Category: Behavioural Economics
Jeff Brenner – final meeting
Met with Jeff Brenner, Medical Director at Camden Coalition of Healthcare Providers.
Learned about him after listening to these freakonomics podcasts:
An eloquent, thoughtful keen student of the history of epidemiology, public health’s political success and a tireless advocate for the underserved communities of Camden, NJ.
Holds a strong, long-term, systems view of change in public health and healthcare.
Currently engaged in a loss-avoidance play as an ACO demonstration site – geographically defined, shared savings project, which has protection from federal anti-trust laws to allow providers to collaborate.
Doubts the claims of most preventive health organisations, on basis of the Medicare Chronic Care Demonstration Project in the 80s where only 3 of 15 corporate participants survived a randomised control trial of preventive interventions after a year.
The game changer in many examples of public health shift are the troubling personal experiences of decision makers.
Emotional, visceral, aesthetic impact.
Tapped into Grenny’s observation about Don Berwick needing to get hospital CEOs to run the analysis of patient harm personally rather than to delegate in order to experience first hand the damage their institutions were doing to their patients.
Examples of AU Health Minister’s personal experience of the harms of tobacco driving the change to plain packaging.
Complex systems are kept in place by:
- goodwill
- money
- tax dollars
- positive media
- These foundations need to be eroded one by one to effect change.
For a venture capitalist, they’ll need a pitch that appeals to their outrage at the lack of evidence or transparency around the way that healthcare works.
For someone on the left, the conversation will need to be nuanced around the human tragedy of chronic disease, and the need for humanity to do better.
Don’t get wedded to the strategy, just the outcome.
There is a 100 year gulf between the way corporations collect and use data, and the way that government uses the same resource.
Analytics allow us to surveil, segment, target and measure interventions, then tell a good story of why things happen.
Dual System Utilizers – healthcare and law enforcement
On the way to the meeting, came up with a name for the concept – the QALYBOND – will grab the domain name.
References
http://www.macfound.org/fellows/886/
- “Bury the Chains” – end of slavery
- “The Children” – civils rights movement
- The fight to roll out covered sewers, welfare reform (fixed by the right)
- Adverse Childhood Event Study – Vince Felitti, KP
RWJF: Starting Early to Teach Healthy Habits
Kevin Volpp: Altering Physician Behaviour
Kevin Volpp: Behavioral Economics and Automated Hovering
RAND: Santa Monica Wellbeing Project
http://wellbeing.smgov.net/
Click here to read more about each panelist, including:
- Saamah Abdallah, New Economics Foundation
- James Anderson, Bloomberg Philanthropies
- Sarah Burd-Sharps, Measure of America
- Anita Chandra, RAND Corporation
- Elizabeth Cox, New Economics Foundation
- Lew Daly, Demos
- Nancy Etcoff, Harvard and Massachusetts General Hospital
- Carol Graham, Brookings Institution
- Jon Hall, United Nations Development Program
- John Helliwell, University of British Columbia
- Tim Kasser, Knox College
- Ewen McKinnon & Lisa Ollerhead, Cabinet Office, UK
- Lori Nathanson, Yale Center for Emotional Intelligence
- Gwyther Rees, University of York
- Gus Speth, Vermont Law School
- Arthur Stone, University of Southern California
- Mathis Wackernagel, Global Footprint Network
- Benjamin Warner, Jacksonville Community Council Inc.
- Liz Zeidler, Happy City Initiative, Bristol
Also the New Economics Foundation – economics as if people and the planet mattered.
http://www.neweconomics.org/teams/entry/Well-being
http://www.rand.org/blog/2015/04/wellbeing-project-to-weave-science-into-government.html
COMMENTARY
(Santa Monica Daily Press)
April 29, 2015
Wellbeing Project to Weave Science Into Government Decisions
Photo by paylessimages/Fotolia
Today the City of Santa Monica is releasing the initial findings of a robust research project that aims to measure the wellbeing of Santa Monica’s residents. The findings will serve as a baseline for how the community is doing now so that wellbeing can be tracked on an ongoing basis. While important, the findings that are being released are only a small part of Santa Monica’s Wellbeing Project. The project is working to fundamentally change how the government thinks about its citizens, by integrating the science of wellbeing into its very foundation.
But what is wellbeing? Are we saying that Santa Monica is measuring how happy people are? Certainly that is a factor, but wellbeing is much more than only happiness or wellness. Wellbeing is about individuals having the skills and opportunity to live a meaningful life. There are countless things that cities do that either contribute or detract from that sense of meaning. The Wellbeing Project is about collecting data on a range of factors, linking across findings, and then translating these findings into action.
Santa Monica is the first to more fully relate both the subjective and personal experiences of its residents to specific conditions that support or detract from wellbeing. That is groundbreaking. In other words, Santa Monica and its partners have identified specific, measurable conditions that directly influence personal and subjective wellbeing. To do this, several dimensions of the wellbeing experience were identified including the social, physical and economic environment. Once these dimensions were defined, the city collected and examined a range of data across agencies and sectors at the city level, as well as through resident survey and social media, in order to create a baseline of wellbeing in the community.
Creating a baseline of wellbeing for Santa Monica required unprecedented examination of what data the city currently collects. This motivated a real examination of whether current city data systems support the ongoing monitoring and evaluation of wellbeing, and whether the volumes of data that cities often collect have the signal value to inform policies and programs that actually promote wellbeing. While cities collect data all the time, a full examination of how disparate sources of data connect and how it can be used to inform government decisions that support wellbeing is novel.
The important distinction of the city’s efforts is the difference between data, information and insight. Collecting immense amounts of data does not automatically lead to information. The data must be analyzed and distilled into something translatable and consumable. Additionally, information alone does little good unless the city can learn from the findings and take action upon them.
This initial findings release is only the beginning. Now the city is enhancing the conversation about how government, its partners, and the community work together to cultivate a community that thrives and flourishes. And the city is examining whether it has the data organizational culture, and concurrent governance structure it needs for wellbeing decision-making. We now have the framework in place to propel the city into action, so that Santa Monica can lead the charge in examining the roles and responsibilities of the city government in the 21st Century.
Anita Chandra is a senior policy researcher and director of RAND Justice, Infrastructure, and Environment at the nonprofit, nonpartisan RAND Corporation.
This commentary originally appeared on Santa Monica Daily Press on April 28, 2015.
Health Evolution Summit – Overview
http://www.healthevolutionsummit.com/Default.aspx?PageID=16199729
1:00 pm – 2:15 pm
Pre-Summit Sessions (concurrent)
CEOs of leading providers/payers share their outlook on their critical innovation priorities and highlight respective approaches to vet solutions. A variety of provider/payer executives then connect with innovative CEOs from relevant service, IT and product companies to learn about new solutions and provide insights on the solutions’ value to the market.
Pavillions IV & V
Payer Connect: Where payer executives and innovative CEOs meet
Select health plan CEOs will share their strategic forecasts and the critical innovations necessary to remain competitive in a dynamic market. Payer executives and CEOs of relevant health service, IT and product companies will network briefly to share ideas and make a plan to reconnect pending mutual benefit.
Moderator:
Mike Gaffney, Co-Founder and Managing Director, EDG Partners
Speakers:
Dan Hilferty, President and CEO, Independence Blue Cross
Steve S. Martin, President and CEO, Blue Cross and Blue Shield of Nebraska, Summit Chair
Networking tables will be hosted by:
Aetna – Bjorn Thaler, VP, Head of Corporate Development
Blue Cross & Blue Shield of Nebraska – Steve S. Martin, CEO and Lew Trowbridge, President and Chief Operating Officer
Blue Cross & Blue Shield of North Carolina – Andy Brynes, VP, Strategic Development, Mosaic Health Solutions
Cambia Health Solutions – Ben Albert, Operating Partner, Rob Coppedge, SVP Strategic Investment & Corporate Development
Highmark Health – Nanette DeTurk, EVP, Chief Administrative and Strategy Officer and Treasurer
Independence Blue Cross – Terry Booker, VP of Corporate Development and Innovation, and Tom Olenzak, Managing Director Strategic Innovation Portfolio
Salons I & II
Provider Connect: Where provider executives and innovative CEOs meet
Select provider CEOs will share their strategic forecasts and the critical innovations necessary for their organizations to remain relevant and competitive. Provider executives and CEOs of relevant health service, IT and product companies will briefly network to share ideas and make a plan to reconnect pending mutual benefit.
Moderator:
Robert Wah, MD, Chief Medical Officer, CSC; President, AMA
Speakers:
John Brooks, President and CEO, Joslin Diabetes Center
John D. Doyle, President and CEO, Ascension Holdings
Michael Wagner, MD, FACP, President and CEO, Tufts Medical Center
Networking tables will be hosted by:
Dignity Health – Richard Roth, Chief Strategic Innovation Officer
Hospital Corporation of America – Chip Blaufuss, AVP of Strategic Innovation
Kaiser Permanente – Chris Stenzel, VP of Business Development and Innovation
Stanford Health Care – Kash Kapadia, VP and General Manager, Digital Health
Sutter Health – Peter Anderson, Chief Strategy Officer
Swedish Medical Group – Ralph Pascualy, Chief Executive
2:15 pm – 3:15 pm
The Monarch Bay Sunset Terrace
The Monarch Bay Sunset Terrace
Alumni Reception
Before the Summit begins, relax and reconnect with fellow alumni. All Summit alumni welcome to attend.
2:15 pm – 3:15 pm
Monarch Pool Terrace
Monarch Pool Terrace
First-Time Participant Welcome
Meet fellow first-time Summit participants. All first-time Summit participants welcome.
General Session: Emerging (and Decaying) Models
The Summit explores the macro implications of emerging (and decaying) models in health and the micro implications that flow from them through a lens that cuts across traditional industry lines of health care services, health IT and life science. Sessions explore the economic underbelly of big issues in search of sustainable business models, directional opportunities and Beachheads.
3:30 pm – 3:45 pm
Salons III & IV
Salons III & IV
Opening Comments
Patrick Geraghty, Chairman and CEO, GuideWell and Florida Blue, Summit Chair
Ann H. Lamont, Managing Partner, Oak HC/FT Partners, Summit Innovation Chair
Charlie Martin, Chairman and CEO, Martin Ventures
Julie Murchinson, CEO, Health Evolution Summit
3:45 pm – 4:30 pm
Salons III & IV
Salons III & IV
A Perspective with Steve Hemsley
Interviewer:
Todd Cozzens, Partner, Sequoia Capital, Summit Innovation Chair
Speaker:
Steve Hemsley, CEO, UnitedHealth Group
4:30 pm – 5:20 pm
Salons III & IV
Salons III & IV
Building the Business Case for High-Priced Therapeutics
Specialty drugs in the U.S. now comprise more than 25% of total pharmaceutical spend and the annual cost per patient can be as high as $100,000 per year. By 2020, the cost of specialty drugs is projected to quadruple and cost the nation more than $400 billion. Is the high-priced approach the new business model for innovation? Are there economically rational reimbursement approaches for certain high-costs diseases? Leaders with high stakes in the game will explore these trade-offs, emerging approaches and financing mechanisms.
Moderator:
Arnold Milstein, MD, MPH, Professor of Medicine, Director of Clinical Excellence Research Center, Stanford University
Speakers:
Joshua Ofman, MD, MSHS, SVP, Global Value and Access and Policy, Amgen
Tim Wentworth, President, Express Scripts
5:20 pm – 6:00 pm
Salons III & IV
Salons III & IV
The Consumer-Engaged Enterprise
To both attract and retain customers, even the most well-established, integrated delivery networks are striving to re-engineer their approach to consumer-centric convenience and service. Meanwhile, newer companies are striving to demonstrate an entirely new level of consumer experience with tools and delivery models that speak to consumer interests. Hear from an established integrated delivery system and a novel primary care model on what is working and where they are headed.
Moderator:
Brad Fluegel, Chief Strategy and Business, Development Officer, Walgreens Boots Alliance,Summit Partner Committee
Speakers:
Rushika Fernandopulle, MD, MPP, CEO and Co-Founder, Iora Health
Glenn D. Steele Jr., MD, PhD, President and CEO, Geisinger Health System
6:00 pm – 9:00 pm
Dana Lawn
Dana Lawn
Welcome Event
Dinner served
9:00 pm – 11:00 pm
The Terrace Salon Balcony
The Terrace Salon Balcony
Après Dessert and Digestifs
APRIL
30
THURSDAY
6:00 am – 7:00 am
The Gazebo
The Gazebo
Morning Fitness Boost
Summit Run, hosted by HealthLine
7:00 am – 6:00 pm
Salon Foyer
Salon Foyer
Registration Open
7:00 am – 8:00 am
The Monarch Bay Courtyard
The Monarch Bay Courtyard
Breakfast
7:00 am – 8:00 am
Salon I
Salon I
Breakfast Session
Profitable Innovation: Invention, Commercialization, Execution
Facilitated by Dentons
Facilitated by: Bruce Fried, Partner, Dentons with panelists: Ronald Kuerbitz, CEO, Fresenius Medical Care North America and Ed Dougherty, Principal, Dentons
Senior executives in every sector of the industry are charged with delivering value. Some need to shorten time to market, others need to produce near term ROI, and others still need to deliver quality healthcare services and improve treatment outcomes in an increasingly price-sensitive environment.
On the eve of the Kentucky Derby, we award the ‘Triple Crown’ to healthcare executives, whose success depends on winning multiple races: being responsive to investors, compliant with regulators and innovators, and delivering affordable, high quality products and services for providers and patients. This session will discuss keys to winning the healthcare triple crown including a baseline model, synthesizing the global clinical and business literature, and testing this model against panelist and audience experience and expertise. Participants will leave with a framework within which to test concepts presented throughout the Summit against the real opportunities and constraints of the business of healthcare.
General Session: Emerging (and Decaying) Models
8:00 am – 9:00 am
Salons III & IV
Salons III & IV
The CMS Perspective: Where Do We Go From Here?
Interviewer:
Bruce Bodaken, Visiting Scholar, Brookings Institution and former Chairman and CEO, Blue Shield of California, Summit Chair
Speaker:
Andy Slavitt, Acting Administrator, Centers for Medicare & Medicaid
9:00 am – 10:00 am
Salons III & IV
Salons III & IV
The Real Deal: Taking on High-Cost, Complex Patients at Scale
Despite challenges, we are seeing an incredible wave of new solutions in caring for populations with multiple chronic diseases, more significant behavioral health issues and complex social situations. Many suspect these solutions will have even more opportunities ahead as they transform individual care. Hear payer, investor and innovator perspectives on what can really be achieved and what new opportunities have yet to be tackled.
Introducer:
Guy Eiferman, Senior Vice President, Strategic Planning and Managing Director, Healthcare Services and Solutions, Merck
Moderator:
Mark D. Smith, MD, MBA, Founding President, California HealthCare Foundation, Summit Chair
Speakers:
Adam Boehler, CEO, Landmark Health
Jay M. Gellert, President and CEO, Health Net, Inc.
Leeba Lessin, President and CEO, CareMore Health System
Thomas A. Scully, General Partner, Welsh, Carson, Anderson & Stowe
10:00 am – 10:30 am
The Monarch Bay Courtyard
The Monarch Bay Courtyard
Morning Break
10:30 am – 11:20 am
Salons III & IV
Salons III & IV
Size Matters: New Approaches to National Provider Brands
Even the most notable regional systems face a growth dilemma, causing some to explore innovative approaches to national expansion, unburdened by brick-and-mortar models. Cleveland Clinic and DaVita HealthCare Partners are on the forefront of these efforts, and others are not far behind. How are best-of-breed providers thinking about scale, how are they ensuring quality and how will they avoid obstacles seen in past waves?
Introducer:
Kris Joshi, PhD, Executive VP, Products, Emdeon
Moderator:
Michael E. Chernew, PhD, Leonard D. Schaeffer Professor of Health Care Policy and Director, Healthcare Markets and Regulation Lab, Harvard Medical School
Speakers:
Toby Cosgrove, MD, President and CEO, Cleveland Clinic
Kent Thiry, Co-Chairman and CEO, DaVita HealthCare Partners
11:30 am – 12:30 pm
Deep Dive Sessions
Salons II
What the Consumer Really Wants: Data Insights into Purchasing Behavior
Hosted by Aon
Facilitated by Matt Levin, EVP and Head of Global Strategy, Aon and Janet Faircloth, SVP, Strategy and Solutions, Aon
Pavilion I
Big Brains on the Internet of Things (IoT)
Hosted by Box
Facilitated by Aneesh Chopra, former CTO, White House, President Obama with panelists: Aaron Levie, CEO, Box; Lee Shapiro, former President, Allscripts and Bill Russell, CIO, St. Joseph Health System
Salon I
Transparency of Cost and Quality: Changing Consumer Behavior at Scale?
Hosted by Emdeon
Facilitated by Doug Ghertner, President, Change Healthcare and Jason Gorevic, CEO, Teladoc
The Plaza
The Next Holy Grail: Strategic Cost Control
Hosted by Healthagen
Facilitated by Charles Kennedy, MD, Chief Population Health Officer, Healthagen
12:30 pm – 2:00 pm
The Monarch Bay Courtyard
The Monarch Bay Courtyard
2:00 pm – 2:50 pm
Salons III & IV
Salons III & IV
Harnessing the Reality of End-of-Life
End-of-life care accounted for over 28% of Medicare’s budget—or $170B spent in the last six months of life for Medicare beneficiaries alone. According to the Institute of Medicine, enhancing the quality of medical and social services at the end of life would create substantial progress toward a sustainable U.S. health care system. Now more than ever, end-of-life services are becoming a strategic industry priority. Two prominent payers and a health system leader will discuss the most critical issues, where best economics are emerging and potential models for advancing management of end-of-life care.
Moderator:
Alexandra Drane, Co-Founder and Chair of the Board, Eliza Corporation; Co-Founder, Engage with Grace
Speakers:
Mark B. Ganz, President and CEO, Cambia Health Solutions, Summit Chair
Wright R. Lassiter, III, President, Henry Ford Health System
Harold L. Paz, MD, MS, EVP and Chief Medical Officer, Aetna
3:00 pm – 4:00 pm
Deep Dive Sessions
Pavilion I
Busting Myths about the 50+: Tracking that Works
Hosted by AARP
Facilitated by Jody Holtzman, SVP Thought Leadership, AARP, with presenter Brad Fain, Principal Research Scientist, Head of the Human Systems Engineering Branch, Georgia Tech Research Institute and panelist Julio Corredor, Director, Worldwide Innovation
Salon I
The Complexities of Patient Financial Responsibility
Hosted by Availity
Facilitated by Russ Thomas, CEO, Availity with panelists; Alan Levine, CEO, Mountain States Health Alliance, Rob Coppedge, SVP Strategic Investment and Corporate Development, Cambia Health Solutions, and Sam Khashman, President and CEO, Imagine Software
The Plaza
Agile Health – New Models of Care Need New Models of IT
Hosted by CSC
Facilitated by Robert Wah, MD, Chief Medical Officer, CSC, and President of the AMA and Lisa Pettigrew, Industry General Manager, Global Healthcare, CSC
Salon II
Zip Code-Driven Health Insights…More Informative than Genetic Code?
Hosted by Optum
Facilitated by Paul Bleicher, MD, PhD, CEO, Optum Labs, and Dave Dickinson, Chief Innovation Officer, Optum Labs
4:00 pm – 6:00 pm
The Monarch Bay Courtyard
The Monarch Bay Courtyard
Afternoon Break
4:15 pm – 5:15 pm
The Terrace Salon
The Terrace Salon
Confab of Women Building Impactful Companies
Join an unmoderated discussion among female healthcare leaders focused on what it takes to build strong teams, how to bring out the best “male” and “female” traits, what “female” traits provide distinct advantages, and what women are getting it done and why.
Speakers:
Gail Boudreaux, Former CEO, UnitedHealthcare
Alexandra Drane, Co-Founder and Chair of the Board, Eliza Corporation; Co-Founder, Engage with Grace
Ann H. Lamont, Managing Partner, Oak HC/FT Partners, Summit Innovation Chair
Lisa Suennen, Managing Partner, Venture Valkyr
6:00 pm – 7:00 pm
Pacific Promenade Lawn
Pacific Promenade Lawn
Global Health Reception
7:00 pm – 9:00 pm
The Pacific Promenade
The Pacific Promenade
The Big Dinner
Global Disease: How New Investment Priorities Are Changing the Landscape
As the Bill & Melinda Gates Foundation works with its partners to transform lives in developing countries, they are acutely focused on tapping into the talent and resources of the private sector. If Ebola taught us anything, low-cost, sustainable solutions need to be created and delivered to ensure not only local and global health, but also economic viability for all. Enter stage left…opportunity. Sue Desmond-Hellmann will share the business case for the global frontier.
Introducer:
Robert Margolis, MD, CEO Emeritus, HealthCare Partners, Summit Chair
Interviewer:
David Brailer, MD, PhD, Managing Partner and CEO, Health Evolution Partners; Chairman, Health Evolution Summit
Speaker:
Sue Desmond-Hellmann, MD, CEO, Bill & Melinda Gates Foundation
9:00 pm – 11:00 pm
The Plaza
The Plaza
Après
Blackjack and poker overlooking the Pacific.
MAY
01
FRIDAY
7:00 am – 12:00 pm
Salon Foyer
Salon Foyer
Registration Open
7:00 am – 8:00 am
The Monarch Bay Courtyard
The Monarch Bay Courtyard
Breakfast
General Session: Disruptive Models
Disruption is happening in pockets, at varying paces and in a variety of ways. In 2015, the Summit explores where new innovations are seeing landfall and the army of others just behind.
8:00 am – 9:00 am
Salons III & IV
Salons III & IV
Moon Shots on Health
Moon Shots – big thinking and aiming for breakthroughs instead of incremental improvements – this is the Google[x] mandate. Google has disrupted just about everything we can think of, so what are they up to in health? Will they be the creator or a potential competitor? The former head of the largest health plan in the country shares her perspectives on moon shots…potential profiles, obstacles and how the practical realities of the past may be shifting. Together, this session will raise the stakes and foreshadow areas where we see breakthroughs instead of barriers.
Moderator:
Peter Neupert, Operating Partner, Health Evolution Partners and Former Corporate VP, Microsoft Health Solutions Group, Summit Chair
Speakers:
Gail Boudreaux, Former CEO, UnitedHealthcare
Andy Conrad, PhD, Head of Life Sciences, Google
9:00 am – 9:30 am
Salons III & IV
Salons III & IV
Consumer On Ramps – Disruptive Models Creating Value
As health care endeavors to engage consumers in their health, some companies are also beginning to create efficiencies, support evolving reimbursement streams and position for value creation. From searching for health information to being monitored remotely; from the healthy consumer to those managing chronic disease or facing acute conditions—the early adopters are contributing to the new health economy. This session will highlight a few innovators disrupting information flow and creating value through the holy grail of the consumer engagement.
Moderator:
Brandon H. Hull, Managing General Partner, Cardinal Partners, Summit Innovation Chair
Speakers:
Eric Rock, CEO, Vivify Health
Ben Wolin, CEO and Co-Founder, Everyday Health
9:30 am – 10:25 am
Salons III & IV
Salons III & IV
Corporate Venture Takes Hold of Health Care
Creating a corporate venture group is certainly one of the hippest strategies to hit the health industry in years. And while these ventures all hope to capitalize on the next biggest disruption to hit the market, they will not all look the same in their pursuits. Hear what disruptive models are on the horizon, what factors are being considered and what you can expect.
Introducer:
Mark Speers, Partner and Managing Director, Health Advances, LLC
Moderator:
Lisa Suennen, Managing Partner, Venture Valkyrie
Speakers:
Rob Coppedge, SVP Strategic Investment and Corporate Development, Cambia Health Solutions
Dave Schulte, Managing Director, Kaiser Permanente Ventures
David Stevenson, Managing Director, Global Health Innovation Fund, Merck
Rafael Torres, Head of Healthcare, GE Ventures
10:25 am – 10:30 am
Salons III & IV
Salons III & IV
Comments and Transition to Innovation Activities
Julie Murchinson, CEO, Health Evolution Summit
10:45 am – 1:00 pm
The Plaza
The Plaza
Corporate Venture Action Group
Innovation Activities (concurrent)
Innovators and health leaders roll up their sleeves in an intimate and interactive setting to explore opportunities.
10:40 am – 11:40 am
Salon I
Salon I
Innovations with Traction: Straight Talk from Customer CEOs
Patient retention and new patient acquisition have always been strategic imperatives, but their importance has risen to mission critical in the transition from fee-for-service to fee-for-value. While these areas may have great impact on both risk of lost revenue and new growth opportunities, they have not been easy problems to solve—and several innovative solutions have stalled. A leading health system CEO talks with innovators about the range of challenges health systems are facing, the approach that different companies are taking and the successes that organizations are experiencing to ensure true value is realized.
Facilitator:
Roy Smythe, MD, Chief Medical Officer, AVIA
Speaker:
Rodney F. Hochman, MD, President and CEO, Providence Health & Services
Innovators:
Mark Hefner, CEO, Infina Connect Healthcare Systems
Oran Muduroglu, CEO, Medicalis
10:40 am – 11:40 am
Pavilion II
Pavilion II
Disruption in Progress: Designing for the Consumer
Innovators and health care leaders on the consumer front lines retreat to the boardroom to explore how best to design for the consumer. Innovators are encouraged to roll up their sleeves in this intimate discussion exploring critical needs, while potential payer, provider and retailer customers help to inform design and their approach.
Facilitator:
Joshua Riff, SVP, Consumer Products, Optum
Contributors:
Rushika Fernandopulle, MD, MPP, CEO and Co-Founder, Iora Health
Jeffrey Kang, SVP, Health and Wellness, Services and Solutions, Walgreens Boots Alliance
Tej Shah, SVP, Business Development, Blue Cross Blue Shield of Louisiana
10:40 am – 11:40 am
Pavilion III
Pavilion III
Disruption in Progress: Where Life Science Is Headed:
Opportunities Beyond the Pill
Innovators and life science leaders retreat to the boardroom to explore new opportunities beyond the pill. Innovators are encouraged to roll up their sleeves in this intimate discussion exploring critical needs, while potential pharma, biotech and medical device customers inform their solutions and their approach.
Facilitator:
Naomi Fried, PhD, VP of Innovation, Medical Information and External Partnerships, Biogenidec
Contributors:
Guy Eiferman, SVP, Strategic Planning and Managing Director, Healthcare Services and Solutions, Merck
Diego Miralles, MD, Global Head of Innovation, Janssen Pharmaceuticals, Johnson & Johnson
Pascale Witz, EVP, Global Divisions and Strategic Development, Sanofi
11:45 am – 12:45 pm
Pavilion IV
Pavilion IV
Disruption in Progress: Care Delivery Innovation
Innovators and health care leaders on the front lines of care delivery retreat to the boardroom to explore how to best to design solutions to improve care and reduce cost of delivery. Innovators are encouraged to roll up their sleeves in this intimate discussion exploring critical needs, while provider executives share the value they are seeking and how potential solutions are vetted behind closed doors.
Facilitator:
Molly Coye, MD, Chief Innovation Officer, UCLA Health System
Contributors:
Lyle Berkowitz, MD, FACP, FHIMSS, Associate Chief Medical Officer of Innovation, Northwestern Memorial Hospital
Chip Blaufuss, Assistant VP Strategic Innovation, Hospital Corporation of America
Birthe Dinesen, Professor, Department of Health Science and Technology, Aalborg University (Denmark)
Chuck Dowling, CEO, DiabetesAmerica
11:45 am – 12:45 pm
Pavilion V
Pavilion V
Disruption in Progress: Connecting with Capital
Innovators and seasoned investors retreat to the boardroom to connect on the capital landscape: opportunities on the horizon, what investors are seeking, and what they may require in the coming years. Innovators are encouraged to roll up their sleeves in this intimate discussion to ask their burning questions and to hear from the veterans.
Facilitator:
Jodie Emery, Partner Healthcare and Private Equity, Caldwell Partners
Contributors:
Thomas Carella, Managing Director, Merchant Banking Division, Goldman Sachs
Brandon H. Hull, Managing General Partner, Cardinal Partners, Summit Innovation Chair
Noah Knauf, Managing Director, Warburg Pincus
Ravi Sachdev, Partner, Clayton, Dubilier & Rice
Jeffrey: On millimorts and microlives…
Very good, very interesting piece on risk measurement and reporting…
http://www.jeffreybraithwaite.com/new-blog/2014/11/20/youll-be-dying-to-hear-about-this
You’ll be dying to hear about this
There’s lots of death in the world. Transport is risky, for instance—planes, automobiles, trains and ships can crash, maiming or killing passengers. You don’t have to go much further than seeing the road toll, or hearing about Malaysian Airlines Flight MH17 shot down over the Ukraine, or watching the TV scenes of the Costa Concordia, run aground just off Isola del Giglio near the coast of Italy, to appreciate that death is never far away.
Then there’s infectious diseases. You can all-too-readily catch a cold, or the flu, or TB, or lately, the Ebola virus. And there seem to be never-ending wars and skirmishes in the Middle East; and terror, spread by fundamentalists.
Each of these, depending on fate, can hasten someone’s demise. Wrong place, wrong time, wrong circumstances.
Lifestyle issues can cause problems for your risk profile too—but these are slower, and more stealthy. Think of smoking, drinking too much, eating yourself into a coma or just gross obesity, or the more insidious dangers of sitting at a computer for years on end with little exercise. These can translate over time into heart or lung disease, diabetes, and cancer.
Whether you are active or passive, things you do or don’t do can shorten your lifespan, or kill you a little or a lot faster than you would otherwise last. So what levels of risk do you actually, quantitatively, face in your own life?
*****
Stanford University decision scientist Ron Howard in the 1970s presented a novel way to calculate this risk. He introduced the idea of the micromort, defined as a one-in-a-million likelihood of death. This is such an evocative unit of measurement that it deserves a little further attention.
If you live in the US or another relatively rich, OECD-style country, with good law and order, legislation that keeps society relatively risk free (such as with environmental and public health issues sorted out, effective building codes, and so forth), a well-educated population, access to health care, and a buoyant GDP, you can expect a micromort of one on any particular day. Another way of saying this is that’s the standard expected death rate for any individual today in any one 24 hour period: a microprobability of one in a million is your index of baseline risk.
These are great odds for you, today, as you read this; you are very likely to get through it. Congratulations if you do.
What circumstances lead to an elevated risk? Say if you do dangerous things or even just live life to the full? How does your micromort level get upgraded?
In the United States, you accumulate an extra 16 micromorts each time you ride a motorcycle 100 miles, for instance. Or 0.7 micromorts are added for each day you go skiing; so go for a week and you’ve added five more.
Or you might decide to do something a little more strenuous. With hangliding, the additional risk of dying equates to eight micromorts per flight; or skydiving, nine per freefall.
They are relatively benign compared to moving up to base-jumping. Do so, and you rapidly earn many more risk points: 430 micromorts per jump, in fact.
Marathon running, anyone? That will be seven micromorts to your debit account for each run. Even walking 17 miles adds one micromort, as does a 230 mile car trip, and add another one for every 6,000 mile train trip. But the puzzle is, it’s not always clear how to treat these: the walking introduces an element of risk (you could be out and about and get run over, or be struck by lightning) but it’s also beneficial (it contributes to improved health).
Perhaps even more interesting, there are microprobabilities associated with accumulated chronic risks in contrast to these other single-shot event risks. These are lifestyle choices and behaviors that incrementally add a little more risk through exposure. They won’t kill you if you have bad luck on a given day, but will slowly have an effect—and may claim you in the end.
Every half a liter of wine exposes you to a micromort because it can accrue into cirrhosis of the liver. Each one and a half cigarettes does the same, but the menace here is cancer or heart disease. Even eating 100 char-broiled steaks, 40 tablespoons of peanut butter or 1,000 bananas sneaks up on you in the form, respectively, of cancer risk from benzopyrene, liver cancer risk from aflatoxin B or cancer risk from radioactive potassium-40.
*****
Hang on though. I doubt I’ve done much to help anyone.
Because a clear problem is that people aren’t very good at doing these kinds of statistics, or applying them to their own lives—and are even less capable of acting on them. We can readily appreciate that skiing or motorcycling add some risk for the time you are doing them compared to the everyday activities of being at work or hanging out at home, yet many people are undeterred. People even cheerfully find ways of taking on more risk, such as by climbing Everest, driving fast cars, or having unsafe sex.
Everyone knows about that steadily accumulated risk, too: not too many of us are blind to the fact that drinking too much alcohol can lead to liver disease or smoking to lung cancer over time. And although both have been falling for decades, this hasn’t stopped millions of people indulging. There’s 42.1 million US smokers at last count, or 18.1% of the population, and on average each adult US citizen consumes 8.6 liters of alcohol annually.
This is not the best performance internationally but is by no means high by international standards, and Eastern Europeans smoke more heavily, and really give hard booze like vodka a nudge. Nevertheless, both activities contribute to what public health people quaintly call excess deaths and the rest of us know by “their drinking or smoking (or both) killed them eventually.”
But what does it actually mean that you expose yourself to increased risk if you go out walking regularly or eat bananas? We need another way of looking at this, because it’s too hard to do the sums.
*****
Enter the University of Cambridge medical statistician David Spiegelhalter and his colleague Alejandro Leiva who invented the idea of a microlife. This is another unit of risk which has the calculation built in for you. It is half an hour of your life.
If you increase your risk by one micromort, then this shortens your life by half an hour. These calculations apply to people on average, and work out for entire populations, but any one of us might be lucky or unlucky, depending on our individual characteristics. Any particular risk doesn’t convert exactly to the specific individual. But with enough people in the US (beyond 316 million now) and on the planet (7 billion and rising), there’s a relentlessness accuracy about the statistics.
So now let’s do some life expectancy math with Spiegelhalter. Smoke a pack a day? You lose up to five hours a day. Accumulated, that’s up to eight years off your life. Have six drinks a day and that binge costs you one half hour allocation—a shortened life by ten months or so. Stay eleven pounds overweight and you sacrifice half an hour every day you do so (another ten months across your lifespan), as you do if you watch TV for two hours. Your coffee habit at 2-3 cups daily takes away another half hour lot. So does every portion of red meat each day. Another ten months each time.
It’s not all negative. There’s good news. Eat five serves of fruit and vegetables every day and you gain up to a couple of hours each time. You get three years back. Exercise and the first 20 minutes per day earns you a surprising hour (there’s a good investment—a year and a half), and each subsequent 40 minutes adds up to one more half hour bonus to your credit (a bit more work but that seems a pretty good deal, too, to get a ten month return).
If you have a hobby, activity or diet and it’s not been dealt with so far, you can fill in some of the gaps with some good guesstimates. Do you have passive pursuits, akin to watching TV? This is a net deficit. Do you do active, exercise-oriented activities, such as weekly amateur netball, soccer, bowling or basketball—or just walking regularly? Add some lifespan.
These half hour allocations alter somewhat depending on your genetics of course (you can have lucky or unlucky genes) or your socioeconomic status (wealthy people typically live longer than poorer folks) or your gender (women on the whole live longer than men). That said, with this idea you are now able to alter your risk profile by changing your behavior with a tangible, calculable return.
*****
There’s a punchline to this, and it may be already occurring to you as you reflect on your own lifestyle and lifespan. There are a million microlives in fifty seven years of existence. That, for many of us, is roughly the adult allocation.
Let’s call that your life expectancy baseline. We can assume that you have had a reasonably healthy childhood (not so for everyone, of course, but true for many US children, and true for most readers). Then, from that point on, a large part of your healthy adult life is now measureable.
So: come out of your teens, reach your 21st birthday, and as the “jolly good fellow” and “happy birthday to you” songs subside, imagine you then have 57 years to go. That is, you have an allocation of 78 years in total, maybe a little longer, maybe a little shorter.
Yes, all sorts of unexpected things might happen along the way, but to some degree your lifespan is now no longer vague, but quantifiable. The actual life expectancy in the US indeed hovers around this: it’s 79.8 years overall, 77.4 for males and 82.2 for females. (It’s higher in some northern European countries and Japan, but that’s a story for another day).
However, you might be reading this thinking: Yikes. I’m not 21: I’m a bit older than that. In this case, you’ve already used up a proportion of your time left. Console yourself. At least you got through the riskiest stage of all: being a baby, up to one year of age, and childhood, up to six or so, when many things can go wrong.
But have you used what you were given so far, well? Or do you have a fair bit of regret?
To make an obvious point, however, this isn’t Doctor Who. You don’t have a Tardis to go back in time and fix the past. So stop any lamentations. Look forward.
By now, if you’ve come to value more readily each half hour and especially the cumulative effect of your lifestyle choices to date, don’t listen to me preaching. Feel completely empowered. You know what to do and how to alter your own numbers.
Now, all that’s left is to do the math. You’ll have a much clearer picture of your life and potential death than ever before. It’s your move: what’s next?
Further reading
Blastland, Michael and Spiegelhalter, David (2014). The Norm Chronicles: Stories and Numbers About Danger and Death. New York: Basic Books.
Howard, Ronald (1984). On fates comparable to death. Management Science 30 (4): 407–422.
Spiegelhalter, David (2012). Using speed of ageing and “microlives” to communicate the effects of lifetime habits and environment. British Medical Journal 345: e8223.
Spiegelhalter, David (2014). The power of the MicroMort. BJOG: An International Journal of Obstetrics & Gynaecology 121 (6): 662–663.
The Life Insurance Model kick starts in the US
Andrew Thomas’s life insurer knows exactly when he arrives at his local gym. The company is notified when he swipes his membership card, and 30 minutes later, it checks that he is still there, tracking his location through his smartphone.
The insurance company has a vested interest in keeping Mr. Thomas alive and well. In return for sharing his exercise habits, his cholesterol level and other medical information, Mr. Thomas, a 51-year-old medical publisher who lives in Johannesburg, earns points, which translate into premium savings and other perks. By staying in good shape, it is less likely that Discovery, his insurer, will have to pay out his life and disability policies.
“Every Saturday morning, just for playing golf, I get points,” said Mr. Thomas, who said he received about 9 percent back on his life insurance premiums for each of the last five years. “It is trying to make people live a health y lifestyle.”
Now John Hancock will become the first life insurance company to introduce a similar program for American consumers. The program, being announced Wednesday, will apply to both term and universal life insurance policies and is being operated through a partnership with Vitality, a global wellness company that already works with employers and health insurers in the United States.
The concept — which has been used in South Africa, where Vitality is based, Europe, Singapore and Australia — has the potential to transform the way life insurance is priced, at least for consumers who are willing to continually share their health data. But it also raises questions about how that information will be protected — and whether it could be used in ways that ultimately work against a consumer’s best interests.
People who sign up will receive a free Fitbit monitor, which can be set to automatically upload activity levels to the insurer. The most active customers may earn a discount of up to 15 percent on their premiums, in addition to Amazon gift cards, half-price stays at Hyatt hotels and other perks.
John Hancock, a division of Canadian insurer Manulife Financial, says it hopes the program will help reinvigorate life insurance sales, which have stagnated industrywide for decades. Just 44 percent of households in the United States own individual policies, according to Limra, a trade group, a 50-year low. Any product that reminds consumers of their mortality is hard to get excited about, but industry analysts said that financially strained households, changing demographics and increasingly complex and expensive products have led to the decline in sales.
“It has been a slow to no-growth industry for a long time,” said Michael Doughty, president of John Hancock Insurance, based in Boston. “It is crying out for innovation and for someone to try to reinvent the product to make it more relevant.”
The new program also upends the traditional approach to life insurance underwriting, which typically bases its pricing on a detailed but static snapshot of a person’s medical status. Now, John Hancock’s term and universal policies will be priced continuously, at least for consumers who choose the Vitality program.
John Hancock and Vitality, which is owned by Discovery, said the information would not be sold and would be shared only with entities that help with the program’s administration, though the aggregate data could be used to inform the development of new insurance products.
Nonetheless, some specialists expressed privacy concerns.
“All of a sudden, everything you do and everything you eat, depending on which bits of the information they collect, is sitting in someone’s database,” said Anna Slomovic, lead research scientist at the Cyber Security Policy andResearch Institute at George Washington University and a former chief privacy officer at Equifax and Revolution Health.
Of course, buying any life insurance policy requires customers to share detailed medical histories upfront. But consumers participating in the Vitality program must be comfortable providing enough information continuously to meet certain thresholds that will convert into worthwhile savings. That might include the frequency of workouts, reporting a physical exam or answering sensitive personal questions: During the last 30 days, how often did you feel so nervous that nothing could calm you down? Hopeless? Depressed?
“You do not have to send us any data you are not comfortable with,” Mr. Doughty said. “The trade-off is you won’t get points for that.”
Participants need to amass 3,500 points to achieve silver status, 7,000 to reach gold and 10,000 for platinum. Nonsmokers automatically earn 1,000 points, and people with in-range cholesterol, glucose and blood pressurewill receive 1,000 points for each. A “verified” standard workout three times a week, or an advanced workout twice a week, provides another 3,120 points over the course of a year. Flu shots, 400 points. The clock is reset each year, though 10 percent of points may carry over.
All customers participating in the program will start by paying a premium priced at the gold level. That is a discount of about 9 percent for a 45-year-old man who bought a $500,000 term insurance policy that covered a 20-year period: He would pay $750 annually, compared with the $825 it would cost outside of the Vitality program.
So what if he does everything right, but breaks his leg? Or worse, gets a serious disease like cancer? While those conditions would not directly affect his rate, if he could not maintain gold status for any reason, he could see premium increases of 1.1 to 1.6 percent each year. But if he reached platinum status, his premiums would fall by about 0.30 percent each year.
The program may attract healthier people who have already engaged in these activities on their own. The strategy also tries to tap into the way humans are naturally wired: There is generally no immediate tangible benefit to life insurance, but this program is structured to try to change that.
“People respond far more to immediate gratification than delayed gratification,” said Dr. Kevin Volpp, director of the Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute. (He has performed research sponsored by Vitality.)
The number of points assigned to a particular activity is determined by how it will influence a person’s longevity, based on Vitality’s internal findings — and its level of difficulty. “Stopping smoking is more valuable than one session of activity,” explained Alan Pollard, chief executive of Vitality. “If something is a complex behavioral change, it will attract more points.”
Vitality’s research has found that Americans are generally five years older than their actual age, after taking into account various health and wellness factors. All participating policyholders will be given a “Vitality age,” which will help the program set personal guideposts.
“The people who have the time to devote to jumping through all the hoops are likely to be better off than average, and those healthy enough to do wellness activities may be unrepresentative of the chronically ill,” saidFrank Pasquale, a professor at University of Maryland Carey School of Law. “I believe that is one reason why there is empirical research severely questioning the value of wellness programs.”
John Hancock, which operates in all 50 states, said the universal life program had been approved by insurance regulators in 30 states, while the term program is available in 20 states; more states are expected to be announced throughout the year. It said no regulators had declined to approve it yet.
“It changes the paradigm of life insurance,” Dr. Volpp said. “In some sense, it tries to change your insurance into less of a passive vehicle that pays the bills if something happens, into a more active vehicle to get people to lower their risk.”
Meeting: Dr Shantanu Agarwal, CMS
Met with Dr Shantanu Agarwal, Deputy Administrator and Director, Center for Program Integrity
Excellent discussion comparing notes on system integrity in Australia and US.
CMS overall pays $1 trillion in program payments annually.
Point estimate is that 12% are improper payments – $48-52B per year.
The observation was made that FFS schedules like MBS were more than administrative tools, but effectively were clinical guidelines given the powerful incentives that they provide for particular treatments.
Analytic methods have been set and maturing for the last 5 years.
Most challenging element is how to close loop on anomalous behaviour:
- Start with on-boarding/educating newly enrolled clinicians (prevention) using videos, literature, data, feedback.
- Engagement with providers needs to be longitudinal, long term, personal, especially around low value care.
- You need a credible (peer matched) messenger and data needs to be properly presented and matched.
This Health Affairs article describes a typical journey for a system Shantanu used to work for – ChenMed in Miami.
Discussed:
- Fraud > Abuse > Waste > Error continuum
- The agile human adversary
- Chasing value slide
- Gamma scoring methodologies
- Choosing wisely > disinvestment
- Surgeon dashboard
- Surgeon selector
Shantanu mentioned that http://www.healthcostinstitute.org/ were seeking to build out similar statistical presentations to our own, but had so far only developed cost-oriented metrix with no dimension for quality/experience etc.
Other references for the meeting:
Reducing Medicare and Medicaid Fraud and Abuse – interview
Powerpoint: 764496_slide_CMS_DrShantanuAgrawal
