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Healthcare Innovations: Trends, Transitions, Technology, and Talent. Ricardo Martinez, MD, FACEP Chief Medical Officer North Highland Company, North Highland Worldwide. It Starts…. Care given at home People paid out of their pockets directly

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Healthcare Innovations: Trends, Transitions, Technology, and Talent

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Healthcare Innovations:

Trends, Transitions, Technology, and Talent

Ricardo Martinez, MD, FACEP

Chief Medical Officer

North Highland Company,

North Highland Worldwide

it starts
It Starts…
  • Care given at home
  • People paid out of their pockets directly
  • Hospitals largely for poor or travelers without a home

-run by charities and religious orders.

  • Physicians started many of today’s hospitals to deliver advances in medicine.
  • In the 1920-30’s, health insurance started by hospitals and doctors to help people pay for hospital and physician care.
  • Then… went nuts.

putting the fun in dysfunction
Putting the “Fun” in Dysfunction….

Common Characteristics of Current Healthcare System

  • Expensive, with hidden prices
  • Activity-based rather than performance
  • Fragmented and uncoordinated
  • Insular
  • Difficult to access and to use. Not user-friendly
  • Inefficient
  • Ineffective
  • Highly variable
  • Autonomous and insular thinking
  • Slow to adopt and change

Market Failure – Widespread Demand For Improvement

what is innovation innovare to renew or change
What is Innovation?Innovare; "to renew or change”

Steps to Innovation

The Nature of Innovation

Unique, not just new.

Must be definably valuable

Must be worthy of exchange – of time, money or effort

  • Curiosity
  • Discovery
  • Invention
  • Innovation
four types of innovation
Four Types of Innovation
  • Transformational
    • A paradigm shift that changes society
  • Category
    • Building new industry within transformation
  • Marketplace
    • Builds or expands markets, reach new customers
  • Operational
    • Redesign to improve business processes and customer experience
the innovators dilemma
The Innovators Dilemma
  • Great companies fail for doing the right things.
  • Too much emphasis on current customer needs and fail to adopt new technology or business models
  • Stuck in a value network
  • Examples: computers, steel minimills
  • Healthcare?
the big trends
The Big Trends
  • Financial
  • Social
  • Technological
  • Political
market drivers toward value based care quality costs

Drivers of HealthCare Trends

Market drivers toward Value Based Care = Quality/Costs

Positioning Enterprises for Success.

Responds when patient need arises

Centered around provider practice and schedules

Independent practices

Highly variable practice

Systems designed for commercial rates to be profitable

Large administrative burden


High utilization = revenue

Margins dependent upon reimbursement

Patients finds access points and navigates fragmented system



  • Limited Reimbursement
  • Financial Risk Sharing
  • Consumer as payment source


  • Health Reform
  • Increased Medicaid
  • Insurance and Data Exchanges
  • Payment reform
  • Consumerism
  • Aging population
  • Chronic Disease
  • Shortage of staff


  • Rapid growth health IT
  • Mobile devices
  • Telehealth
  • Cloud and exchanges

Value-Based Care Rapidly Emerging

Activity-Based Care Fading Away

Healthcare enterprises must change or die.

  • Identifies unmet needs and responds proactively
  • Centered around patient needs and schedules
  • Integrated network
  • Highly repeatable practice
  • Systems designed for Medicaid rates to be profitable
  • Frictionless healthcare
  • Value-based
  • Utilization = costs
  • Margins dependent upon costs
  • Patients ushered to appropriate access point and navigated thru integrated health system
financial crest
Financial Crest
  • Reimbursement peaking
  • Move toward “Pay for Value” – Quality/$$
  • Shift away from high fixed costs
  • Move toward risk sharing models
  • Greater scrutiny from payers and public
  • Growth of defined contribution benefits
  • Increasing patient co-pays makes them a payer source
  • Value-based insurance design
building capability requires a phased approach
Building capability requires a phased approach

Road Map of Future Shifts in Reimbursement Models

Phase 1: Foundational

Phase 2: Enhanced

Current State

Phase 3: Advanced

Decrease Costs

Decrease Costs

Decrease Costs

social waves
Social Waves
  • Aging of population
  • Growth of chronic diseases
  • Shortage of physician and healthcare workers
  • Increasing consumerism
  • Shift from Independence to Interdependence [Systems Thinking]

I think I’m going Japanese…

Source: The Economist: Into the Unknown. November, 2011


growth of chronic disease
Growth of Chronic Disease
  • 5% of population accounts for ~ 50% of total health expenditures
  • The 15 most expensive health conditions account for 44%
  • 25% of US have one or more of 5 major chronic conditions
    • Mood disorder, diabetes, heart disease, asthma, hypertension
  • Rise in population treated with 7 of top 15 conditions, rather than rising treatment costs per case, accounted for greatest part of spending growth.
  • And obesity continues to climb – which causes hypertension, diabetes, heart disease and hyperlipemia.
shortage of physicians and health workers
Shortage of Physicians and Health workers
  • US has 3 specialists for each generalists, the inverse of other countries.
  • Geographic maldistribution of healthcare resources
  • Leads to difficulties and delays in access to care
  • Each state has different laws on scope of practice of various
  • Will only get worse
shift from independence to interdependence
Shift From Independence to Interdependence
  • Started in the US in the 1960’s
  • Systems Thinking accelerated with The 5th Discipline, 1990’s
  • Most other industries adopted and “reengineered”
  • Relatively new concept to Healthcare
  • Physicians taught autonomy often without skills needed for success in systems.
increasing consumerism
Increasing Consumerism
  • Want more control and choice in health relationship
  • Desire more convenient access to care
  • Think they own their medical information
  • Increasingly cost conscious
  • Can collaborate with others with the same disease
  • Want access to medical information
  • Desire personalized experience
technological waves
Technological Waves
  • Rapid growth and implementation of Health IT across healthcare allows capture and exchange of clinical data.
  • Expansion of wireless broadband increase flow of information
  • Rise of digital sensors and imaging that can provide information and be shared
  • Boom of mobile devices for collaboration and information retrieval, including consumers.

What is the “Road Ahead” ?

  • Patient-centered, physician-directed teams
  • Value-driven: high quality at lowest cost
  • Connected and integrated – culturally and digitally
  • Delivers measurable quality health care (meaningful metrics, dashboards)
  • Data-driven performance, with Business Intelligence – constantly learning


maintaining margin depends on lowering costs
Maintaining Margin Depends on Lowering Costs

Road Map of Future Shifts in Reimbursement Models

Phase 1: Foundational

Phase 2: Enhanced

Current State

Phase 3: Advanced

Decrease Costs

Decrease Costs

Decrease Costs

the medicaid paradox
The Medicaid Paradox

Decrease Costs

Recalibrating the system for Medicaid rates will increase margins for other payers.

Source: Hospital and Physician Cost Shift: Payment Level Comparison of Medicare, Medicaid, and Commercial Payers. Milliman. December 2008.

controlling cost per unit service
Controlling Cost Per Unit Service

Ways to decrease costs of care delivery:

  • Provider substitution
  • Diagnostic/treatment substitution
  • Setting Substitution
  • Process redesign:
      • Eliminate steps and processes
      • Add missing steps and processes
      • Re-engineer process
  • Offload costs to patient and family

Progressive strategies build

in a cost-effective manner


“Value” requires matching patient need

with the lowest cost access point…

Care Continuum

Ambulatory Surgery Center

Cost of Care

Ease of Access

Consistent Quality and Connectivity / Culture

…while maintaining consistent quality

hiring the patient
Hiring the Patient
  • Patient Empowerment and Activation
    • Self-monitoring and feedback “self quantification” – Nike?
    • Patient health portals, shared with caregivers
    • Healthcare Gamification
    • Home testing and diagnostics
    • Disease-specific communities of care
    • Decision support
    • Informed Consent
redesigning the process and patient experience
Redesigning the ProcessAnd Patient Experience
  • Delivery process re-engineering
    • RFID, Real-time Locations Systems, Kiosks
  • Care Coordination across spectrum
  • Care Navigators and health coaches
  • Focused factories and value streams
  • Health malls
  • Cost transparency
  • Patient compliance tracking
setting substitution
Setting substitution
  • Home diagnostics, with wireless connectivity
  • Retail clinics, expanding into chronic care
  • Urgent care, tightly affiliated with networks
  • Telemedicine/teleheath
  • Hospital At Home programs for >100 DRGs
  • Home-based chronic care
  • Online/email consultations
diagnostics therapeutics substitution
Diagnostics/therapeutics substitution
  • Utilization management programs
  • Consumer decision-support and Intelligent Virtual Assistants
  • Online/telemedicine
    • Behavioral health, neurology, wound care, cardiology, chronic care, EM
  • Decentralized lab and testing - POC
  • Computer-guided diagnostics
  • Sleep testing and therapy
provider substitution
Provider Substitution
  • Generalist over Specialist – Medical Home
  • MLP or Associate Provider over MD
  • Nurse over Associate Provider
  • LPN over Nurse
  • Tech over LPN
  • Community Worker over Tech
  • Do it yourself
  • Big Data – drowning in it
    • “Money Ball”Analytics
    • Predictive Modeling
    • Integrated dashboards
  • Cloud-based solutions
  • Crowd sourced solutions and epi
  • Computer-assisted diagnostics

These interconnected competencies

drive successful transformation.

what talent attributes are needed now
What “talent” attributes are needed now?
  • Leadership
  • Teamwork
  • Systems thinking
in the road ahead leadership counts
In The Road Ahead…Leadership Counts