Reimagining Physician-Payer Collaboration for the Real-time Digital Age
Now that the Meaningful Measures Program and the Alternative Payment Models (APMs) and outcomes driven are driving the healthcare agenda, how can we move to a more real-time quality data exchange capability?
Health Behaviors Clinical Care Social & Economic Factors Physical Environment 30% 20% 40% 10% Access to Care Quality of Care Education Employment Income Family/Social Support Community Safety Air & Water Quality Housing & Transit Source: RWJF/UWPHI. Genetics Diet & Exercise Tobacco Use Alcohol & Drug Use Sexual Activity Sleep Where should we focus first? “Meaningful Measures” is still too broad
Vector 2: Evidence-Based Decisions Vector 3: B2C Health Improvement Programs Vector 1: Next Generation Primary Care Self-tracking/testing: Wearables/Hardware Personalized Medicine/Genomics Health Information Care Navigation Disease Management Peer Networks Health Coaching Decision-Making Tools Care Access Remote Patient Monitoring Patient Engagement Health Behaviors 30% Wellness Programs Source: RWJF/UWPHI. Genetics Diet & Exercise Tobacco Use Alcohol & Drug Use Sexual Activity Sleep Family support & self-help patient groups Health behaviors inflection points
Vector 5: Analytics and Clinical Decision Support Vector 2: Next Generation Primary Care Vector 3: Value-Based Care Vector 4: Operational Efficiency Vector 1: Disease-Specific Care Pathways Care Coordination Patient Engagement Big Data Personalized Medicine Medication Management Clinical Care 20% Access to Care Quality of Care Nanotechnology Source: RWJF/UWPHI. Knowledge Sharing Clinical care inflection points Practice Management, EMRs, Pharmacy Management Transparency Tech-enabled services Retail Clinics, DPC House Calls
Advance Directives Programs/Services Next Gen Benefits Social Services Access/Management Vector 1: Equilibrating Healthcare Expense Vector 2: Community-Based Health Initiatives Vector 3: Aging & End-of-Life Programs Social & Economic Factors 40% Education Employment Income Family/Social Support Community Safety House Calls Hospice Programs Virtual Medicine Incentive Programs Wellness Programs Source: RWJF/UWPHI. Early ID and prevention programs Social & economic factors inflection points
The Digital Transformation Spectrum Manual Data Collection Systems Integration Reporting and Analytics Data Mining Predictions Machine Learning Augmented Intelligence Artificial Intelligence Docs and nurses as clerical staff TODAY
The Digital Transformation Spectrum Manual Data Collection Systems Integration Reporting and Analytics Data Mining Predictions Machine Learning Augmented Intelligence Artificial Intelligence PGHD, Med Device Connectivity TODAY, ACCELERATING
The Digital Transformation Spectrum Manual Data Collection Systems Integration Reporting and Analytics Data Mining Predictions Machine Learning Augmented Intelligence Artificial Intelligence Automating retrospective visibility TODAY
The Digital Transformation Spectrum Manual Data Collection Systems Integration Reporting and Analytics Data Mining Predictions Machine Learning Augmented Intelligence Artificial Intelligence Pattern matching mastery (unsupervised and supervised)
The Digital Transformation Spectrum Manual Data Collection Systems Integration Reporting and Analytics Data Mining Predictions Machine Learning Augmented Intelligence Artificial Intelligence Use past knowledge to make rudimentary predictions about the future
The Digital Transformation Spectrum Manual Data Collection Systems Integration Reporting and Analytics Data Mining Predictions Machine Learning Augmented Intelligence Artificial Intelligence Finding known needles in haystacks and pop health TODAY, MAY SKIP FOR ML
The Digital Transformation Spectrum Manual Data Collection Systems Integration Reporting and Analytics Data Mining Predictions Machine Learning Augmented Intelligence Artificial Intelligence Semi autonomous intelligence which needs humans ARRIVING SOON
The Digital Transformation Spectrum Manual Data Collection Systems Integration Reporting and Analytics Data Mining Predictions Machine Learning Augmented Intelligence Artificial Intelligence Real intelligence indistinguishable from humans and fully autonomous YEARS AWAY
Where ML and AI are applicable (care) Therapies Therapeutic Tools Diagnostics Diagnostic Tools Patient Administration Payer Admin Clinical Professional Education Public Health Education Patient Education Most Regulation Least Regulation Cohort specific Personalized Risk Data Sharing
Where ML and AI are applicable (care) Therapies Therapeutic Tools Diagnostics Diagnostic Tools Patient Administration Payer Admin Clinical Professional Education Public Health Education Patient Education Most Regulation Least Regulation Auto Literature Review Specialty-specific Content
Where ML and AI are applicable (care) Therapies Therapeutic Tools Diagnostics Diagnostic Tools Patient Administration Payer Admin Clinical Professional Education Public Health Education Patient Education Most Regulation Least Regulation Auto Adjudication Fraud Detection Quality Compliance Contract Adherence
Where ML and AI are applicable (care) Therapies Therapeutic Tools Diagnostics Diagnostic Tools Patient Administration Payer Admin Clinical Professional Education Public Health Education Patient Education Most Regulation Least Regulation Patient Self Diagnostics Unlicensed Pro Diagnostics Digitally and Heuristically Guided Diagnostics Images (self, guided, consulted) Labs and Chemistry (self, guided, consulted) Multi-omics (self, guided, consulted) Molecular Biology
Where ML and AI are applicable (care) Therapies Therapeutic Tools Diagnostics Diagnostic Tools Patient Administration Payer Admin Clinical Professional Education Public Health Education Patient Education Most Regulation Least Regulation Auto Triage for Low-risk Augmented Triage for Higher risk Infection control / Anti-microbial Stewardship Consulted Tele Diagnostics Med Device Continuous Diagnostics
Where ML and AI are applicable (care) Therapies Therapeutic Tools Diagnostics Diagnostic Tools Patient Administration Payer Admin Clinical Professional Education Public Health Education Patient Education Most Regulation Least Regulation Physical Mental (chat, VR, etc.) Digital (nutritional, etc.) Clinical Research ( “systematic review automation”) Drug Development Clinical Discovery (unattended and digital)
Where Digital Medicine is applicable (data) Proteomics Genomics Biochemical Imaging Behavioral Phenotypics Admin Economics Connectivity Integration Transformation Comprehension Enrichment Insights Cognition No outcomes driven medicine possible without these
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