Pull, Push, Pay Adding Value To Patient Decision Aids
Don Kemper, CEO, Healthwise
Presented to the National Health Policy Conference
Academy Health
February 8‐9, 2010
® 2010 Healthwise, Incorporated
About 300 Million Decisions Per Year
50 Million Surgeries
100 Million MRIs, CT Scans, etc.
150 Million Medication Changes
Pull, Push, Pay
• Pull (from the Web)
• Push (with coaches and Ix®)
• Pay (incentives/accountability)
Decision Aids Value Chain
22
4
100
50% 90% 90% 50% 90% 50% Decision Aids Value Chain
Pull
Push
Pay
150 Decision Points
Engaged
Confident
Informed
IPDAS-Standards
International Patient Decision Aid Standards
Pull Strategies
Patient Pulls From the Web
Licensed To Over 200 Web Sites
11,000,000 Uses Per Year
Pull Strategies
Patient Pulls
From the Web
300,000,000
Decisions Per Year
11,000,000
How To Enhance “Pull”
• Mental Models: Help users “identify”
• Graphic Design: Intuitive and easy to use
• Social Networks: Increase the buzz
Push Strategies
Information Therapy:
Prescribing:
• the right information
• to the right person
• at the right time
As part of the process of care
What Is an Ix?
Medication Prescription
(Medical Therapy)
Information Prescription
(Information Therapy)
Information Therapy changes
the role of patient information:
From:
Information is
“about your care”
To:
Information “is care”
Analytics and Triggering
• Claims Data Analysis
:
e
g
n
e at a
l
• Data Mining
l
a
D
h
h
C s
e
• Rules Engines r
F
• Predictive Modeling
l
o
o
T
M
T
• Health Risk Assessments
on
Ix
t
u
B
t
InfoButton
HL7 Context‐Aware Knowledge Retrieval Standard
• Patient demographics (age, sex, ...)
• Clinical Context (provider, setting, ...)
• Clinical Data (diagnosis, tests, drugs, …)
Allows real‐time analysis of this “moment in care”
•MD Use: Support for clinical decisions and care coordination
•Ix Use: Info to support patient self‐management and decision making
n
o
t
t
u
B
Ix
InfoButton
IxButton
HL7 Context‐Aware Knowledge Retrieval Standard
PHR
Knowledge Request
Patient, Problem, Context Data
EHR
i
HL7
Clinician
Information
HL7
Infobutton
Manager
HL7
Knowledge Response
This diagram is adapted from the HL7 standard.
Patient
Education
Information
IxButton Benefits
• Identifies who needs a decision aid (now)
• Eases workflow for the clinician
• Allows personalization & targeting of the message
Pay Strategies
Incentives/Accountability
Two Examples:
• MedEncentive’s Aligned Incentive Plan
• HPN’s Health Improvement Plan
• Both are Healthwise clients
e • Small sample sizes
r
u
s
o
l
c
Dis
• Internal evaluations
Aligned Incentive Program
1. MDs get 10‐20% bonus for reviewing guidelines
2. Patients get $20+ waiver for reviewing Ix
Trust and Verify
Builds strong doctor‐patient relationship
• Doctor wants to look good to patient
• Patient wants to look good to doctor
Results: City of Duncan, OK Savings:
.
$1,612,985
Cost: $181,227
ROI: 8:1
Thousands of dollars
ine
l
d
n
tre
n
o
i
t
fla
n
i
t
s
Co
4,088
Flat cost line
3,286
3,353
3,005
2,778
Non-Catastrophic
Catastrophic
Health Promotion Network (Chicago)
Health Improvement Plan
Choose Your Plan!
Eligibility Requirements for HIP
Paid claims have remained below 2006 levels
Health Promotion Network (Chicago)
Health Improvement Plan
Choose Your Plan!
Eligibility Requirements for HIP
Paid claims have remained below 2006 levels
Keys To Accountability
• What’s in it for me?
• Who will know what I do?
• How will it make me feel?
Summary:
Pull: Mental Models/Engagement
Push: IxButton For “Fresher” Analytics
Pay: Aligned Incentives & Accountability
A value chain connecting decision aids to those who need them
As big as the
difference is…
El Paso
$7,504
McAllen
$15,000
The Family-To-Family Difference Is Bigger
Smiths
Jones
Smith
Family
Issues
Jones
Family
Grandpa
No
No
Heart Attack
• Aspirin ?
• Beta Blockers ?
Grandpa
Yes
Yes
Sam
Yes
Acute Back Pain
Surgery ?
Jim
No
Grandma
Yes
Gallstone Attack
Surgery ?
Grandma
Diet Change
WORKUP
Major
Chest Muscle Pain Work up
Minor
Work-up ?
Grandpa, Grandma,
Sally, Sue, Sam, & Seth
Jim, Joe, Grandpa,
Grandma, Jill, & Joan
Thank you!
Pull
Push
® 2010 Healthwise, Incorporated
Don Kemper, Healthwise
http://www.healthwise.org/demos
User Name: NHPC2010
Password: PullPushPay
(Expires 3/31/2010)
Pay