2016年-德勤全球_High-value_health_care_17页_2mb

Deloitte: High-value Health Care - Innovative Approaches to Global Challenges

Core Content

Deloitte's report explores innovative strategies to enhance the value of health care globally, emphasizing the need for new approaches to improve health outcomes while controlling costs. It highlights successful models from various countries and regions, including the United States, Canada, Germany, Spain, Mexico, and others, that address key challenges such as social determinants of health, economic incentive alignment, patient-centered care, chronic disease management, and medication adherence.

Main Challenges in Health Care

• Social determinants of health: Non-medical factors like housing, nutrition, and safety significantly impact health outcomes.
• Economic incentives misalignment: Traditional payment models often do not reward quality and cost-effective care.
• Patient-centered care: Moving from a provider-centric model to one that prioritizes patient needs and preferences.
• Chronic care management: Chronic conditions account for a large proportion of health spending and mortality.
• Medication adherence: Poor adherence leads to increased health costs and worse outcomes.

Innovative Models and Solutions

1. Addressing Social Determinants of Health

Health Leads (US)

• Overview: A program that connects patients to community resources to address unmet social needs.
• Approach:
  • Patients are screened for social issues.
  • Trained workforce (e.g., community health workers) helps connect patients to local services.
  • Uses Health Leads Reach™ for case management and resource allocation.
• Outcomes:
  • Improved chronic condition management.
  • Enhanced patient satisfaction.
  • Better access to social services.
• Implications: Can be replicated in programs where providers share in cost savings.

Connecting to Care (Saskatchewan, Canada)

• Overview: Uses "hotspotting" to identify high-cost patients and provide targeted support.
• Approach:
  • Proactive outreach to prevent hospitalizations and ER visits.
  • Leverages EHRs, community partners, and mobile check-ins.
• Outcomes:
  • Reported reductions in ER visits and hospitalizations.
  • One patient's hospital days reduced by 84%.
• Implications: Shows the value of personalized, needs-based care in reducing health system costs.

2. Aligning Economic Incentives

Gesundes Kinzigtal (Germany)

• Overview: A shared savings model for integrated care.
• Approach:
  • Providers share savings with sickness funds when costs fall below benchmarks.
  • Performance bonuses tied to health outcomes (e.g., weight loss, A1c levels).
• Outcomes:
  • Decline in overuse, underuse, and misuse of health care.
  • 16.9% savings in health care spending between 2006 and 2010.
• Implications: Offers a replicable model for aligning provider incentives with cost and quality outcomes.

Pacific Business Group on Health (California, US)

• Overview: A C-section reduction program.
• Approach:
  • Payment system redesign to reduce C-section incentives.
  • Data feedback for quality improvement.
  • Consumer education and decision support.
  • Revising health benefits to include midwives and doulas.
• Outcomes:
  • 20% reduction in C-section rates.
  • $5 million in annual savings.
  • No increase in reported complications.
• Implications: Demonstrates the effectiveness of reconfiguring payment models to improve care quality and reduce costs.

3. Patient-Centered Care

Kaiser Permanente HealthConnect (California, US)

• Overview: A $4 billion investment in HIT to empower patients.
• Approach:
  • My Health Manager portal allows patients to access medical records, schedule appointments, and communicate with providers.
  • Offers secure reminders and prompts for medication adherence.
• Outcomes:
  • Over 90% patient satisfaction for virtual visits.
  • 6% improvement in medication adherence for diabetes patients.
  • Lower LDL levels in adherent patients.
• Implications: Highlights the value of HIT in enabling patient engagement and improving outcomes.

Ribera Salud (Spain)

• Overview: A patient-centered medical home (PCMH) model.
• Approach:
  • Multidisciplinary care teams.
  • Shared health information system among providers.
  • Incentives for providers to maintain quality and service.
• Outcomes:
  • 23–38% lower average cost per patient.
  • 28% fewer inpatient admissions.
  • 16% fewer ER visits.
  • 26% fewer hospital readmissions.
  • Higher outpatient major surgery rates.
• Implications: PCMH model can be a blueprint for other health systems aiming to improve chronic care and reduce costs.

4. Improving Chronic Disease Management

CASALUD (Mexico)

• Overview: A mobile health initiative to improve primary care delivery.
• Approach:
  • Uses mobile tools like MIDO® Mobile Module Cart and MIDO® Backpack for proactive care.
  • Focuses on patient self-management and clinician support.
• Outcomes:
  • Operates in over 130 clinics across 27 states.
  • Improved patient self-management and clinical decision-making.
  • Potential cost savings for chronic conditions like diabetes.
• Implications: Useful for remote and underserved populations; supports shared savings models.

Blueprint for Health (Vermont, US)

• Overview: A state-led initiative to transform primary care delivery.
• Approach:
  • PCMH model with coordinated care teams.
  • Emphasis on preventive and effective care.
• Outcomes:
  • Lower annual expenditures for patients.
  • Reduced hospitalization and specialty care costs.
  • Better performance on preventive care metrics.
• Implications: Provides a roadmap for health systems looking to integrate chronic care into their models.

5. Improving Medication Adherence

Polypill (Europe & Latin America)

• Overview: A single pill containing multiple medications for cardiovascular conditions.
• Approach:
  • Fixed-dose combination of aspirin, simvastatin, and ramipril.
  • Low cost, with $14–$18 monthly price in Latin America.
• Outcomes:
  • 66% adherence rate in trials.
  • Improved blood pressure and cholesterol management.
  • Potential 20% adherence improvement over 10 years in the UK.
• Implications: A promising solution for improving adherence in chronic conditions.

BlueStar (US)

• Overview: A mobile app for diabetes management.
• Approach:
  • Real-time coaching and education for patients.
  • Direct data uploads to providers for clinical decision support.
• Outcomes:
  • 1.2% reduction in blood glucose levels.
  • 2% reduction in A1C levels.
• Implications: Technology can be a key enabler in improving adherence and outcomes.

Key Takeaways

• Multi-pronged approaches are essential for addressing complex health care challenges.
• Innovative technologies (software, devices, mobile apps) play a crucial role in enabling high-value care.
• Aligning economic incentives with health outcomes can drive cost savings and quality improvements.
• Patient-centered models improve engagement, satisfaction, and health outcomes.
• Chronic disease management is a major focus, with successful models emphasizing integration, prevention, and shared savings.
• Medication adherence is a critical area where technology and design can significantly reduce costs and improve outcomes.

These models and solutions illustrate that high-value health care is not only achievable but also scalable, offering valuable lessons for health systems worldwide.