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Nearly half of Americans are expected to have chronic conditions by 2020* #1 Cause of • Seven out of 10 deaths among Americans Death each year • Heart disease, cancer and strokes account for >50 percent of all deaths each year 4/5 of total • $2 trillion annually by 2009 healthcare cost • expected to increase 6.1 % YoY • Excl >$200B associated Supervisory Care Chronic Diseases • Strain societys capacity to respond to Capacity health challenges • Capacity: Beds and Manpower Life Style / • Many chronic conditions, such as arthritis Disability (currently the most common cause of disability), can result in one or more daily activity limitations
Prevalence of chronic condition and attitude towards healthy living orwellness across 12 selected countries% Diagnosed with >1 chronic condition % participate in healthy living or wellness programBy Doctor or other medical professional (Past 12 months) 55% U.S. 25% 41% UK 11% 42% Switzerland 9% 51% Portugal 9% 40% Mexico 33% 45% Luxembourg 8% 55% Germany 16% 50% France 9% 41% China 47% 52% Canada 16% 46% Brazil 23% 52% Belgium 12% 60% 50% 40% 30% 20% 10% 0% 0% 10% 20% 30% 40% 50% Source: Deloitte Health Consumer Survey 2011
Patients are generally receptive to help manage their disease• Nearly 80% of patients with one or more chronic condition are receptive to participating in a health plan disease management program• While patients are receptive to disease management only 32% of surveyed patients with a chronic condition are enrolled in a disease management program, which represents a large potential opportunity for lower cost interventions with the remaining patients How Likely Would You Be To Participate in Do You Currently Participate in a a Health / Disease Management Program? Health / Disease Management Program? If it cost you nothing to do so 71%76% / 41% 39% If it entitled you to reduced insurance costs or a financial reward Yes, 32% 21% 19% No, 69% 13% 14% 8% 7% 6% 6%4% 3% 3% 2% 5% 4% 2% 1% 2% 1% 1 2 3 4 5 6 7 8 9 10Not at all likely Extremely likely n = 2,192 respondents with one or more chronic conditions n = 2,192 respondents with one or more chronic conditions Deloittes 2009 Survey of Health Care Deloittes 2009 Survey of Health Care Consumers
Chronic Care Delivery Models • Planned, systematic approach • Focus to information and self-management needs of patients • Multi-disciplinary teams from teams of physicians, nurses, social workers, aides, and others Chronic Care Delivery • Extensive coordination required across settings and Model clinicians, and over time • Timely access to clinical information is critical • Lifestyle related **
Traditional Health Care Service Delivery Model: GP Hospitals Allied Health Polyclinic Pharmacies Preventative Care Coordination of Care Business Model Outcome Based Sustainability Incentives Strategic Partnerships Disease Plan Design Build Operate Operator Management Organization Technology Cost / Economics Leadership Governance & Accountability(Simplified for illustrative purposes)
DMOs has potential to change the patient pathway (illustrative only) GP Hospitals Allied Health Polyclinic Disease Management Organization Pharmacies Preventative Care KPI: Health Outcomes Information and technology DMO Operation Skilled workforce Health Payment / Billing Medical Devices Information Governance Services Infrastructure Exchange Connectivity Financing and Health system performance (Illustrative )
Disease management represents a comprehensive, ongoing, and coordinated approach to achieving desired outcomes for a population of patients Roles & Integration with Responsibilities health plans / of DMO care Sponsoring team agency Coordination: Patient Care: Physicians & Integration of all Other Health Outcomes health needs Practitioners (KPI) Patient Medical Stratification to Leadership* ensure appropriate intervention Disease Management Organization Asses/ Identification Prevention Promotion Manage Monitor/Analyze*includes representatives from Primary care physicians, Specialty physicians as appropriate
Vision and Guiding Principles of Disease Management Organization Guiding Principles to Achieve Vision Person/family – centred • A system that is accessible around the person and their family/caregivers. • Focuses on collaboration among health service providers while including the individual and Supportive & Collaborative family in the care team. • Cultural sensitivity is embedded throughout the future model. A population that is as • Refocusing efforts on prevention and health promotion to foster a healthy population. healthy as possible • A simplified system and continuum of services that is seamless to the person. • Easily navigated to enable individuals to move through the system with ease. • Clear, timely, and transparent communication for all involved members of the circle of care Coordinated / integrated which may include health service providers (regulated / non-regulated) and people receiving care. • A system that has available resources and allows for sharing of resources (i.e. volunteer management) • Emphasis on self-management to enable people to “own” and be accountable for their health for Empowerment those who are able. • Focus on holistic healing that includes mental, physical, emotional, and spiritual health. Healthy / integrated healing • A culture/environment which makes it easier to live with a chronic disease by reducing the burden of disease. • Focus on care and planning for the future (i.e. targeted towards 2020). • Accountability is woven throughout system by ensuring that program elements are evidence- Focus on future (2020) based and outcome-oriented. • Develop a system that is flexible and adaptable to new technologies. • Leverage existing resources and don’t reinvent the wheel.
Defining the Disease Management Organization - Operating Model11