Cell Death
• Proliferation Markers

Lung Cancer

• Most common fatal malignancy
• 85 of patients die of their disease
• US direct medical costs gt5 B

Diagnostic Image
IVD/Chromosome
Therapy Selection
Monitoring
Indicative 5yr Survival
Therapy Evaluation
Tomorrow
Detection Today
Survival Rate Based Upon Early Detection
Source GE Healthcare
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Agenda

• Introductions
• Uncertain Medicine Current State of Care
  Delivery
• Artful
• Opinion-Based
• Cost-Driven / Reactive
• Facilities-Based
• Certainty Quantum Care
• Transparent / Patient-Friendly
• Information-Driven / Evidence-Based
• Phenotype Molecular-Based
• Barriers
• Infrastructure
• Incentives
• Closing Thoughts

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Diffusion of Innovation
Diffusion of Innovation

• Diffusion is the process by which an innovation
  is communicated through certain channels over
  time among the members of a social system.
• The four main elements of the theory are
• The innovation
• Communication channels,
• Time, and
• The social system.

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Diffusion of Innovation
Diffusion of Innovation

• Diffusion of Innovations Theory looks at the
  process by which an innovation is adopted by
  members of a given group in society (Rogers,
  1995).
• Some inventions 'take the world by storm'
  (archetype the Sony Walkman).
• Others seem to fail, lie dormant for decades, but
  when 'their time has come', their use grows
  quickly, even explosively (archetype the fax
  machine).
• Most achieve slow penetration at first, then
  their adoption grows more quickly, but later
  slows down again.

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Diffusion of Innovation
Diffusion of Innovation

• Recipe for success
• Innovations that are perceived by individuals as
  having greater relative advantage, compatibility,
  trialability, observability, and less complexity
  will be adopted more rapidly than other
  innovations
• (Rogers, 1995)

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Incentives

• Misalignment can occur between the physicians,
  hospitals, insurance companies and senior
  management in the following ways
• Using new techniques can create benefits that
  have low visibility and little direct payback for
  those that have to use it.
• Incentives and required actions may not be well
  aligned- Physicians may feel that cost savings
  from HCIT accrues mainly to the insurance
  companies but require all the efforts from the
  hospitals or the physicians without any
  additional incentives (e.g. favored reimbursement
  rates) from the insurer

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Agenda

• Introductions
• Uncertain Medicine Current State of Care
  Delivery
• Artful
• Opinion-Based
• Cost-Driven / Reactive
• Facilities-Based
• Certainty Quantum Care
• Transparent / Patient-Friendly
• Information-Driven / Evidence-Based
• Phenotype Molecular-Based
• Barriers
• Infrastructure
• Incentives
• Closing Thoughts

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Questions to consider

• What will it take to align stakeholders within
  the healthcare ecosystem to support Quantum Care?
• What is the role of the consumer?
• Will we ever be able to pay for it?
• Many of the innovations associated with
  Personalized Medicine can be seen in the field of
  oncology. When will it come to primary care?
• Is the US uniquely advantaged or disadvantaged,
  relative to other countries, to promote Quantum
  Care?