The Future of Sleep
Health
Con Iber
Fairview Health Systems
University of Minnesota Health
Objectives
• To identify opportunities in transitioning from
sleep medicine to sleep health
• To propose a snapshot of the future of the
field
• To identify methods of transforming ourselves
into what the future requires of us
Caveat
There will be unanswered questions
that we must all solve together
Harry:
“OK……where’s the map?”
Harry, don’t check the map
while your driving!!
Where should we go and how should we get there?
Let’s get a higher altitude view
Pressures for Change
• Health care cost/quality gaps
• History of perverse incentives
• Technical innovation
• Public accountability
OECD Health data 2012
Unreasonable practice variation
Sutherland, Skinner, Fisher. NEJM 2009; 366:1227
Medicaid
20%
Other
1%
Commercial
27%
6%
22%
35%
2011
37%
Medicare
52%
AHA Trendwatch Chartbook 2011
2021
Medical economics July 2013
What are the opportunities for merging sleep
medicine into sleep health?
More adaptable to changing models
• diagnosis at home
• decreased reliance on complex testing
• increased utilization of evolving therapies
More honest• shift work/insufficient sleep
• preventative methods are more powerful
• better alignment with driving forces
Insufficient sleep and shift work:
49 million
• Behavioral
• Genetic
• Countermeasures
Shift work
Insufficient sleep
37 million
11.8 million
3.8
4.7
3.3
night
rotating
irregular
What are the opportunities for
transitioning from sleep
medicine into sleep health?
More diversified• meets need for distributive model
• population/employee based
• flexibility of cross-training workforce
More integrated –
• case finding->diagnosis->therapy
• population management
Home Sleep Studies
[example of forced change]
2012
HomePAP N=373 randomized
usage [hrs]
adherence [%]
5
4.5
4
3.5
3
70
60
50
40
30
home
lab
home
doi: 10.5665/sleep.1870
lab
2014 Health System N=4625 uncontrolled
wait [wks]
# studies/2yr
2794
3000
2000
1471
1000
0
lab
home
12
10
8
6
4
2
0
9.9
1.1
lab
doi: 10.1155/2014/418246
home
Dental devices
[example of change to be forced]
Gapunderutilization of devices in the US
Drivers• user preference
• guideline changes
• payer preference
Snapshot of the future
Where do we want to go?
• Change that will improve sleep health
• Quality and cost optimization
• Adaptable to predictable forces
• User satisfaction
Strategies-high altitude
• Distribute care and maintain continuity
• Incorporate population management
• Develop and integrate collaborative networks
• Negotiate change consensus
• Leverage technology
Tactics-zoom lens
[adopt new lexicon]
• Reduce variation
• Virtual care
• Sleep therapy management
• Cross discipline collaboration
• Payer negotiation
• Stratified resource use
• Cross-training workforce
Sleep Therapy
Management
% of Patients Compliant
100
90
80
70
70
68
72
70
65
64
62
May
June
July
70
72
Aug
Sept
60
50
40
30
20
10
0
Jan
Feb
March
April
Components of Change
Structural changes: reduce points of care and
variation, expand comprehensive care, develop
stem to stern pathways, partner, tune to
outcomes
Behavioral changes: team concept, monitor
progress to achievable/meaningful goals,
anticipate and manage failure, expand scope of
practices
• “Single visit”: initial diagnostic procedure for
uncomplicated sleep apnea and insomnia moved to
primary care with therapy determination made by sleep
center and virtualization of >50% of point of care followup
visits.
• Consolidation of laboratory studies to verify ambiguous
home studies, serious comorbidities, parasomnias,
suspected seizures.
• Increased scope of onsite clinic operations to include
partners in dental, otolaryngology, pediatric, and
occupational sleep medicine.
• Population management to incorporate long term
management, innovation, outcome monitoring, payer
negotiation.