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Consumer-Centric Healthcare with Integrated Informatics SAS M2007 Conference, Las Vegas, October 2007 Dave Kil, Chief Scientist, Health Informatics Accenture Technology Labs Copyright © 2007 Accenture All Rights Reserved
Contents • Introductions • Motivations • Healthcare Informatics Trends • Overview – Integrated Healthcare Informatics & Consumer Experience Optimization (CEO) • Technology Components with Results • Future Directions
Copyright Accenture All Rights Reserved
2
Motivations The Opportunity • Reducing medical costs without sacrificing care and with active participation from healthcare consumers – how to make healthcare and wellness fun & rewarding
Our Solution • The Insight Engine for Member Health Management is an informatics suite that improves consumer health and cuts medical costs • Our estimates show medical cost savings of 25% at the population level can be realized beyond benefits from existing care management or disease management systems
Health-care premiums still outpacing wages and inflation - Wall Street Journal Sept 26, 2006
– Focus on Provable ROI & consumer experience optimization – Incorporate all available data to predict & maximize impact – Multi-channel, personalized optimization 3
Copyright Accenture All Rights Reserved
Healthcare Informatics Trends
Current situation
Road blocks
Target Future
Silo’ed data/analytics
EHR/Integrated analytics
Niche predictive models
Integrated Impact & ROI prediction
Cost + RTTM clinical triggers Consumerism = Higher OOP cost with HSA
Short-term focus (1 year) Cookie cutter benefit plans Contentious outcomes (providers, DM, etc.)
• Repeatable ROI proof • Economic incentive mismatch • Health behavior change measurement • Traditionalism and inertia • Financial well-being
Behavioral triggers Consumerism = Consumer Exp. Optimization Long-term focus (3–5 year) Optimized to each consumer with incentives Scientific outcomes with drilldown
Once-a-year touch with claims lag
Continuous real-time engagement
Nurse-centric CM/DM
Tech-centric, scalable, continuous wellness 4
Copyright Accenture All Rights Reserved
The Consumer Health Insight Engine uses analytics to reduce medical costs and improve care Insight Engine: Member Health Management Integrates data sources into single, unified view
"Scores" consumers across multiple dimensions (health, lifestyle, impactability, etc.) Membercentric Data Model
Acquires or infers health risk assessment (HRA), claims, behavioral marketing, and biometric-sensor/, and ecological momentary assessment data
Validates, calibrates and creates intervention/EBM, consumer-engagement rules
Data Acq. Manager
Rules Manager
Harvest Data
Analyze & Predict
Act and Adapt
Optimize Processes
ROI Engine Measures actual outcomes using predictive models and propensity score shaping Copyright Accenture All Rights Reserved
Health Trajectory Predictors
Intervention Opportunity Finder
Resource Allocation Manager
Predicts and personalizes ROI for each intervention opportunity
Optimizes interventions over predicted future health, costs, enagagability and impactability
Business Process Integrator Optimized intervention decisions are integrated with enterprise systems (CM, benefits, medical policies, etc.) via SOA
5
The platform addresses the shortcomings of current approaches Limitations with Current Approaches
Insight Engine for Member Health Management
Medical cost savings are difficult to measure, understand and prove
• ROI Engine scientifically dissects contribution of inter-dependent programs to pin-point value • Hierarchical Rules Manager facilitates rules creation, validation, and deployment
Missed opportunities as members are qualified for programs based on historical clinical triggers instead of future health needs
• Health Trajectory Predictors forecast disease progression using lifestyle and HRA data • Intervention Opportunity Finder intelligently searches for intervention candidates
Suboptimal ROI because member engagability and impactability are not considered and continuous consumer touch is too expensive with a nursecentric touch platform
• Resource Allocation Manager personalizes intervention programs using engagement parameters derived from HRA and lifestyle data (inferred where necessary) • ROI optimized across the population and over time • High-tech touch channel with consumer-centric IHM
Hybrid out-sourced and in-sourced approaches require complex IT, process and governance resulting in limited flexibility
• Modular SOA design integrates with commercial offthe-shelf (COTS) solutions including DM/CM tools • Future-proofed to support future interventions (esp. scalable high-tech channels)
Copyright Accenture All Rights Reserved
6
Looking for Inspirations from Consumer-Focused R&D Projects and Consumer-Centric Companies Æ Fun Always Sells
Persuasive mirror Nike+
Business 2.0 Top 10 ideas, July 2007
Online health
Communications: Virtual Dining
Copyright Accenture All Rights Reserved
Multiple-Player, Role-Playing, Lifestyle-Rewarded Wellness Game to Bring Fun and Excitement to Take Care of One’s Health Watch with speech sensing and/or calorie tracking
Speech/ non-speech separation
Shoe with movement sensor
DSP & transformation
Speaker co-channel separation
Owner voice filter
Speech feature extraction
Time series feature extraction
Activity classification
Immersive user data collection
Consumer profile
Social context & emotion classification
Sensor processing engine
Wireless pedometer
Initialization engine Simple effective user interface for interactive and immersive user data collection
Preprocessing Learning Profiling
Consumer understanding engine
Avatar profile Social network profile
MPRPLR game
MPRPLR analytics engine Copyright Accenture All Rights Reserved
Rewards & Outcomes Database
Population Navigator: Stakeholder-specific views using RIA (Rich Internet Apps)
Intervention opportunities for various population clusters prioritized in terms of total cost and ROI with drilldown
Overall population view to population cluster-centric view to understand ROI opportunities and projected savings to be tracked real time using ROI engine 9
Copyright Accenture All Rights Reserved
Intervention Opportunity Finder: Analyze health trajectories to identify intervention opportunities
Flexible population navigation and drilldown across clinical and lifestyle data
Map 1: All (119997 members)
Map 2: ENMI (54933 members)
Future
Future
Analyze and compare past, present and future health of membership to identify opportunity for intervention
Health Trajectory Predictors using advanced analytics
Drill-down to individual members for personalized analysis
Copyright Accenture All Rights Reserved
Resource Allocation Manager: Personalized intervention programs that optimize ROI
Interventions are assessed for each member by understanding the links between health, lifestyle and impactability
Personalized interventions are optimized to maximize impact and ROI
11
Copyright Accenture All Rights Reserved
50% cost savings? Regression to the Mean Overall population
Year-2 cost
PMPM 4876 Æ 2126
Inpatient population
Prevalence rate
$2000 PMPM
Year-1 cost
Members with year-1 cost at least $25K Before and after cost distributions
Members with at least one inpatient episode during year 1 Copyright Accenture All Rights Reserved
How to move from wait-and-see outcomes analysis to nearreal-time outcomes measurement and tracking Predictive Ratio vs. Group Size 1.7 1.6 1.5 1.4 PR μ and σ
SOA paper by Cumming et al., “A Comparative Analysis of Claims-based Methods of Health Risk Assessment for Commercial Population,” May 2002.
R2 = 0.3870 R2 = 0.7597
1.3 1.2 1.1 1 0.9 1
10
2
10 Group size
3
10
4
10
Copyright Accenture All Rights Reserved
Dynamic Impact Analysis PSS + PM for Operational Performance Tracking in Tactical and Strategic Settings Divergence from 0.83 to 0.09 after PDF shaping 0.83
0.49
Find control members similar to test members on the fly using ideas from machine learning
0.09
Copyright Accenture All Rights Reserved
ROI Engine: Rules driven by scientifically measured outcomes Æ Facilitation of new program design
• Decodes contributions from multiple programs and intervention channels • On-the-fly control population selection • Individual vs. group impact analysis • Foundation for clinical program optimization and new program design
Social Social Networks Networks Impact Impact vs. vs. Psychosocial Psychosocial behavioral behavioral parameters parameters Email Impact vs. Social Group Email Impact vs. Social Group Clusters Clusters Disease Disease Management Management Impact Impact vs. vs. Disease Disease Clusters Clusters Health Coaching Impact vs. Disease Clusters
Heart Cancer Diabetes disease Understand program impact vs. disease conditions ESRD Liver MusculoHIV GUS skeletal Infection
Respiratory COPD
Digestive
Inpatient
15
Copyright Accenture All Rights Reserved
Causal pathway analysis to measure outcomes in multiple dimensions (time & stakeholders)
OGTT: Oral Glucose Tolerance Test FPG: Fasting Plasma Glucose DCCT: Diabetes Control and Complications Trial UKPDS: UK Prospective Diabetes Study
Kaiser Archimedes Copyright Accenture All Rights Reserved
16
Future Directions • Consumer experience optimization – Sufficient statistics questionnaire design to minimize consumer burden and maximize predictive accuracy while providing fun (immersive gaming environment) – Health MPRP online games with lifestyle rewards – Integrated outcomes analysis with predictive analytics Æ Integrated micromarketing
• R&D efforts focused on Consumer Health Insight Engine & CEO – Non-traditional data gathering – Preprocessing – Mobile healthcare informatics
• SOA applied to both devices (SODA), enterprise Web services architecture, and delivery channels – – – –
Mobility Intelligent device integration Synergy among data, algorithms, and business services Tool vendor neutral solution accelerators
Copyright Accenture All Rights Reserved
Contents • Introductions • Motivations • Healthcare Informatics Trends • Overview – Integrated Healthcare Informatics & Consumer Experience Optimization (CEO) • Technology Components with Results • Future Directions
Copyright Accenture All Rights Reserved
2
Motivations The Opportunity • Reducing medical costs without sacrificing care and with active participation from healthcare consumers – how to make healthcare and wellness fun & rewarding
Our Solution • The Insight Engine for Member Health Management is an informatics suite that improves consumer health and cuts medical costs • Our estimates show medical cost savings of 25% at the population level can be realized beyond benefits from existing care management or disease management systems
Health-care premiums still outpacing wages and inflation - Wall Street Journal Sept 26, 2006
– Focus on Provable ROI & consumer experience optimization – Incorporate all available data to predict & maximize impact – Multi-channel, personalized optimization 3
Copyright Accenture All Rights Reserved
Healthcare Informatics Trends
Current situation
Road blocks
Target Future
Silo’ed data/analytics
EHR/Integrated analytics
Niche predictive models
Integrated Impact & ROI prediction
Cost + RTTM clinical triggers Consumerism = Higher OOP cost with HSA
Short-term focus (1 year) Cookie cutter benefit plans Contentious outcomes (providers, DM, etc.)
• Repeatable ROI proof • Economic incentive mismatch • Health behavior change measurement • Traditionalism and inertia • Financial well-being
Behavioral triggers Consumerism = Consumer Exp. Optimization Long-term focus (3–5 year) Optimized to each consumer with incentives Scientific outcomes with drilldown
Once-a-year touch with claims lag
Continuous real-time engagement
Nurse-centric CM/DM
Tech-centric, scalable, continuous wellness 4
Copyright Accenture All Rights Reserved
The Consumer Health Insight Engine uses analytics to reduce medical costs and improve care Insight Engine: Member Health Management Integrates data sources into single, unified view
"Scores" consumers across multiple dimensions (health, lifestyle, impactability, etc.) Membercentric Data Model
Acquires or infers health risk assessment (HRA), claims, behavioral marketing, and biometric-sensor/, and ecological momentary assessment data
Validates, calibrates and creates intervention/EBM, consumer-engagement rules
Data Acq. Manager
Rules Manager
Harvest Data
Analyze & Predict
Act and Adapt
Optimize Processes
ROI Engine Measures actual outcomes using predictive models and propensity score shaping Copyright Accenture All Rights Reserved
Health Trajectory Predictors
Intervention Opportunity Finder
Resource Allocation Manager
Predicts and personalizes ROI for each intervention opportunity
Optimizes interventions over predicted future health, costs, enagagability and impactability
Business Process Integrator Optimized intervention decisions are integrated with enterprise systems (CM, benefits, medical policies, etc.) via SOA
5
The platform addresses the shortcomings of current approaches Limitations with Current Approaches
Insight Engine for Member Health Management
Medical cost savings are difficult to measure, understand and prove
• ROI Engine scientifically dissects contribution of inter-dependent programs to pin-point value • Hierarchical Rules Manager facilitates rules creation, validation, and deployment
Missed opportunities as members are qualified for programs based on historical clinical triggers instead of future health needs
• Health Trajectory Predictors forecast disease progression using lifestyle and HRA data • Intervention Opportunity Finder intelligently searches for intervention candidates
Suboptimal ROI because member engagability and impactability are not considered and continuous consumer touch is too expensive with a nursecentric touch platform
• Resource Allocation Manager personalizes intervention programs using engagement parameters derived from HRA and lifestyle data (inferred where necessary) • ROI optimized across the population and over time • High-tech touch channel with consumer-centric IHM
Hybrid out-sourced and in-sourced approaches require complex IT, process and governance resulting in limited flexibility
• Modular SOA design integrates with commercial offthe-shelf (COTS) solutions including DM/CM tools • Future-proofed to support future interventions (esp. scalable high-tech channels)
Copyright Accenture All Rights Reserved
6
Looking for Inspirations from Consumer-Focused R&D Projects and Consumer-Centric Companies Æ Fun Always Sells
Persuasive mirror Nike+
Business 2.0 Top 10 ideas, July 2007
Online health
Communications: Virtual Dining
Copyright Accenture All Rights Reserved
Multiple-Player, Role-Playing, Lifestyle-Rewarded Wellness Game to Bring Fun and Excitement to Take Care of One’s Health Watch with speech sensing and/or calorie tracking
Speech/ non-speech separation
Shoe with movement sensor
DSP & transformation
Speaker co-channel separation
Owner voice filter
Speech feature extraction
Time series feature extraction
Activity classification
Immersive user data collection
Consumer profile
Social context & emotion classification
Sensor processing engine
Wireless pedometer
Initialization engine Simple effective user interface for interactive and immersive user data collection
Preprocessing Learning Profiling
Consumer understanding engine
Avatar profile Social network profile
MPRPLR game
MPRPLR analytics engine Copyright Accenture All Rights Reserved
Rewards & Outcomes Database
Population Navigator: Stakeholder-specific views using RIA (Rich Internet Apps)
Intervention opportunities for various population clusters prioritized in terms of total cost and ROI with drilldown
Overall population view to population cluster-centric view to understand ROI opportunities and projected savings to be tracked real time using ROI engine 9
Copyright Accenture All Rights Reserved
Intervention Opportunity Finder: Analyze health trajectories to identify intervention opportunities
Flexible population navigation and drilldown across clinical and lifestyle data
Map 1: All (119997 members)
Map 2: ENMI (54933 members)
Future
Future
Analyze and compare past, present and future health of membership to identify opportunity for intervention
Health Trajectory Predictors using advanced analytics
Drill-down to individual members for personalized analysis
Copyright Accenture All Rights Reserved
Resource Allocation Manager: Personalized intervention programs that optimize ROI
Interventions are assessed for each member by understanding the links between health, lifestyle and impactability
Personalized interventions are optimized to maximize impact and ROI
11
Copyright Accenture All Rights Reserved
50% cost savings? Regression to the Mean Overall population
Year-2 cost
PMPM 4876 Æ 2126
Inpatient population
Prevalence rate
$2000 PMPM
Year-1 cost
Members with year-1 cost at least $25K Before and after cost distributions
Members with at least one inpatient episode during year 1 Copyright Accenture All Rights Reserved
How to move from wait-and-see outcomes analysis to nearreal-time outcomes measurement and tracking Predictive Ratio vs. Group Size 1.7 1.6 1.5 1.4 PR μ and σ
SOA paper by Cumming et al., “A Comparative Analysis of Claims-based Methods of Health Risk Assessment for Commercial Population,” May 2002.
R2 = 0.3870 R2 = 0.7597
1.3 1.2 1.1 1 0.9 1
10
2
10 Group size
3
10
4
10
Copyright Accenture All Rights Reserved
Dynamic Impact Analysis PSS + PM for Operational Performance Tracking in Tactical and Strategic Settings Divergence from 0.83 to 0.09 after PDF shaping 0.83
0.49
Find control members similar to test members on the fly using ideas from machine learning
0.09
Copyright Accenture All Rights Reserved
ROI Engine: Rules driven by scientifically measured outcomes Æ Facilitation of new program design
• Decodes contributions from multiple programs and intervention channels • On-the-fly control population selection • Individual vs. group impact analysis • Foundation for clinical program optimization and new program design
Social Social Networks Networks Impact Impact vs. vs. Psychosocial Psychosocial behavioral behavioral parameters parameters Email Impact vs. Social Group Email Impact vs. Social Group Clusters Clusters Disease Disease Management Management Impact Impact vs. vs. Disease Disease Clusters Clusters Health Coaching Impact vs. Disease Clusters
Heart Cancer Diabetes disease Understand program impact vs. disease conditions ESRD Liver MusculoHIV GUS skeletal Infection
Respiratory COPD
Digestive
Inpatient
15
Copyright Accenture All Rights Reserved
Causal pathway analysis to measure outcomes in multiple dimensions (time & stakeholders)
OGTT: Oral Glucose Tolerance Test FPG: Fasting Plasma Glucose DCCT: Diabetes Control and Complications Trial UKPDS: UK Prospective Diabetes Study
Kaiser Archimedes Copyright Accenture All Rights Reserved
16
Future Directions • Consumer experience optimization – Sufficient statistics questionnaire design to minimize consumer burden and maximize predictive accuracy while providing fun (immersive gaming environment) – Health MPRP online games with lifestyle rewards – Integrated outcomes analysis with predictive analytics Æ Integrated micromarketing
• R&D efforts focused on Consumer Health Insight Engine & CEO – Non-traditional data gathering – Preprocessing – Mobile healthcare informatics
• SOA applied to both devices (SODA), enterprise Web services architecture, and delivery channels – – – –
Mobility Intelligent device integration Synergy among data, algorithms, and business services Tool vendor neutral solution accelerators
Copyright Accenture All Rights Reserved
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