2013-07-17: Health Innovation, A General Dynamics IT Perspective

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Property of General Dynamics Information Technology
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Health Innovation –
A GDIT Perspective
Craig Miller
Vice President, Health Strategy and Innovation

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do not distribute or re-use content without permissionGeneral Dynamics Proprietary Information
PROBLEMS

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1: The Unsustainable
Cost Curve
• Healthcare accounts for nearly 18% of US GDP (Health
Affairs 31(1): 208-219)
• $2.6 trillion in total spending in 2010, over 10x spending 25
years ago (Centers for Medicare and Medicaid Services, Office of
the Actuary, National Health Statistics Group, National Healthcare
Expenditures Data, January 2012.)
• Insurance premiums have risen 113% in last decade (Kaiser
Family Foundation and Health Research and Educational
Trust. Employer Health Benefits 2011 Annual Survey. September
2011.)

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Cost growth comparison with
other countries
Source: Organisation for Economic Co-operation and Development (2010), "OECD Health
Data", OECD Health Statistics (database)

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Overall cost comparison with
other countries (2009)
Source: Organisation for Economic Co-operation and Development (2010),
"OECD Health Data", OECD Health Statistics (database)

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2: Waste
Almost one
third of the
US spending
on healthcare
($750 billion)
is
unnecessary,
according to
the 2012
Institute of
Medicine
study Best
Care at Lower
Cost

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3. Unacceptable Outcomes
• According to the recently release IOM report “U.S. Health in International
Perspective: Shorter Lives, Poorer Health”, compared to 16 other peer
industrialized countries:
• America ranks last in probable life expectancy for males <50, second to last
for females <50
• Americans as a group fare worse in at least nine health areas:
- infant mortality and low birth weight
- injuries and homicides
- adolescent pregnancy and sexually transmitted infections
- HIV and AIDS
- drug-related deaths
- obesity and diabetes
- heart disease
- chronic lung disease
- disability

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INSIGHTS

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4: The Chronic Disease
Epidemic
• According to the CDC:
- 7 out of 10 deaths among Americans each year are from chronic
diseases. Heart disease, cancer and stroke account for more than
50% of all deaths each year.
- In 2005, 133 million Americans – almost 1 out of every 2 adults –
had at least one chronic illness.
- Obesity has become a major health
concern. 1 in every 3 adults is obese
and almost 1 in 5
youth between the ages of 6 and 19
is obese
- If current trends continue
1 in 3 Americans will have
diabetes by 2050
US Adult Type II Diabetes Incidence, 2008

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5: The Five Percent
• According to AHRQ
study The High
Concentration of U.S.
Health Care
Expenditures:
- Five percent of the
population accounts
for almost half (49
percent) of total
health care
expenses.
- The 15 most
expensive health
conditions account
for 44 percent of total
health care expenses

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OPPORTUNITIES

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6: Coordinated Care
• The “5 Percent” typically
exhibit complex
comorbidities and
extensive chronic disease
• Often characterized by
frequent hospital
readmissions and
extensive end-of-life care
• At-risk populations need to
move from isolated,
reactive models of care to
coordinated, proactive
models of care

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Coordinated Care Enablers
• Health Information Exchange
• Open Source HIE solutions, such as HIEOS
• Patient Centered Medical Homes
• Care coordination teams
• Accountable care organizations

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7. Disruptive Care
Models
• Move to value-based purchasing for healthcare presents
unique opportunities for disruptive innovation
• “Winners” in ACO-like environments will do the best job of
aggressively managing chronic disease, incenting better
patient self-care, and moving care to less expensive
providers and settings
Hospital Outpatient Home
High cost of care Low cost of care
Care provider
Care setting
Physician
Nurse /
NP PA
Self-Care

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Disruption Enablers
• Remote monitoring
• Remote consultation
• Mobile platforms
• Social networks
• Increased autonomy/privileges for NP/PA and other
non-physician clinicians

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8: Solutions for Three
Types of Fraud
• Identity: one or more participants in the
transaction is a false identity (provider, patient,
processor, etc.)
• Transactional: real patient and provider, but
fictitious or inappropriate/unnecessary service or
product (also includes waste and abuse)
• Collusive: Larger pattern of transactions indicates
organized conspiracy to defraud, such as pill
mills and rent-a-patient schemes
• Each type of fraud needs a different solution

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FWA Solution Enablers
• Move to prepayment detection of potential fraud and
claim denial
• Integrate data from clinical sources and
public/financial records in addition to traditional
claims data
• Create a longitudinal view of true patient health
status to evaluate claims for waste and abuse

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9: The Analytics
Revolution
• Widespread EHR and HIE adoption will provide a rich
stream of computable clinical data that can significantly
enhance the utility of analytic applications
• “Big data” tools will enable analytics on unstructured data
(e.g. clinical notes, social media, etc.) to augment the
traditional structured data analysis
• Significant challenges remain in reconciling inconsistent
data from multiple sources and in de-identifying personal
health data for public use

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Analytics Enabler: Data
Fusion
Clinical
Encounters
Claims
Quality
Reporting
Research
Data
Public
Records
Analytics
Comparative
Effectiveness
FWA
Population
Health
Chronic
Disease
Management
Clinical
Decision
Support

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10: Create a Learning
Health System
• Past studies have shown it may
take a decade or more for new
clinical knowledge to make its
way into routine practice
• A learning health system is one
that collects digital evidence from
clinical experience, analyzes it to
gain new insights and then
rapidly applies them to front-line
care to lower cost and improve
quality

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LHS Enabler: The Circle of
Health Data
• Meaningful Use provisions
and health economics are
driving the industry towards
the creation of “learning
health systems”
• EHR adoption and HIE
alone are insufficient to
achieve this
• Real value comes from
identifying populations at risk
and moving from reactive to
proactive, coordinated
models of care that integrate
analytic insights into practice
• Follow example of integrated
delivery network systems
Collect and
manage
health data
Exchange
health data
Analyze
health data
Integrate
insights into
practice

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For More Information
HIMSS Innovation
Community
http://66.77.252.5/asp/innovation_commu
nity_home.asp
HIEOS http://sourceforge.net/projects/hieos/
GDIT Health Solutions http://www.gdit.com/Capabilities/Health/
Learning Health
Community
http://healthinformatics.umich.edu/initiative
s/lhs/national-summit

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Contact Information
Email craig.miller@gdit.com
Website www.gdit.com
Twitter @HealthITCraig
Phone 703.405.1408

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General Dynamics Proprietary Information

2013-07-17: Health Innovation, A General Dynamics IT Perspective

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2013-07-17: Health Innovation, A General Dynamics IT Perspective