Impact Of Change Methodology

Impact of Change Methodology Outline Ogan Gurel, MD

I.

Traditional healthcare utilization forecasting a. Approaches i. Population-based demand forecasting ii. Supply-based forecasting – Roemer’s law iii. Historical trending b. Examples: i. 1990s overall inpatient utilization: e.g. managed care depressed inpatient utilization below population-based growth ii. CABG and CAD prevalence: e.g. build cardiac ORs and they may not come iii. Building on the basis of high recent (e.g. last three years) demand would have resulted in overbuilding c. Conclusion: i. Forecasting based on only a limited set of drivers is intrinsically inaccurate ii. Historical trending may also be inaccurate and does not provide information on the factors driving the change

II.

SG-2 comprehensive driver-based forecasting a. Fundamental approach i. Identifying the what, when and impact ii. Not explicitly historic trend-based iii. Demand based iv. Population plus other drivers including technology v. Differential (difference) equation mathematical formulation b. The What: Identifying the drivers i. Overall set of drivers: e.g. population, technology, sociocultural, economic, payment and practice pattern ii. Purely political and legislative changes are not modeled. iii. Technology landscape c. When: Determining the time evolution of the drivers i. The concept of timing as being the time evolution of the impact ii. Basic logistic curve as a paradigm for technology adoption and diffusion iii. Intro Year, Inflection Year, r-value and Decline Year. iv. Both logistic and non-logistic timing curves can be approximated by using an appropriate set of timing parameters or via a sum of logistic curves. d. The Impact: Determining the impact i. Research sources: academicians, clinical experts, vendors, clinician practitioners, equity research ii. Technology has a range of impacts: e.g. increasing utilization, decreasing utilization and shifting utilization iii. Examples 1. Drug-eluting stents 2. Aneurysm coiling 3. Coronary CT angiography iv. Assignment of impact factors

III.

Application to the Johns Hopkins project a. Data sources b. Clinical interviews c. Assessment of technology adoption stance d. Strategic forecast e. Operational utilization methodology