Management of Transformative Healthcare Trends How to ... · Estimated 2018 US Healthcare Spending...
Transcript of Management of Transformative Healthcare Trends How to ... · Estimated 2018 US Healthcare Spending...
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JJacque J. Sokolov, MD
V14.2
Management of Transformative Healthcare Trends –
How to Expect the Unexpected
SEPTEMBER 6, 2018
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PROPRIETARY 2MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Presentation Overview
Management of Transformative Healthcare Trends – How to Expect the Unexpected
̶ The Basics: Expenditures, Populations and Products̶ Transformative Healthcare Trends
• Disruption in the “Healthcare Food Chain”• The Birth of the “Unicorn” Physician Practice Management Company • The Population Specific “Virtual Digital EPO”• Destination Medical Center Meets Super Consumer Experience• Adaptive Artificial Intelligence, Expert Systems and Blockchain Technology• VA CCN – The Next Evolution in VA Care• RNA Neo-epitopes Drive New Cancer Diagnosis and Treatment Models
Conclusions and Critical Takeaways
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September 2018
Management of Transformative Healthcare Trends –How to Expect the Unexpected
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Management of Transformative Healthcare Trends
̶ The Basics: Expenditures, Populations and Products
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PROPRIETARY 4MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
The Basics: Expenditures, Populations and ProductsEstimated 2018 US Healthcare Spending by Payer Source
* Sources: CMS/NHE with 4.6% year over 2015-2016 and an estimated 5.3% year over year 2016-2017
Cost of Healthcare 5.3% ̶ High-deductible HP’s̶ Hospital-owned MD Groups̶ Pharma Cost Escalation̶ Utilization trends – Aging, etc.̶ Hospital-owned ASC’s JVs, etc.
Total Healthcare
Expenditures$3.67 Trillion*
OUT OF POCKET10%
PRIVATE HEALTH INSURANCE
34%
MEDICARE20%
MEDICAID17%
OTHER INSURANCE…
OTHER THIRD PARTY…
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PROPRIETARY 5MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
The Basics: Expenditures, Populations and Products Providers Create Structures to Optimize Value-Based Care Participation
Value-Based Reimbursement New Payer Products
Alignment of Quality Metrics with Financial Incentives
Business Model
̶ Fee-for-Service
̶ “Hybrid FFS/Value”
̶ APR DRGs
̶ Shared Savings
̶ Bundles
̶ Episodes of Care
̶ Global Risk
Clinical Model
̶ Care Transformation
̶ Population Health Management
• Individual
• Small Group
• Mid-Size Group
• Mid-Large Group
• Private Exchange
• PCP/ Specialty Referrals
• Expansion
• FFS
• Block Grants/VB
• APR DRGs• FFS
• MSSP ACO
• Medicare Advantage
Patient Care/Experience
Changes in Reimbursement
Commercial Insurance
ERISA (ASO)
VA Expansion & TriCare
Medicaid
Medicare
Expansion of Patient Population Coverage Creates New Products and
Purchase Options
New Provider Entities
ACOSpecialty
CIN
DEFINITIONS
CIN- FTC- compliant Clinically Integrated
Network
ACO- Accountable Care Organization
Medicare Shared Savings Plan
Specialty CIN- CIN for CV, Orthopedics, Oncology,
CV, Spine and other key specialties
CIN/CMMI
KEY TAKEAWAYHospitals and affiliated physicians have an opportunity to capture incentive-based reimbursement by entering into “value-based” contracts with payers. But to do that, they need to form a Clinically Integrated Network (“CIN”) or a “Value Based” Enabled Entity to Execute on VB Products
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PROPRIETARY 6MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Seeking Strategic Opportunities
Managing a Specific Condition
or Service Line
Provider Care Accountability and integration
Re
lati
ve F
inan
cial
Ris
k
FFS
SharedIncentives
Bundles and Episodes of Care
% of Premium
Global Risk
Provider Assets/ JVs
Managing Health of a
Designated Population
Achieving Specific Quality and Cost
Improvement Metrics or
PCMH Status
Participating in a Narrow Network
Narrow Network(or Tiered)
Four Examples of Payer/Provider Goals:
1) Find NEW partners in CURRENT VB partnership categories
2) Find NEW partners in NEW VB partnership categories
3) Expand EXISTING partners into NEW VB partnership categories
4) Evaluate POTENTIAL Expanded Provider Asset Acquisitions /JV Partnerships
How do Health Plan product strategies align with specific provider VBC initiatives?
What approach/support leads to “win/win” provider collaborations?
Provider Asset Acquisitions/
JV Partnerships
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PROPRIETARY 7MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
MSSP Incentive Award Opportunity
• Part A and Part B claims for beneficiaries attributed to the ACO
• Benchmark projection based on 3 years of CMS data
• In Year 1, requirement is complete and accurate reporting on all measures
• In Years 2 and 3, a performance score is calculated for the ACO
• Total award is capped at a % of Benchmark expenditures depending upon chose track (Track 1: 10%, Track 2: 15%, Track 3: 20%)
• Calculation of award occurs 6-9 months after end of year.
AC
O B
en
chm
ark
$$
AC
O A
ctu
al $
$Savings
Preventative Health (8metrics)
Care Coordination
Patient Safety (6 metrics)
Patient/Caregiver
Experience (7 metrics)
Managing At-Risk
Populations (12 metrics)
$$$
ACO Portion of Shared Savings
H
Physicians Hospital
33 Total Performance Metrics
Expenditure Reduction
Achieved by ACO ×Track 1: 50%
Track 2: 60%
Track 3: 75%
Performance Score
Earned by ACO× =MSSP Shared Savings Award
Paid to ACO
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September 2018
Management of Transformative Healthcare Trends –How to Expect the Unexpected
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Management of Transformative Healthcare Trends
Transformative Healthcare Trends• Disruption in the “Healthcare Food Chain”• The Birth of the “Unicorn” Physician Practice Management Company • The Population Specific “Virtual Digital EPO”• Destination Medical Center Meets Super Consumer Experience• Adaptive Artificial Intelligence, Expert Systems and Blockchain Technology• VA CCN – The Next Evolution in VA Care• RNA Neo-epitopes Drive New Cancer Diagnosis and Treatment Models
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PROPRIETARY 9MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Disruption in the “Healthcare Food Chain” – The Community Pool in 2017
Care Coordination and Patient OutreachProgram Advisory and Implementation Services
Data Aggregation and Intelligence Risk Management and Analytics
END-TO-END
Source: Curating the Best of Digital and Population Health, Dr. Gordon Joneshttp://www.slideshare.net/elcid84/phmslideshare2014?qid=331b8a6e-df33-4f6b-8bbf-ee7bc139c465&v=default&b=&from_search=3
http://www.slideshare.net/elcid84/phmslideshare2014?qid=331b8a6e-df33-4f6b-8bbf-ee7bc139c465&v=default&b=&from_search=3
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PROPRIETARY 10MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Disruption in the “Healthcare Food Chain”– Who Will Be the Shark(s) in the Community Pool in 2018?
̶ Apple →Medical Clinics ̶ Google/Alphabet →Medicaid̶ Microsoft → Cloud̶ Amazon → Prescriptions̶ Facebook → Hospital Data̶ Uber → Ambulances̶ Others
Market Capitalization
̶ Aetna̶ Cigna̶ Humana̶ Anthem – Government $̶ United Health/Optum̶ Merck, Pfizer, J&J̶ Others
Market Capitalization $$- $ 250 Billion+ ̶ $100 Billion+
̶ CVS̶ Express Scripts̶ Walmart̶ Kaiser̶ Walgreens̶ HCA̶ MDs, Other Providers
Market Capitalization$ 250 B+ ̶ $ 50 Billion+$$$- $ 1 Trillion + ̶ $750 Billion +
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PROPRIETARY 11MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Disruption in the “Healthcare Food Chain”Types of Healthcare Transactions
New Healthcare
Hybrid Entities
Health Retailers
Technology Invaders
Employer Sponsored Initiatives
Vertical & Horizontal Integrators
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PROPRIETARY 12MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Disruption in the “Healthcare Food Chain”Types of Healthcare Transactions
1. Vertical & Horizontal Integrators – CVS Health and Aetna, Optum and DaVita Medical Group, and Cigna and Express Scripts. These hybrid organizations are trying to lower costs of the supply chain by owning more of it and extending those savings to consumers. The challenge? Execution risk is very high with poor history of success.
2. Employer Sponsored Initiatives – JPMorgan/Berkshire Hathaway/Amazon, Blackstone, etc. Combinations such as this are setting out to limit the growth of their own healthcare costs. The challenge? Previous employer lead initiatives have had variable success and sustainability (e.g. SCE, Ford, Macy, Kaiser, etc.) and always require geographic and scope scale.
3. Technology Invaders – Google, Apple, Amazon, Lyft and Uber live in this class. These deals will command more space in the healthcare industry, and they have an advantage in their understanding of modern consumer expectations and new currently non existent healthcare relevant technologic advances. The challenge? Technology invaders need technology that is applicable and actually provides real synergy in both the clinical and business facing applications.
4. Health Retailers – Retailers including Walmart, CVS Health, Amazon and Rite Aid want to gain market share by functioning as healthcare providers directly or as referral conduits. The challenge? Scope of care, complexity of treatment, telehealth, tele monitoring, etc. complicate the patient/provider/payer relationships.
Adapted from Becker’s Hospital Review May 29, 2018
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PROPRIETARY 13MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
SUMMITHEALTHMANAGEMENT
MANAGEMENT SERVICE AGREEMENTS LICENSED ORGANIZEDDELIVERY SYSTEM
(assumes financial risk for the provision of healthcare services)
ARIZONA
OREGON
REAL ESTATE HOLDING COMPNAIES
SUMMIT SELECT
The Birth of the “Unicorn” Physician Practice Management Company Zoonie/Summit Health Management Example
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PROPRIETARY 14MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
The Birth of the “Unicorn” Physician Practice Management Company Zoonie/Summit Health Management (SHM)
• Physician owned, managed, governed – No Debt
• For profit, projected collections $ 950+MM in 2018 with over %50% of Revenue from Value Contracts
• 1,000+ providers in 70+ medical specialties
• 3 States have 100+ Locations
• High Acuity Urgent Care Centers with Multiple Population Specific Designs
• 4,000 employees
• 125,000+ patient treatments per month
• Care to 700,000+ unique patients, 280,000+ attributed patients and 150,000+ at risk lives
• Comprehensive Diagnostic Radiology & Lab/Pathology
• MD Anderson Cancer Center Partnership
• Multiple “Horizon” % of Premium Contracts
• Pioneers in Clinical IT Solutions
• Physician growth of 400 Physicians in 2014-2018
• 250,000 SF expansions/consolidations in Development
Summit Health Management Expands to NJ, OR, & AZ Markets
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PROPRIETARY 15MA N A G E M E N T O F TR A N SF O R M A T IV E HC TR E N D S | SE P T E M B E R 2018
Physician Governance and Leadership
• Facilitate goal development• Create alignment of Clinical and Management
responsibilities• Effectuate culture change to successfully transitions
from FFS to FFV
Population Management
• Care management models
• Quality reporting
• Clinical intelligence
• Strategic clinical programs
Operations Management
• Consolidation & Clinical Integration
• Maximize Practice Performance
• Access, capacity, utilization, productivity, staffing
• Technology Infrastructure Management
• Roadmap for integration
• Strategic real estate development
Revenue Management
• Revenue cycle optimization
• Financial Statements & Budgeting
• Contracting
• Coding Compliance & Education
• Regulatory change management
• Payer contracting assessment
The Birth of the “Unicorn” Physician Practice Management CompanyZoonie/Summit Health Management – Key Elements for Success in Both FFS and “Hybrid FFS Value Based” Reimbursement
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PROPRIETARY 16MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
The Birth of the “Unicorn” Physician Practice Management Company Successful Summit Medical Group Year-Over-Year Savings for It’s Commercial ACO with Horizon While Maintaining Robust SMH Margins
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PROPRIETARY 17MA N A G E M E N T O F TR A N SF O R M A T IV E HC TR E N D S | SE P T E M B E R 2018
Birth of the “Unicorn” Physician Practice Management Company Significant Upside Supports Premium Valuation – Generic Example *
Financial Buyers are competing head to head with Strategic Buyers for Physician Organizations, IT Platform Companies, etc.
Multiple Levers for Continued Value Creation
• Transition of out patient reimbursement to In patient reimbursement methodologies
• Economies of scale• Margin expansion• Accretive acquisitions• Organic growth• New product development and
innovation• Expansion of addressable market• Growing recurring revenue streams• Multiple expansion based n greater
scale, market position
Source of Additional Value Creation
~3x Return
$ 50 MM
Revenue2018E
$ 125 MM
35%Margin
$ 45 MM
Revenue EBITDA2022E
$275 million - $375 million
5.5 – 7.5x 2018E Revenue
$800 million - $1+ Billion
6.5 – 8.5x Revenue
19x – 24x EBITDA
~25% EBITDARevenue Margin
CAGR Expansion
*Generic Example Adapted from KeyBank/Cain Brothers/SSB materials
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PROPRIETARY 18MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
The Population Specific “Virtual Digital EPO”Medicare Highest Spend Areas are Leading the Transition from Fee-for-Service to Medicare Advantage Plans
Source: Dartmouth Atlas
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PROPRIETARY 19MA N A G E M E N T O F TR A N SF O R M A T IV E HC TR E N D S | SE P T E M B E R 2018
The Population Specific “Virtual Digital EPO”High-Cost Seniors – Governmental and Commercial Focused Programs
Source: Fischbeck, Paul. "US-Europe Comparisons of Health Risk forSpecific Gender-Age Groups.” Carnegie Mellon University: September 2009
An
nu
al p
er
cap
ita
he
alth
care
co
sts
Age0 10 20 30 40 50 60 70 80 90
$45,000
$40,000
$35,000
$30,000
$25,000
$20,000
$15,000
$10,000
$5,000
$-
UK
Germany
Sweden
US
Spain
U.S. is spending much more for older ages
Key Takeaway: The CIN must also have clinical models for the management of specialty care, including chronic care management and the management of episodic care.
Governmental Programs Have Focused on High Cost Medicare Beneficiaries – CV, Spine, Ortho, Oncology, End of Life Expenses Lead to the Expansion of Medicare Advantage Plans and Medicare Shared Savings Programs
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PROPRIETARY 20MA N A G E M E N T O F TR A N SF O R M A T IV E HC TR E N D S | SE P T E M B E R 2018
The Population Specific “Virtual Digital EPO” Digital Medicare Advantage Narrow Network/EPO Technology –Care Coordination Platform Improved MLR, Stars, & Performance Incentives
Eligibility /
Authorization
PaymentsMessaging
MarketPlace
ClinicalData
Exchange
e-Screening
Referral
Management
Access Center/
Gap CloserWaitlist
MarketPlace
Self-Service
Solution Capability
Increase Scheduling Access2
2
Enhance Scheduling1
1
Scheduling
Unify the Scheduling Experience3
3
Platform
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PROPRIETARY 21MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
9+Online patients per provider per month
25%Increase in referral
capture
9 dayReduction in lead time
19%Show rate
improvement
The Populations Specific “Virtual Digital EPO”Quantitative Metrics/Outcomes from the Digital EPO
400%Efficiency gains
5XCall center conversion
improvement
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PROPRIETARY 22MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
The Population Specific “Virtual Digital EPO”Revenue Implications – FFS Medicare vs. Medicare Advantage
Assume 5,000 enrollees at $1,200 PMPM (HCC= 1.23) without additional “star” reimbursement
$72MM in Total Premium MA Revenue vs. $60MM in total FFS Premium Revenue
MLR = 85% (industry incentives) to providers/Humana Model*
MA Health Plan $MM
Administration 7.2
Profit 3.6
Totals (15% MLR) 10.8
Providers
Hospital (Inpatient) 20.2
Physician Services 14.4
Pharmacy/OP/Other 14.4
Totals (68% MLR) 57.1
Incentive Allocation
Hospitals (50%) 7.14
Physicians (50%) 7.14
Totals (17% MLR) 14.3
Financial Impact on Key StakeholdersMedicare FFS vs. Medicare Advantage ($MM)
*Humana = 81% MLR: Aetna FL 83% MLRWithout 5 Star incentive allocation (4%+)
1.8
$25.05
$16.80$17.40
7.2
$20.20
$14.4 $14.4
TPI/MA Hlth Pln Hospitals Physicians Parmacy/OP Other
Medicare FFS Medicare Advantage
$21.5 Total+28%
+400%
-17%
$27.3 Total+9%
-14%
-19%
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PROPRIETARY 23MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Clinical, Geographic and Cultural Models Synergize Each Other
Source: SSB adapted changes from EYGM Limited 2017 and CMS Sources
Destination Medical Center Meets Destination Super Consumer Experience Engaging the Super Consumer with Transformative Health
Transportation
ConsumerGoods
Technology
FinancialServices
Entertainment
Telecom
Caregivers
Life Sciences
Product or Service
Developer
Government and Regulators
Investors
Non-Governmental Organization
Payer
Health Providers
SUPERCONSUMER
Policies that create a transparent market to stimulate investment
Investing in businesses and technologies that have growth potential
Affording speed to adoption of new technologies
Providing the most cost-effective health solutions to my members
Obtaining right, affordable treatment and support to be healthy
Delivering the most cost-effective care toachieve health improvement
Using affordable tools to help manage loved ones’ care
Identification of innovative ways to gain new revenue opportunities
Payment appropriate for providing novel products
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PROPRIETARY 24MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Destination Medical Center meets Destination Super Consumer Experience Hospital System CV Destination Center of Excellence
Infrastructure-Staff, Technology and Partnerships
High-Performing Community-Based Independent Physicians
Dedicated Faculty Practice Physicians
CARDIOVASCULAR DESTINATION CENTER OF EXCELLENCE
Co
mp
lex
Car
dio
logy
Co
mp
lex
Vas
cula
r Se
rvic
es
Co
mp
lex
Arr
hyt
hm
ia
Man
age
me
nt
Co
mp
lex
CT
Surg
ery
HEART AND VASCULAR INSTITUTE
DR. “D”DR. “B”
DR. “C”DR. “A”
Clinical Programmatic
Innovation
Industry Relationships
Teaching and Training
Inte
rven
tio
nal
No
n-I
nte
rven
tio
nal
Car
dia
c &
Th
ora
cic
Dia
gno
stic
Ther
apeu
tic
Ad
van
ced
Dev
ices
End
ova
scu
lar
Surg
ical
CVDCOE Steering Committee (Clinical Integration)
Research and Conferences
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PROPRIETARY 25MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Inpatient Market Share Market Share Ranking1st: Aggregate Market Share 1st: Burns1st: Cardiology 1st: ENT1st: General Medicine 1st: GeneralSurgery1st: Neurology1st: Neurosurgery1st: Ophthalmology 1st: Orthopedics1st: Rehab1st: Thoracic Surgery 1st: Urology1st: Vascular2nd: Gynecology 2nd:Obstetrics2nd: Neonatology 2nd: Spine2nd: Oncology
211 Locations
$5B+ Total Assets$4B+ Net Operating Revenue 22,000
Employees; 5,000 Medical Staff
Greater Houston MSA 6.36 million population, projected to 6.9 million by 2018
Destination Medical Center meets Destination Super Consumer Experience“Population Specific” Consumer Facing Regional Programs of Excellence
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PROPRIETARY 26MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Destination Medical Center meets Destination Super Consumer Experience Equality Health – “Culturally Focused” Programs of Excellence
Equality Health is the nation's first integrated
healthcare delivery system focused solely on
improving care delivery for the underserved through
the lens of their own culture
We help managed care organizations improve health
outcomes transition to value-based care and better
engage their most vulnerable members through
culturally-relevant care
We are initially focused on the HispanicLatino
community in Arizona. with plans for southwest
expansion
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PROPRIETARY 27MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Destination Medical Center meets Destination Super Consumer Experience Community Integration – “Meet the Customer/Patient Where They Are"
Equality Health Initiatives exists to improve the health of
individuals, families, and communities by addressing
the social, economic and environmental determinants of
health
Excellent medical care alone is not sufficient to create
healthy communities. To bring about demonstrable
improvements in health. We partner with others to build
health-promoting physical. behavioral. social and
economic environments
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PROPRIETARY 28MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Destination Medical Center meets Destination Super Consumer Experience Rochester, MN Area Foundation (RAF)/Mayo Clinic – “Medical Footprint”Destination Medical Center (DMC) – “Non Medical Footprint” Trend
• Working in association with Mayo Clinic on the DMC will be the Rochester Area Foundation, Mortenson Co. as constructor, and HCDG/SSB in leading Mayo’s expressed focus in accessing New Markets Tax Credit financing. Because of the long-term, expansive nature in developing the DMC and attentive projects in the Discovery Square area, HCDG/SSB envisions this effort as running for many years with the opportunities for better than a decade’s worth NMTC, state tax credit, and related transactions. The following graphic is a rendition of the overall project area.
• Mayo Clinic is embarking upon a $5.6 billion Destination Medical Center (DMC) project within the research and technology center of Discovery Square in Rochester, construction expected to commence next year. The DMC is slated to be a 10-20 year build-out project aimed at turning Rochester into America’s healthcare capital. The DMC environs will cover six-blocks to include transportation, hospitality, livable city and learning environments, as well as research and technology, toward making it a global destination for health and wellness.
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PROPRIETARY 29MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Old World
New World
Where Shift Happens
Adaptive Artificial Intelligence, Expert Systems and Blockchain TechnologyWhat Is Really Possible?
Time
World
Blockchain
Health Information Exchange
Internet
Industrial Assembly
Computer/EHR
Adapted from Multiple Sources including Universal Health Coin
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PROPRIETARY 30MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Advanced Artificial Intelligence, Expert Systems and Block Chain Technology the Constellation of AI Technology and Business Applications8
8Adapted from multiple sources
Intelligentagent
Extended reality
Text, speech, image
and video
analytics
Intelligentproducts
Recommendation systems
Collaborativerobotics
Speechto text
Expert systems
(inference)
Knowledgerepresentation
Predictive systems
Natural language
understanding
Computer Vision
Audio signal
processing
Speech and optimization
DeepLearning
Shallowlearning
Personalization
Intelligentautomation
Biometrics, facial and gesture
recognition
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PROPRIETARY 31MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Adaptive Artificial Intelligence , Expert System and Blockchain TechnologyState of Electronic Medical Records in the US1
The Starting Point for Data Ingestion ?
1 Blockchains and electronic health records; Ben Yuan, Wendy Lin and Colin McDonnell
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PROPRIETARY 32MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Artificial Adaptive Intelligence, Expert Systems and Blockchain Technology
EHR Interoperability through a Health Information Exchange Example2
2 Adapting Blockchain Technology for Electronic Health Record Interoperability – Submitted by cognizant Technology SolutionsAuthors: Nitesh Gupta, Anand Jha and Purna Roy
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PROPRIETARY 33MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Adaptive Artificial Intelligence, Expert Systems and Blockchain TechnologyEHR Interoperability with Blockchain and Health One Cloud Example3
Hospital B
Assumption: Even if Health-One-Cloud becomes available, the legacy EHRs of various health networks will not be retired in the near future.
1. Hospital A creates the EHR for John’s visit and puts it on its health network as well as on Health-One-Cloud.
2. Hospital A has John digitally sign a related record with the visit metadata, an EHR hash, and a URL for Health-One-Cloud on the Health-Metadata-Blockchain
3. Hospital B searches for John’s recent visits on the Health-Metadata-Blockchain and finds the record.
4. Granted permission with John’s public key, Hospital B decrypts the record to find the EHR hash and the Health-One-Cloud URL and accesses it to get the visit information EHR created b Hospital A.
Hospital A
EHR PortalURLEHR HashPatient IDProvider IDVisit IDDate
EHR Interoperabilityvia Blockchain
Health-One-Cloud
Health-Metadata-Blockchain
EHR Cloud for Hospital A and its Health Network
EHR of John’s visit at Hospital A
EHR of John’s visit at Hospital A
1
1
2
4
3
Hash
2 Adapting Blockchain Technology for Electronic Health Record Interoperability – Submitted by cognizant Technology SolutionsAuthors: Nitesh Gupta, Anand Jha and Purna Roy
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PROPRIETARY 34MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Adaptive Artificial Intelligence, Expert Systems and Blockchain Technology
AAI Examples – CTI, Babylon, Leidos, etc.
• AAI: Adaptive Artificial Intelligence ( Terminology is often Incorrect )
– Evolving self-learning expertise
∙ Access to relevant context data
∙ Pattern identification – UK Use for Imaging Purposes
∙ Deconstructionist
∙ Appropriate logic
∙ Internal assessment and adjustment
– Risk management
– Minimal human involvement
– Most Common/Important Use is in NSA Applications Today
Adapted from CTI
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PROPRIETARY 35MA N A G E M E N T O F TR A N SF O R M A T IV E HC TR E N D S | SE P T E M B E R 2018
Adaptive Artificial Intelligence, Expert Systems and Blockchain Technology
• Expert Systems created by Human Protocols
• Database Systems
– Fixed pattern relations
– Relations provided by human experts
• Rules Based Logic
– Provided by human experts
• Human Interface Query Systems
– Human operator final decision
– Risk management human
• Fixed Systems
– Large human involvement
Adapted from CTI
Expert Systems Examples – IBM Watson, Multiple Analytic, etc.
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PROPRIETARY 36MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
Adaptive Artificial Intelligence, Expert Systems and Blockchain Technology
Adapted from Multiple Sources including Universal Health Coin
How would a Healthcare Blockchain System Work?
̶ Every Healthcare Event (HCE) identified from whatever “Data Ingestion Source” (e.g., EHR, Lab, Claims, Pharma, etc.) would lead initially to a financial transaction with greatly enhanced speed, accuracy and work flow.
̶ The challenge is that current Blockchain structure allows for only 8 bytes of data to populate a singular block so that financial transactions would be doable but transferring clinical data with from HIE or another data structure would be difficult without modification and/or development of a new Blockchain structure (Health-Metadata-Blockchain solution ?).
̶ A system of smart contracts at pre negotiated rates would direct revenue flow into the financial healthcare Blockchain entity will cut down transaction costs and proportionally the middlemanburden.
̶ Anonymity on behalf of the member
Healthcare Blockchain Transactional System
̶ Universal Health Coin, etc.
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PROPRIETARY 37MA N A G E M E N T O F TR A N SF O R M A T IV E HC TR E N D S | SE P T E M B E R 2018
CURRENT STATE
Fragmented Community Care Resources
National Dialysis
Contracts
Retail Pharmacy ContractsEmergency CarePatient-Centered Community
Care (PC3)
National Dialysis Contracts
Retail Pharmacy Contracts
Federally-Affiliated Facilities
Emergency Care
Project ARCHVeteran’sChoice
Community Care Network
• VHA Vision is to build a “System of Systems” to administer CCN
- High-Performing Network Systems
- Integrated Customer Service Systems
- Integrated Coordination of Care Systems
- Integrated Administrative Systems
- Integrated Operations Systems
VA Community Care Network (VA CCN) – Next Evolution in VA CareCCN Organizes Current Offerings into Single Integrated Entity
• Fragmented and inefficient programs
• Typically focused on a specific population
• Overlapping or inconsistent eligibility criteria
• Employ multiple processes for the same activity (e.g., claims processing)
• Care often inconsistent with best practices
• Veteran experience is generally suboptimal
FUTURE STATE
Resources Integrated into Single Program
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PROPRIETARY 38MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
VA CCN – Next Evolution in VA CareVA Community Care Regions and Estimated Eligible Veterans
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PROPRIETARY 39MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 201839
VA CCN – Next Evolution of VA CareVA Care Enabled by Advanced Platform Technology5
5 GlobalMed
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PROPRIETARY 40MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
VA CCN – Next Evolution in VA CareKey Takeaways Regarding VHA Transformation
✓ $80 Billion+ In VA to private sector transfer in the four VA regions over the next eight years
✓ Major re-alignment/optimization of VAMC and private network utilization
✓ Major implications for private sector hospitals/physicians willing to accept additional VA referrals
✓ VA Bidder decisions anticipated for most regions by October 2018
1) What level of referrals do you currently receive from local and regional VA facilities today?
2) If located in a market with a meaningful number of Veterans, have you specifically analyzed strategic engagement options for your relationship with the local or regional VAMC health system?
3) What can you do to differentiate your services with the local VHA to ensure you are a preferred referral resource?
QUESTIONS FOR PROVIDERS
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PROPRIETARY 41MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
RNA Neo-epitopes Drive New Cancer Diagnosis and Treatment Models
Focused Diagnostic Capabilities and New Vaccine Therapies6
• Focused RNA Neo-epitopes Drive New Diagnostic Models
– Advanced Diagnostic RNA Neo Antigens present before legacy diagnostic testing
– Less Expensive Diagnostic Modality
• Focused RNA Neo-epitope Vaccines Drive New Therapeutic Models
– Vaccines for Particular Cancer Types Can Be Developed-Especially hard to detect “Cold Cancers” including Glioblastoma, Pancreatic Cancer, etc.
– Not Personal, But High NeoAntigen Coverage
– Pre-made and Pre-Approved
6 Adapted from multiple Stephen A. Johnston, PhD presentations
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PROPRIETARY 42MANAGEMENT OF TRANSFORMATIVE HC TRENDS | SEPTEMBER 2018
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