IBM Healthcare and Life Sciences Patient Centered Collaborative

IBM Healthcare and Life Sciences Patient Centered Collaborative Care: New Healthcare Delivery Models Enabled by Information Technology Dr. Joseph M. Jasinski Distinguished Engineer and Program Director Healthcare and Life Sciences IBM Research

IBM Healthcare and Life Sciences Today’s Discussion • What does Accessibility mean in the Context of Healthcare? • A New Healthcare Delivery Model • Technologies to Enable Improved Healthcare Delivery 2 IBM Research | © 2008 IBM Corporation

IBM Healthcare and Life Sciences Healthcare Environment – More Spending Does Not Guarantee Better Health as Measured by Longevity • World spends about $4. 5 Trillion, U. S. spends about $2 Trillion • US ranked 37 th by WHO in Healthcare effectiveness (btw Costa Rica and Slovenia) • In the U. S 42% of spend is Centers for Medicare and Medicade Services, much of the rest is large employers • Large Corporations spend significant amounts on healthcare through self insurance • 47 million Americans have no health insurance • Approximately 100 K deaths in US every year from preventable medical Source: error. IBM Global Business Services and IBM Institute for Business Value 3 IBM Research | © 2008 IBM Corporation

IBM Healthcare and Life Sciences A proactive, value-based health system should help move people from right to left – and keep them there. IT is a natural way to improve efficiency, safety and reduce costs Health care spending Health Status Healthy/ Low Risk At. Risk High Risk Active Early Symptoms Disease 20% of people generate 80% of costs A value-based health care system Source: IBM Global Business Services and IBM Institute for Business Value 4 IBM Research | © 2008 IBM Corporation

IBM Healthcare and Life Sciences What Does Accessibility Mean in the Context of Healthcare? • Accessibility Challenges - Availability: Shortage of Primary Care Physicians; Needs of Rural/Developing - 5 Economies Cost: Universal Access to Health Insurance; Chronic Disease; Genetic Predisposition Physical Access: Elderly, Home Bound, Limited Mobility Cognitive Access: Literacy, Language, Cognitive Impairment IBM Research | © 2008 IBM Corporation

IBM Healthcare and Life Sciences Today’s Discussion • What does Accessibility mean in the Context of Healthcare? • A New Healthcare Delivery Model • Technologies to Enable Improved Healthcare Delivery 6 IBM Research | © 2008 IBM Corporation

IBM Healthcare and Life Sciences Why is the healthcare system broken? “ We don't have a health care delivery system in this country. We have an expensive plethora of uncoordinated, unlinked, economically segregated, operationally limited micro systems, each performing in ways that too often create suboptimal performance both for the overall health care infrastructure and for individual patients. " George Halvorson We believe…. q Collaboration across the full care team is missing q Taking a longitudinal view of the whole person’s health from wellness and prevention to at risk to chronic care to end of life is missing q Technology is insufficient and not helping the care team do their jobs, thus not being adopted q Accountability and incentives are not in place to encourage delivery of quality cost effective care q Care is not centered on patient needs 7 IBM Research | © 2008 IBM Corporation

IBM Healthcare and Life Sciences What do we want our healthcare to be? Healthcare Team Physicians Healthcare Team Care Givers Medicaid Staff Employers Medicaid Client Patients I want my healthcare to be To value me for what I do To give me a better life balance Founded on a strong patient clinician relationship Focused on the total health of the individual Actively engaged in helping people be healthy and well Able to help individuals make healthy choices, more and more often Allowing me to access important health records no matter what place of care created them To be driven by evidence based medicine and robust information about all relevant aspects of an individuals live To reduce practice overhead To free me from administrative hassles To improve my access to information about my patients To let me do what I do best, practice medicine Coordinated with others responsible for providing patient care and support Affordable to employers and individuals now, as well as in the future Affordable so I can offer coverage to my employees Easy to understand, with less hassle Cost effective To be in control, and result in the best outcome Information to be in one place, like banking online Accessible 24 x 7, for advice, planning, scheduling, request prescription refills and … To be affordable Provide me alerts, i. e. , screen events Higher quality Provide me information I need about me and my kids when I need it Give me access to someone who knows me, and can answer my questions…and coach me through my decisions 8 IBM Research | © 2008 IBM Corporation

IBM Healthcare and Life Sciences The political pressure for healthcare reform has never been greater • “…the cost of our health care has weighed down our economy and the President Obama health care conscience of our nation long enough. So let -there be. Barack no doubt: reform cannot wait, it must not wait, and it will not wait another year. ” Coverage for All Payment Reform Health Information Technology Tools to Rebuild. Align andincentives Restructure Health Care Pay for Value Strengthen Primary Care Source: Obama, Barack. “Remarks of President Barack Obama -- Address to Joint Session of Congress” http: //www. whitehouse. gov/the_press_office/Remarks-of-President. Barack-Obama-Address-to-Joint-Session-of-Congress/ 9 IBM Research | © 2008 IBM Corporation

IBM Healthcare and Life Sciences Patient-Centered Medical Home (PCMH) is an approach to deliver comprehensive care, coordinated by a physician-led care team (not your house with a lot of technology) Personal Relationship with a Physician and Care Team + Proactive Focus on Health, Care Intervention and Chronic Disease Management • Brief history of the evolution of the PCMH: - 1967: American Academy of Pediatrics defined medical home concepts related to children with special needs - 2000 -present: AAFP and ACP developed and extended the concept to include care for all patients with chronic illness and patient centeredness - 2006 -07: AAFP, AAP, ACP and AOA develop a common definition of “patient-centered medical home” and link PCMH to reform of payment for physicians + Technology, Services & Applications to Support the New Collaborative Care Model Principles of PCMH • Patient Centric/Personal Physician • Physician directed medical “team” • Whole person orientation • Care is coordinated and/or integrated • Emphasis on quality and safety • Enhanced access • Appropriate reimbursement “The Patient-Centered Medical Home (PCMH) provides care that is “accessible, continuous, comprehensive and coordinated and delivered in the context of family and community. ” 1 Source: 1) www. medicalhomeinfo. org/join%20 statementpdf 10 IBM Research | © 2008 IBM Corporation

IBM Healthcare and Life Sciences Medical Home in the Current National Debate on HC Reform • Current House Legislation • Medical Home Pilot Program -- An expansion of the medical home demo in Medicare. Establishes a medical home pilot program to asses the feasibility of reimbursing for qualified patient-centered medical homes. There are two models in the program: 1) the independent patient-centered medical home structured around a provider, targeted at the top half of high need Medicare beneficiaries with multiple chronic diseases, or 2) the community based medical home, targeted at a broader population of Medicare beneficiaries with chronic diseases and allows state-based or nonprofits to provide care management. Provides approximately $1. 6 billion from the Trust Fund for the 5 year pilot programs • Medicaid medical home pilot program -- A 5 year medical home pilot program for high-need Medicaid beneficiaries. The federal government would match costs of community care workers at 90% for the first 2 years and 75% for the next 3, up to a total of $1. 235 billion. 11 IBM Research | © 2008 IBM Corporation

IBM Healthcare and Life Sciences Today’s Discussion • What does Accessibility mean in the Context of Healthcare? • A New Healthcare Delivery Model • Technologies to Enable Improved Healthcare Delivery 12 IBM Research | © 2008 IBM Corporation

IBM Healthcare and Life Sciences Working Definitions for Today’s Discussion • Electronic Medical Record – EMR. An electronic collection of patient documents specific to one physician, clinic, hospital. (Also Electronic Patient Record – EPR) - Institution or physician centric - Episodic - Many versions and types exist • Electronic Health Record – EHR. An electronic collection of all healthcare documents for an individual - Patient Centric - Longitudinal - ‘Gold Standard’ – physician and institution maintained - Very few exist in reality • Personal Health Record – PHR. An electronic collection of all healthcare documents that an individual chooses to maintain - Patient Centric - Longitudinal - Patient Controlled and Editable - Emerging area for healthcare in some countries 13 IBM Research | © 2008 IBM Corporation

IBM Healthcare and Life Sciences http: //www. accenture. com/NR/rdonlyres/15 D 767 DA-7 F 3

IBM Healthcare and Life Sciences Denmark 15 IBM Research | © 2008 IBM Corporation

IBM Healthcare and Life Sciences Sundhed. dk Services for Citizens • • • General information Information from hospitals all around Denmark Yellow-pages for the entire Danish health sector Waiting-list information Information about medicine E-booking calendar Secure communication (“e-mail”) Personal Medicine Profile Citizens event log Registration as Donor 16 IBM Research | © 2008 IBM Corporation

IBM Healthcare and Life Sciences Mobile Health – Robust Monitoring for Outpatient Population • Initial application for pharmaceutical industry drug trials - Real-time feedback improves patient safety Enables monitoring and dosage adjustments based on results Accuracy & compliance documented Sensor equipped Bubble Pack Compliance monitoring Health Monitoring Data Bluetooth Enabled 17 IBM Research | Real-time Feedback Server © 2008 IBM Corporation

IBM Healthcare and Life Sciences Plug. Fest November 2008 PAN Interface Device Manager XHR Interface Sender Receiver Wired Glucose Meter PHM Report • Glucose (canned) Telehealth Service Wired Glucose Meter PHR (canned) PHM Report • Weight Wired AHD Telehealth Service Wired Weighing Scale EHR Wired Independent Living Activity Hub 18 IBM Research | Continua Health Alliance © 2008 IBM Corporation 18

IBM Healthcare and Life Sciences Online Analytics using a stream optimized system CENTURY’S FOCUS PROACTIVE OUTBREAK DETECTION REALTIME HEALTH CENSUS VERY LARGE NUMBER OF STREAMS Biometric Sensor Data + Census, CDC HIGH SPEED STREAMS MONITORING SERVICES SLOW SPEED STREAMS TRENDING ANALYSIS Contextual Data Sources CLINICAL DECISION Clinical, Insurance WELLNESS SERVICES THIRD PARTY CONSULTING SELF MANAGEMENT Wellness, Citizen IBM System-S 19 IBM Research | © 2008 IBM Corporation

IBM Healthcare and Life Sciences Medical Information Hub http: //www. youtube. com/watch? v=VAw. Ydm. Ud 59 A 20 IBM Research | Source: Andre Elisseeff Zurich Rsch and Nhumi Corp © 2008 IBM Corporation