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Matthew Holt talk at HIMSS N. Cal

Matthew Holt
Matthew Holt

Matthew Holt analyzed several forecasts and scenarios related to health care spending and insurance coverage in the United States. His analysis showed that forecasts from 2010 underestimated the number of uninsured Americans and overestimated per capita health care spending. Reform after 2010 led to fewer uninsured Americans but health care spending as a share of GDP remained higher than predicted. Without reform, more Americans would be uninsured and health care costs would continue to rise rapidly.

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Matthew Holt
Forecasting the future is really hard
Matthew Holt talk at HIMSS N. Cal
Guess ONE: 65m uninsured; 19% of GDP 2010 Reality? & Guess TWO: 52 million uninsured $10,000 per capita 47m uninsured; 16% of leads to spending only $8,300 Per capita GDP & Reform after 2010 Share of GDP 17.3% $8,600 per capita leads to No Reform after 2010
Who do Americans Believe Can Predict the Future? 50 45 40 35 30 25 20 15 10 5 0 Bi Fa As Ps Po Ou M bl rm tro yc lls ag Percentage who ic al er log hi cs ter ija B ic Pr 's er s oa 8B believe op Al s rd all he m cy an ac Source: Peter D. Hart Research Associates, for the Shell Poll 1998
Unemployment: The hours are great, but
Founded 2003 First months visits 73
Media sources people trust
Health Care Costs Too Much
7000 Dollars spent per capita 6000 Canada France Us Average 5000 Germany spending on health United Kingdom Them per capita United States 4000 ($US PPP) 3000 2000 Source: Gerard F. 1000 Anderson, Ph.D., and Patricia Markovich, Data: OECD Health Data 2008 (June 0 2008) Commonwealth 1980 1984 1988 1992 1996 2000 2004 Fund 2008
Health spending as share of GDP 16 Average spending on 14 health Us per capita ($US PPP) 12 Them 10 Canada France 8 Germany Switzerland United Kingdom 6 United States Source: Gerard F. Anderson, Ph.D., and Patricia Markovich, Data: OECD Health Data 2008 (June 4 2008) 1980 1984 1988 1992 1996 2000 2004 Commonwealth Fund 2008
I = f(PDI) = f(M5B + MBZ) Where: I is increase in health care costs PDI is physicians desired income M5B is mortgage payment on a 5 bedroom house with a pool MBZ is monthly lease on a new 300 series Mercedes
Rapid Increase in Uninsurance; in the Middle Working adults in US who were uninsured for at least 3 months in a 2 year period 60% 51% 52% Lowest 48% 50% 48% quintile 41% 44% Second 40% 39% 35% 37% Third 24% 25% 20% 20% 21% Fourth 18% 8% 10% 10% 11% 11% Highest 4% 5% 6% 6% 5% quintile 0% 1999* 2000 2001 2002 2003 Source: Analysis of the March 19882004 Current Population Surveys by Danielle Ferry, Columbia University, for The Commonwealth Fund
And it got much worse (2010) Adults in Percentage of families with a those who had job loss in past insurance 2 years = 47% = 24% or Percentage of 43 million those who lost insurance = 57% or 9m Source: The Commonwealth Fund Biennial Health Insurance Survey (2010).
Matthew Holt talk at HIMSS N. Cal
Matthew Holt talk at HIMSS N. Cal
But in health care: the future is like the present, only longer
We do a shitty job with chronically ill patients
Who cant do chronic care? Views of the Health Care System from those with chronic illness Percent AUS CAN FR GER NETH NZ UK US Only minor changes needed 22 32 41 21 42 29 38 20 Fundamental changes needed 57 50 33 51 46 48 48 46 Rebuild completely 20 16 23 26 9 21 12 33 Base: Adults with any chronic condition Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.
Disease managed? Maybe not % of diabetics who received four key preventative services* 80 67 59 60 43 39 40 40 31 20 0 CAN FR GER NETH UK US * Hemoglobin A1c checked in past six months; feet examined for sores or irritations in past year; eye exam for diabetes in past year; and cholesterol checked in past year. Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.
Did Not Get a Recommended Test, Treatment or Follow-up Due to Cost, by Income 50% Below average income Above average income 36% 25% 17% 18% 14% 14% 9% 11% 4% 4% 2% 0% AUS CAN NZ UK US 2001Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive
Adults Uninsured for Any Time Had Highest Rates of Cost-Related Problems Getting Needed Care Percent of adults ages 1964 who had any of four access problems* in past year because of cost 75 2001 2005 2010 63 66 60 59 55 52 50 37 41 29 28 31 25 21 0 Total Insured all year Insured now, time Uninsured now uninsured in past year *Did not fill a prescription; did not see a specialist when needed; skipped recommended medical test, treatment, or follow-up; had a medical problem but did not visit doctor or clinic. Source: The Commonwealth Fund Biennial Health Insurance Surveys (2001, 2005, and 2010).
We do different things to the same people in different places
Cost & Quality in Healthcare Health Affairs April 7, 2004 More spending better Ritz-Carlton outcomes Quality Motel 6 Cost
Matthew Holt talk at HIMSS N. Cal
Portland 22.7% Salem 16.9% Bend Eugene 23% 18.4% Medford 16.4%
Matthew Holt talk at HIMSS N. Cal
Matthew Holt talk at HIMSS N. Cal
Our primary care system is broken
Matthew Holt talk at HIMSS N. Cal
New physicians follow the money
Matthew Holt talk at HIMSS N. Cal
Data: MGMA
Matthew Holt talk at HIMSS N. Cal
Matthew Holt talk at HIMSS N. Cal
This is America: Theres always a new technology
IT History Quiz, Part 1 1947 Christmas Eve Shockley & pals invent the transistor 1959 Noyce (Intel) & Kilby (the other guy from TI) invent the integrated circuit (separately) 1981 IBM introduces the PC (Bonus Question--Why did they give it away?) Expected to sell 295,000 in first ten years! 1986 Microsoft and Oracle go public
IT History Quiz, Part 2 1991 & 1993 WWW & Mosaic Browser 1998 Google founded 2004 Google goes public (Bonus Question--Why didnt Matthew buy the stock?) Thought it was overvalued at $80 a share! 2004 Facebook (but for students only for 3 years) 2007 Apple releases iPhone 2010 Apple releases iPad
The Rise of the CyberChondriacs 2007 160 million adults 84% of those online Source: Harris Interactive
The ever-so-slow EMR uptake Source: CDC
EMRs: Yes We Can! EMR Use: The N factor Netherlands 88% Norway 90% NZ 80% 10 years ago! Source: Harris Interactive 2002
EMR Evolution HITECH $34 Billion
1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance
This is America: Theres always a new generation
珂温岳岳鞄艶敬s Screwed! 珂温岳岳鞄艶敬s wife Amanda 珂温岳岳鞄艶敬s business partner, Indu
Matthew Holt talk at HIMSS N. Cal
Regina Holliday Patient EMR/Data Advocate/Artist Ted Eytan MD Kaiser Premanente EMR Evangelist
Matthew Holt talk at HIMSS N. Cal
Matthew Holt talk at HIMSS N. Cal
Matthew Holt talk at HIMSS N. Cal
Technology + people = massive potential for change
Web 2.0 Ecosystem (circa 2005)
What is Health 2.0 Holts best guess at the constituent parts Personalized search that looks into the long tail, and cares about the user experience Communities that capture the accumulated knowledge of patients and caregivers and explain it to the world Intelligent tools for content delivery -- and transactions Better integration of data with content And not just a maybe. Technologies fusing as patients increasingly guide their own care
Health 2.0: User-Generated Healthcare Content Social Networks Search Tools Transaction Data
Matthew Holt talk at HIMSS N. Cal
Matthew Holt talk at HIMSS N. Cal
Matthew Holt talk at HIMSS N. Cal
Matthew Holt talk at HIMSS N. Cal
Search & Online Communities +
Emergence of Consumer-Focused Tools 1. Personalized 2. Analytical 3. Supporting Decisions 4. Enabling Transactions
Matthew Holt talk at HIMSS N. Cal
Matthew Holt talk at HIMSS N. Cal
INDIVIDUAL Biological/Clinical User-generated Claims EMR
POPULATION Government Data Private Data
REFERENCE Food Databases Drug Mapping/GPS Weather
Permissions Identity
Matthew Holt talk at HIMSS N. Cal
Unplatforms
Matthew Holt talk at HIMSS N. Cal
This is America: Theres always a new idea
Matthew Holt talk at HIMSS N. Cal
Matthew Holt talk at HIMSS N. Cal
Matthew Holt talk at HIMSS N. Cal
Matthew Holt talk at HIMSS N. Cal
Matthew Holt talk at HIMSS N. Cal
Matthew Holt talk at HIMSS N. Cal
Matthew Holt talk at HIMSS N. Cal
In the end. Its the human touch
Matthew Holt talk at HIMSS N. Cal
Can You and Your Loved Ones Answer These Questions? 1.On a scale of 1 to 5, where do you fall on this continuum? 1 2 3 4 5 Let me die in my own bed, without any Don't give up on me no matter what, try any proven medical intervention and unproven intervention possible 2.If there were a choice, would you prefer to die at home, or in a hospital? 3.Could a loved one correctly describe how youd like to be treated in the case of a terminal illness? 4.Is there someone you trust that youve appointed to advocate on your behalf when the time is near? 5.Have you completed any of the following: written a living will, appointed a healthcare power of attorney, or completed an advanced directive? engagewithgrace.org The One 際際滷 Project
matthew@matthewholt.net thehealthcareblog.com Health2con.com

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Matthew Holt talk at HIMSS N. Cal

  • 2. Forecasting the future is really hard
  • 4. Guess ONE: 65m uninsured; 19% of GDP 2010 Reality? & Guess TWO: 52 million uninsured $10,000 per capita 47m uninsured; 16% of leads to spending only $8,300 Per capita GDP & Reform after 2010 Share of GDP 17.3% $8,600 per capita leads to No Reform after 2010
  • 5. Who do Americans Believe Can Predict the Future? 50 45 40 35 30 25 20 15 10 5 0 Bi Fa As Ps Po Ou M bl rm tro yc lls ag Percentage who ic al er log hi cs ter ija B ic Pr 's er s oa 8B believe op Al s rd all he m cy an ac Source: Peter D. Hart Research Associates, for the Shell Poll 1998
  • 7. Founded 2003 First months visits 73
  • 9. Health Care Costs Too Much
  • 10. 7000 Dollars spent per capita 6000 Canada France Us Average 5000 Germany spending on health United Kingdom Them per capita United States 4000 ($US PPP) 3000 2000 Source: Gerard F. 1000 Anderson, Ph.D., and Patricia Markovich, Data: OECD Health Data 2008 (June 0 2008) Commonwealth 1980 1984 1988 1992 1996 2000 2004 Fund 2008
  • 11. Health spending as share of GDP 16 Average spending on 14 health Us per capita ($US PPP) 12 Them 10 Canada France 8 Germany Switzerland United Kingdom 6 United States Source: Gerard F. Anderson, Ph.D., and Patricia Markovich, Data: OECD Health Data 2008 (June 4 2008) 1980 1984 1988 1992 1996 2000 2004 Commonwealth Fund 2008
  • 12. I = f(PDI) = f(M5B + MBZ) Where: I is increase in health care costs PDI is physicians desired income M5B is mortgage payment on a 5 bedroom house with a pool MBZ is monthly lease on a new 300 series Mercedes
  • 13. Rapid Increase in Uninsurance; in the Middle Working adults in US who were uninsured for at least 3 months in a 2 year period 60% 51% 52% Lowest 48% 50% 48% quintile 41% 44% Second 40% 39% 35% 37% Third 24% 25% 20% 20% 21% Fourth 18% 8% 10% 10% 11% 11% Highest 4% 5% 6% 6% 5% quintile 0% 1999* 2000 2001 2002 2003 Source: Analysis of the March 19882004 Current Population Surveys by Danielle Ferry, Columbia University, for The Commonwealth Fund
  • 14. And it got much worse (2010) Adults in Percentage of families with a those who had job loss in past insurance 2 years = 47% = 24% or Percentage of 43 million those who lost insurance = 57% or 9m Source: The Commonwealth Fund Biennial Health Insurance Survey (2010).
  • 17. But in health care: the future is like the present, only longer
  • 18. We do a shitty job with chronically ill patients
  • 19. Who cant do chronic care? Views of the Health Care System from those with chronic illness Percent AUS CAN FR GER NETH NZ UK US Only minor changes needed 22 32 41 21 42 29 38 20 Fundamental changes needed 57 50 33 51 46 48 48 46 Rebuild completely 20 16 23 26 9 21 12 33 Base: Adults with any chronic condition Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.
  • 20. Disease managed? Maybe not % of diabetics who received four key preventative services* 80 67 59 60 43 39 40 40 31 20 0 CAN FR GER NETH UK US * Hemoglobin A1c checked in past six months; feet examined for sores or irritations in past year; eye exam for diabetes in past year; and cholesterol checked in past year. Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.
  • 21. Did Not Get a Recommended Test, Treatment or Follow-up Due to Cost, by Income 50% Below average income Above average income 36% 25% 17% 18% 14% 14% 9% 11% 4% 4% 2% 0% AUS CAN NZ UK US 2001Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive
  • 22. Adults Uninsured for Any Time Had Highest Rates of Cost-Related Problems Getting Needed Care Percent of adults ages 1964 who had any of four access problems* in past year because of cost 75 2001 2005 2010 63 66 60 59 55 52 50 37 41 29 28 31 25 21 0 Total Insured all year Insured now, time Uninsured now uninsured in past year *Did not fill a prescription; did not see a specialist when needed; skipped recommended medical test, treatment, or follow-up; had a medical problem but did not visit doctor or clinic. Source: The Commonwealth Fund Biennial Health Insurance Surveys (2001, 2005, and 2010).
  • 23. We do different things to the same people in different places
  • 24. Cost & Quality in Healthcare Health Affairs April 7, 2004 More spending better Ritz-Carlton outcomes Quality Motel 6 Cost
  • 26. Portland 22.7% Salem 16.9% Bend Eugene 23% 18.4% Medford 16.4%
  • 29. Our primary care system is broken
  • 31. New physicians follow the money
  • 36. This is America: Theres always a new technology
  • 37. IT History Quiz, Part 1 1947 Christmas Eve Shockley & pals invent the transistor 1959 Noyce (Intel) & Kilby (the other guy from TI) invent the integrated circuit (separately) 1981 IBM introduces the PC (Bonus Question--Why did they give it away?) Expected to sell 295,000 in first ten years! 1986 Microsoft and Oracle go public
  • 38. IT History Quiz, Part 2 1991 & 1993 WWW & Mosaic Browser 1998 Google founded 2004 Google goes public (Bonus Question--Why didnt Matthew buy the stock?) Thought it was overvalued at $80 a share! 2004 Facebook (but for students only for 3 years) 2007 Apple releases iPhone 2010 Apple releases iPad
  • 39. The Rise of the CyberChondriacs 2007 160 million adults 84% of those online Source: Harris Interactive
  • 40. The ever-so-slow EMR uptake Source: CDC
  • 41. EMRs: Yes We Can! EMR Use: The N factor Netherlands 88% Norway 90% NZ 80% 10 years ago! Source: Harris Interactive 2002
  • 42. EMR Evolution HITECH $34 Billion
  • 43. 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance
  • 44. This is America: Theres always a new generation
  • 45. 珂温岳岳鞄艶敬s Screwed! 珂温岳岳鞄艶敬s wife Amanda 珂温岳岳鞄艶敬s business partner, Indu
  • 47. Regina Holliday Patient EMR/Data Advocate/Artist Ted Eytan MD Kaiser Premanente EMR Evangelist
  • 51. Technology + people = massive potential for change
  • 52. Web 2.0 Ecosystem (circa 2005)
  • 53. What is Health 2.0 Holts best guess at the constituent parts Personalized search that looks into the long tail, and cares about the user experience Communities that capture the accumulated knowledge of patients and caregivers and explain it to the world Intelligent tools for content delivery -- and transactions Better integration of data with content And not just a maybe. Technologies fusing as patients increasingly guide their own care
  • 54. Health 2.0: User-Generated Healthcare Content Social Networks Search Tools Transaction Data
  • 59. Search & Online Communities +
  • 60. Emergence of Consumer-Focused Tools 1. Personalized 2. Analytical 3. Supporting Decisions 4. Enabling Transactions
  • 70. This is America: Theres always a new idea
  • 78. In the end. Its the human touch
  • 80. Can You and Your Loved Ones Answer These Questions? 1.On a scale of 1 to 5, where do you fall on this continuum? 1 2 3 4 5 Let me die in my own bed, without any Don't give up on me no matter what, try any proven medical intervention and unproven intervention possible 2.If there were a choice, would you prefer to die at home, or in a hospital? 3.Could a loved one correctly describe how youd like to be treated in the case of a terminal illness? 4.Is there someone you trust that youve appointed to advocate on your behalf when the time is near? 5.Have you completed any of the following: written a living will, appointed a healthcare power of attorney, or completed an advanced directive? engagewithgrace.org The One 際際滷 Project