Health Systems Organizing Themselves Around Individuals

by Clive Riddle, June 11, 2010

This week Benjamin Isgur, Director at PricewaterhouseCoopers’ Health Research Institute gave a presentation in the Healthcare Web Summit event, Healthcare in the Decade Ahead: HealthCast: The Customization of Diagnosis, Care and Cure.

In Ben’s words, what the folk at PWC’s Health Research Institute see in the decade ahead with respect to global trends for health systems, is that the “cost pressures are still there, but we’re seeing a new way forward for sustainability and systems being more efficient and effective, by organizing themselves around individuals.” The headline of his third slide said it all: “Individuals will be at the center of diagnosis, care and cure.”

Ben’s presentation was based on a paper published by their Institute, entitled HealthCast: The Customization of Diagnosis, Care and Cure. The report reflects proprietary research conducted by PwC, including more than 200 in-depth interviews in 25 countries with thought leaders and executives representing government, hospitals, pharmaceutical companies, insurance companies, clinicians, academics and the business community and a survey of 3,500 individuals in seven countries and 590 leaders of health plans, providers, government, employers, physician groups and pharmaceutical/life science firms in 20 countries.

Ben’s case for why today’s health system model must change:

1. “Both young and old consumers are developing chronic diseases in record numbers, leading to an explosive consumption of resources that is driving up spending and creating liabilities for future generations. Following a global recession, health leaders are under pressure to show more value from rising health costs.”


2. “Converging influences in health. Chronic diseases are driven by social, economic, genetic and behavioral factors that are largely unaddressed by today's medical delivery system.”


3. “Technology is leading healthcare into a new era of "mass customization," following other industries such as auto manufacturing, media, and entertainment. The use of metadata is changing the behaviors of individuals and health systems.”

Ben’s presentation used international and domestic cases to support their thesis that the trends ahead for the U.S. are really part of global overarching  developments. For example, in discussing how chronic disease now affects young and old, driving up spending, he shared this Australian experience regarding “drivers of health spending in Australia in respiratory disease (which affects the young) and neurological disease (which affects the old)”:

Respiratory cost drivers:	Neurological Cost Drivers:
Volume per case: 84%	Volume per case: 25%
Price: 9%	Price: 5%
Disease Rate: 4%	Disease Rate: 4%
Ageing: 3%	Ageing: 48%
Population: 0%	Population: 18%

Other key trends Ben addressed in the same manner:

• Health reform is moving the status quo to customized care
• Funding is being redistributed from sickness to wellness
• Incentives are being designed to encourage partnership
• Electronic medical records and IT ease collaboration, customization
• Patient communication is supporting shared decision-making
• Workforce models will be more flexible and efficient

In summary, Ben stated these are the vectors of change for customization and individual engagement:

• Regulatory reform that focuses on efficiency
• Funding that is redistributed
• Incentives that encourage partnership
• EMRs and IT that ease collaboration
• Patient communication that supports shared decision- making
• Workforce models that are flexible

The toolkit PwC prescribes to address this change includes:

1. Coordinated care teams: Consumers want coordinated care. Integrated care networks that share information, care and accountability for patient outcomes are likely to become models for the future.
   
2. Fluent navigators: Individuals lack the knowledge and skills they need to navigate the health system and understand their choices. In a patient-centered health system, there will be a growing need for consumer advocates beyond friends and family. PricewaterhouseCoopers sees the role of healthcare-fluent navigators being played by pharmacists, community workers and possibly the emergence of a new professional field much as financial planners emerged with the rise of consumer-directed investing.
   
3. Patient-experience benchmarks: In a patient-centered health system, more attention will be paid to understanding and meeting consumer expectations. Many health systems already are tracking and publicly reporting on patient-centric metrics of care, such as cleanliness, wait times and physician satisfaction, allowing patients to make more informed decisions.
   
4. Care-anywhere networks: The definition of access is being redefined by telehealth, wireless mobile devices, remote monitoring and new care delivery models that move care from hospitals, nursing homes and physicians’ offices and into patients’ homes, which increasingly are wired with networked devices.
   
5. Medical proving grounds. Through collaboration and investment, some regions and other countries are positioning themselves to be medical proving grounds, or centers of excellence in medical innovation and care as a way to attract patients, researchers and providers looking for the shortest path to access and innovation.

PwC’s Recommendations for adopting a convergence viewpoint:

• Encourage partnership
• Reward competition and innovation
• Fund wellness
• Empower shared decision-making
• Develop dynamic workforce models
• Enable IT

1.      “Both young and old consumers are developing chronic diseases in record numbers, leading to an explosive consumption of resources that is driving up spending and creating liabilities for future generations. Following a global recession, health leaders are under pressure to show more value from rising health costs.”

2.      “Converging influences in health. Chronic diseases are driven by social, economic, genetic and behavioral factors that are largely unaddressed by today's medical delivery system.”

“Technology is leading healthcare into a new era of "mass customization," following other industries such as auto manufacturing, media, and entertainment. The use of metadata is changing the behaviors of individuals and health systems.”