the future of health care

The Future of Health Care

www.shapingtomorrow.com

Presented by:

Michael Jackson

Chairman

Shaping Tomorrow

Virginia Richardson

Institute for Leadership in Medicine

June 8, 2010

To receive this presentation in person, contact:[email protected]

mailto:[email protected]


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Hospital of the Future


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Strategic Foresight

Forecast

Synthesize

Filter

Scan

Evaluate

Act

Strategize


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10:90 Research Gap

• HIV/AIDS Lessons Demonstrate Need for Horizon Scanning

• 10+ Years Translation Lag from Research to Clinical Practice

• 90% of Research Spending on 10% of the illnesses

• Neglect Greatest Health Issues

• Continuous Reactive Planning

Sources: Awasthi et al. (2005). The future of academic medicine: Five scenarios to 2025.; and Cuervo et al. (2008). Global forum update on research for health (Vol. 5): Fostering innovation for global health.


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The Global S-Curve


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Anticipatory Leadership

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The P’s of Future Medicine

Precise

Panoramic

Predictive

Preventive

Patient Centered

Price Competitive

Point of Care

Personalized

Participatory

Principal P’s:


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Healthcare Stakeholder Map

Current

HealthSystem

Source: Shortell and Kaluzny. (2000). Health Care Management: Organizational Design and Behavior (4th ed.).

Service

Providers

Provincial

Governments

Medical/Health

Professional

Agencies

Legal

Political

Branches

Of Health

Hospitals

Boards


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Future Healthcare Network

Pharmaceuticals

Hospitals

Healthcare Technology

Diagnostics

Biotechnology

Nutrition

Medical Devices

Medicine

Academia

Physicians

Nurses

Public Health

The Patient Will Become the Nucleus of Healthcare

Patient

Dentistry

Source: Richardson. (2007). A new course in patient-centered care.


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Horizon 2010 2025

Centers of CareInstitutions Clinics, Surgery Centers & Hospitals

Home / Mobile Avatar, Online, “Smart” Technology

Gatekeeper Primary Care PhysiciansAI via Portable Electronic Diagnostics

and Automated “Care”

GeneticsSimple - Testing for Simple

Disorders Reaches Affordability Critical Mass (<$1,000/profile)

Universal - Testing, Treatment

and Prevention is Mainstream Including Reproductive Health

Implants & Prostheses

Manmade MaterialsSurgical Repair Materials, Drug Delivery, and Synthetic Biochemical Materials

Regenerative Biochemical Process and Technological Advances (Regenerative Organs, Artificial Hemoglobin, etc.)

LongevityDegenerative 80 to 90 Years,

Aging and Metabolic Breakdown

Nearly Non-Degenerative125+ Years, Increased Quality of Life

HospitalsTreatment Center for Disease - LOS in Days

Teaching Center for Patients,– LOS in Hours

Source: Updated from Coates, Mahaffie and Hines. (1997). 2025: Scenarios of US and global society reshaped by science and technology.

Healthcare Horizons


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Sub-Specialist

Specialist

Primary Care Physician

Physician Assistant

Registered Nurse

Med Tech

Patient

Trending Toward Health Care

ProvidedAt Lower Levels

in the Pyramid

Provider Disruption


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Future Technology Trajectory

Smaller

Earlier in the Disease Cycle

Convenient

Faster

Cheaper

Less Invasive


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Health Industry Trends

Economy – back to basics

£/€/$ - pharmaceutical costs

Vaccine to regulated prevention

Nursing & physician shortages

Graying population

Enhanced graduate medical education

Technology - health extender

Greener health delivery

Pay for performance/outcomes

Incentives for healthy living

Short Term

Sources: IBM and PriceWaterhouseCoopers


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Blood Protein Diagnostics

In vitro blood protein diagnostics

Major organs or cells secrete protein blood molecular fingerprint

Single cell analysis

Blood fingerprint will report organ status, distinguish health from

disease, and which disease


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Human Genome

HapMap $ of Human Genetic Variation (Disease Diagnosis)

“Gene Chip”– Multiple Gene Examination

Personal Genome Sequencing DTC (Direct-to-Consumer)

Identified Origins and Causal Relationships of Complex Diseases

“Epigenetic" Factors Linked to Diseases, Heritability Across Generations

Stem Cell Transplants

Human Reproductive Cloning


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Cloning & AI

Legal

Ethical

Social


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The Nano-Medical Universe

Nano-Medicine

Nano-Bots

Nano-Robotic Therapy

Nu-Bots

Nano-Sensors

Bio-Nanobots


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Topic one text Smart ClothesSense Body Functions

Smart BathroomsEvaluate Body Fluids

Smart KitchensPrepare Body Nutrients

Smart HousesPromote

“Intrapendence”

Smart Living


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Mind/Body Bionics

NeuroprostheticBrain Implants to Prevent Disease

Health Avatars Capable of Artificial Thought


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Virtual Reality Surgery

Remote 3D Diagnostics

Robotic-Assisted

Procedures

Minimally Invasive Surgeries

Global Access to Experts


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Remote Tele-Treatment

Electronic ICU (eICU):

Multi-site Access to Intensivists

25% Reduction in ICU Hospital Mortality Rate

17% Decrease in ICU LOS

20% Increase in ICU Capacity Created by Shorter ICU LOS

26% Reduction in Hospital Costs for ICU Patients

Sentara Hospitals eICU Outcomes:

Sources: Pronovost. (2002). Imagining the ICU of the Future; and Leapfrog. (2007). Leapfrog Group ICU Fact Sheet.


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Mental Health

Short Term:

Social Issues Treated as Psychological Disorders

Re-Institutionalization

– Forensic Beds– Involuntary Admissions– Residential Care / Supported Housing

Availability in Psychiatric Resources

Long Term:

Personalized & Pre-emptive Treatment

Emphasized Mental Capital & Wellbeing

Brain Stimulation Therapy / Mental Aerobics

Genetics – Secondary Mental Health Benefits

Drugs to Grow Brain Neurons

Brain Prosthesis

Source: WHO. (2010). Mental Health.


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Alzheimer’s & Dementia

Silver Tsunami

Long Term:

Enzyme inhibitors – reduce plaque

Amyloid gene vaccine – produce antibodies

Deep brain stimulation

Microglia detection

Genetic therapy

Short Term:

Projected to double every 20 years worldwide2010: 35 M; 2030: 66 M; 2050: 115 M

Inadequate £/€/$ on Alzheimer’s research

Institutionalization - residential care

Provider and staff shortages

Treatment resources


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Medical Tourism/Outsourcing

Source: Woodman, J. (2007). Patients beyond borders, Singapore Edition: Everybody’s guide to affordable, world-class medical tourism.


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Spinal Fusion Surgery

Source: All Medical Tourism. (2010). www.allmedicaltourism.com.

http://www.allmedicaltourism.com/


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Internet Users Go Online for Health Information

Began Online Health Inquiry at a Search EngineBegan at a Health-Related Website

Found their Internet Search Affected a Decision About How to Treat an Illness or Condition

Indicate Search Changed their Overall Approach to Maintaining their Health or the Health of Another

Report Search Led to Asking a Doctor New Questions or to Getting a Second Opinion from Another Doctor

Report the Internet Information Affected a Decision About Whether to See a Doctor

58%

55%

54%

80%

35%

66%27%

Source: Fox. (2006). Online Health Search. Pew Internet & American Life Project.

Internet Search Outcomes


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# of Consumers Who Take into

Account a Hospital’s

Success Rates as Measured by

Independent Source

# of Elective Patients Who

Considered the Hospital’s

Quality Rating When Making Their Hospital

Choice.

# of Patients in Need of

Hospitalization, and Exposed to

Ratings, Changed Their

Decision on Where to Get

Treatment

79% 40% 33%

J.D. Power and

Associates, 2004

Opinion Research, 2004 Harris Interactive, 2003

Source: Rice. (2006). Influences, usage, and outcomes of internet health informationsearching: Multivariate results from the Pew surveys.

Ratings War


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Evidence-Based Medicine

Full-scale simulation model of human physiology, diseases, behaviors, interventions, and healthcare systems

Uses advanced methods of mathematics, computing, and data systems to determine best treatment option and cost-based analysis

Archimedes Simulation ModelsDiabetes and

Complications

Coronary Artery

Disease

Hypertension

Congestive Heart

Failure

Stroke

Dyslipidemia

Obesity

Metabolic

Syndrome

Asthma

Colon Cancer

Breast Cancer

Lung Cancer

A single model that contains pathways relating to multiple diseases such as:

Source: Eddy. (2005). Evidence-based medicine: A unified approach. Health Affairs24(1): 9-17. Information on the Archimedes Model can be found at http://archimedesmodel.com.

http://archimedesmodel.com/


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Precision Medicine Continuum

Schizophrenia

Intuitive Empirical Precise

Intu

itiv

eE

mp

iric

al

Pre

cis

e

Depression

Chronic

Back Pain

Osteoarthritis

H5N1

InfluenzaMulti-drug Resistant TB

Migraine

Alzheimer’s

Disease

Obesity

Allergies

Inflammatory

Bowel Disease

Lupus

Osteoporosis

SARS Pulmonary

Embolism

HIV/AIDS

Cystic Fibrosis

Prostate

CancerStroke

Heart

AttackFAP/HNPCC(+)

Colon Cancer

Appendicitis

Abdominal

Aortic Aneurysm

AsthmaPneumonia

Kidney

Stone

Type 1 DiabetesHER2/Neu(+)

Breast Cancer

Gaucher’s

Disease Fractures

Strep Throat

Extent of Understanding of Mechanism Causing the Disease

Exte

nt

of

Tre

atm

en

t E

ffic

ac

y

Multiple Sclerosis

Future

Source: Christensen, Grossman and Hwang. (2009). The innovator’s prescription: A disruptive solution for health care.

Current

2015 20252010


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Longevity

• Increase to 125+ Years

Life Span

• Immediate –Informed Consent Based on Degenerative Metrics

End of Life Issues –

Short-term:

• Future –Informed Consent Based on Non-Health Social Factors

End of Life Issues –

Long-term:


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Games for Health Education

http://asunews.asu.edu/20080222_wiistudy

“Wii” bit of Technology Aids Medical Education

www.healthgamesresearch.org


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Future Mental Model Shifts

Mental Model I Mental Model 2

Curative Preventive

Pharmaceutical Complementary

Western Medicine = The Health System

Western + Contemporary= The Wellness System

Nutrition based Nutrition focus

Institution based Home based

Face to face treatment Space to place treatment

Government responsibility to health

Individual responsibility mediated by government

Information control by professional experts

Open system information

Source: Marsh, N., McAllum, M., Purcell, D. (2002). Strategic foresight: The power of standing in the future.


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Future Provider Competencies

Patient-Centered Equilibrium

Value Innovation Orientation

Multicultural Linguistics / Technologies

Global Mindset

Inclusive Culture Values Orientation

Disruptive Innovator / Early Adopter

Global Alliance Modality

Strategic Foresight & Leadership


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DIABETES & OBESITY

2025 ScenarioPre-

diabetesTotal

diabetesNot

diagnosed Cost

The Frog Didn’t Jump 65M 50M 15M $351B

We Did the Best We Could 50M 45M 10M $395B

Caring Communities & Access to Health Care

45M 40M 1M $345B

Evolving Systems with Enlightened Leaders

35M 28M 0.3M $220B

Scenario Planning

Source: Rowley and Bezold. (2006). “The futures of US health care: The case of diabetes & the paths for eliminating health disparities,” Institute for Alternative Futures.


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Uncertainty

LEVELS OF UNCERTAINTY

1. A Clear-Enough Future

2. Alternative Futures

3. A Range of Futures

4. True Ambiguity

Source: Courtney. (2001). 20/20 foresight: Crafting strategy in an uncertain world.

Each level of uncertainty requires a

different strategic approach

Effective strategy is not

“one size fits all”


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Timeline


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Next Steps

Continuous Anticipatory Planning

Future Issues Brief:

Mental Health: The Perfect Storm

The Alzheimer’s Silver Tsunami

Healthcare Globalization

Leadership/Foresight Training

Scenarios Planning

Roadmap Analysis

Strategic Action Plan


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ILM Foresight Fellows

Global Foresight Fellowships

Leadership & Educational Programs

Peer-to-Peer Research/Analysis

Think Tank Incubation and Co-

Creative Forums Global Peers

ILM Knowledge Center

www.theILM.org


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Thanks for Listening

Further Information

Dr. Michael Jackson, ChairmanShaping Tomorrow www.shapingtomorrow.com

The Habit, Blackladies Kiddemore Green Road | Bishops WoodStaffordshire ST19 9BQ | England

(H)ome: +44 (0)1902 851918(O)ffice: +44 (0)1902 851-985(M)obile: +44 (0)7966 155-912(E)mail: [email protected](S)kype: shapingtomorrow

Best wishes for your journey to the future

http://www.shapingtomorrow.com/

mailto:[email protected]

the future of health care

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