Con IberFairview Health Systems

University of Minnesota Health

The Future of Sleep Health

Objectives• To identify opportunities in transitioning from

sleep medicine to sleep health• To propose a snapshot of the future of the

field• To identify methods of transforming ourselves

into what the future requires of us

Caveat

There will be unanswered questions that we must all solve together

Harry: “OK……where’s the map?”

Harry, don’t check the map while your driving!!

Where should we go and how should we get there?

Let’s get a higher altitude view

• Health care cost/quality gaps • History of perverse incentives• Technical innovation• Public accountability

Pressures for Change

OECD Health data 2012

Unreasonable practice variation

Sutherland, Skinner, Fisher. NEJM 2009; 366:1227

35%

37%

22%

6%

Commercial27%

Medicare52%

Medicaid20%

Other1%

AHA Trendwatch Chartbook 2011

2011

2021

Medical economics July 2013

What are the opportunities for merging sleepmedicine into sleep health?

More adaptable to changing models• diagnosis at home• decreased reliance on complex testing• increased utilization of evolving therapies

More honest-• shift work/insufficient sleep• preventative methods are more powerful• better alignment with driving forces

3.8

3.3

4.7 nightrotatingirregular

11.8 million

Insufficient sleep and shift work:49 million

• Behavioral• Genetic• Countermeasures

Shift workInsufficient sleep 37 million

What are the opportunities for transitioning from sleep

medicine into sleep health?

More diversified-• meets need for distributive model• population/employee based• flexibility of cross-training workforce

More integrated –• case finding->diagnosis->therapy• population management

Home Sleep Studies[example of forced change]

2012 HomePAP N=373 randomized

home lab3

3.54

4.55

usage [hrs]

home lab3040506070

adherence [%]

lab home0

50010001500200025003000

1471

2794# studies/2yr

lab home02468

1012 9.9

1.1

wait [wks]

2014 Health System N=4625 uncontrolled

doi: 10.1155/2014/418246

doi: 10.5665/sleep.1870

Dental devices[example of change to be forced]

Gap-underutilization of devices in the US

Drivers-• user preference• guideline changes• payer preference

Snapshot of the future

Where do we want to go?

• Change that will improve sleep health• Quality and cost optimization

• Adaptable to predictable forces• User satisfaction

• Distribute care and maintain continuity• Incorporate population management• Develop and integrate collaborative networks• Negotiate change consensus• Leverage technology

Strategies-high altitude

• Reduce variation • Virtual care• Sleep therapy management• Cross discipline collaboration• Payer negotiation• Stratified resource use• Cross-training workforce

Tactics-zoom lens[adopt new lexicon]

Jan Feb March April May June July Aug Sept0

10

20

30

40

50

60

70

80

90

100

70 6872 70

65 64 62

70 72

% of Patients Compliant

Sleep Therapy Management

Structural changes: reduce points of care and variation, expand comprehensive care, develop stem to stern pathways, partner, tune to outcomes

Behavioral changes: team concept, monitor progress to achievable/meaningful goals, anticipate and manage failure, expand scope of practices

Components of Change

Are we are here?

• “Single visit”: initial diagnostic procedure for uncomplicated sleep apnea and insomnia moved to primary care with therapy determination made by sleep center and virtualization of >50% of point of care followup visits.

• Consolidation of laboratory studies to verify ambiguous home studies, serious comorbidities, parasomnias, suspected seizures.

• Increased scope of onsite clinic operations to include partners in dental, otolaryngology, pediatric, and occupational sleep medicine.

• Population management to incorporate long term management, innovation, outcome monitoring, payer negotiation.