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The Health Services Researcher of 2020: A Summit on the Future of HSR Data and Methods Learning 2.0: Robust, Rigorous, Relevant, and Rapid Paul Wallace.

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Presentation on theme: "The Health Services Researcher of 2020: A Summit on the Future of HSR Data and Methods Learning 2.0: Robust, Rigorous, Relevant, and Rapid Paul Wallace."— Presentation transcript:

1 The Health Services Researcher of 2020: A Summit on the Future of HSR Data and Methods Learning 2.0: Robust, Rigorous, Relevant, and Rapid Paul Wallace MD Permanente Federation Kaiser Permanente Paul.Wallace@kp.org

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3 Gray Areas... 3 Insufficient evidence because the evidence is: A.Of insufficient quantity and/or quality B. Conflicting or inconsistent C. There is no evidence Medically appropriate Generally not medically appropriate 66 3 7 38 1 The last 115 new technologies examined: ?

4 Gray Areas... 4 Insufficient evidence because the evidence is: A.Of insufficient quantity and/or quality B. Conflicting or inconsistent C. There is no evidence Medically appropriate Generally not medically appropriate 66 3 7 38 1 The last 115 new technologies examined:

5 Comparative Population Effectiveness: The Kaiser Permanente National Joint Replacement Registry [Evaluation] feedback changed practice with respect to: implant selection, minimally invasive procedures, uncemented knees, and surgical indications and preoperative care. Paxton,EW et al; The Permanente Journal 15:12-16, 2008

6 Predictive Modeling... In patients with diabetes, Aspirin- Lisinopril- Lovastatin (ALL) as a daily combination, has a greater impact on cardiovascular risk than aggressive HbA1c (glucose) control

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8 8 Sean Tunis, CMTP

9 Diabetes Heart Failure Coronary Artery Disease Depression Chronic Pain Cancer Asthma and COPD Dementia Falls Obesity … CO-MORBIDITIES The Business of Health Care in 2009… chronic health conditions increasingly underlie the bulk of health care costs 0% 20% 40% 0%20% 40% 60%80%100% 0% total cost 30 + % of total cost % of People 1% of people 70% of people20% of people Premium level 100% 80% 60%

10 Is more care better for the patient with Multi-Morbidity? N Engl J Med 351;27 2870-2874 December 30, 2004 What is the dose response for relating the number of things you do to achieving clinical outcomes? # of Interventions Desired Result

11 11 2030405060708090 Age Working or Not?Working Years $ FFS Medicare Prevention Usual Care A key challenge Phil Madvig MD The Permanente Medical Group (Not to scale at higher ages – not even close!)

12 12 2030405060708090 Age Mortality diffWorking or Not?Working Years $ FFS Medicare Prevention DM + End-of-Life Palliative Care Usual Care A key challenge: Living to utilize... Phil Madvig MD The Permanente Medical Group (Not to scale at higher ages – not even close!)

13 Care in the last 6 months of life... KP Medical Centers Non-KP Medical Centers (Same Cities) Non-KP Medical Centers (All US) The Dartmouth Atlas Applied to Kaiser Permanente: Analysis of Variation in Care at the End of Life By Matt Stiefel, MPA, Paul Feigenbaum, MD, and Elliott S Fisher, MD, MPH The Permanente Journal/ Winter 2008/ Volume 12/ Number 1

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17 Health 0.0 Rules of the Game model Coverage policies, prior approval, utilization management ? Evidence Based Medicine

18 Health 0.0 Rules of the Game model Coverage policies, prior approval, utilization management ? Evidence Based Medicine Skin in the game model Co-payment and Deductibles Financial incentives High Deductible, Value Based and Consumer Directed Health Plans (Shared Decision Making)

19 Health 0.0 Rules of the Game model Coverage policies, prior approval, utilization management ? Evidence Based Medicine Skin in the game model Co-payment and Deductibles Financial incentives High Deductible, Value Based and Consumer Directed Health Plans (Shared Decision Making) Brain in the game model Sustainable behavior change Motivational interviewing and coaching Shared Decision Making

20 Health 1.0...

21 Health 2.0 User Generated Content Patient Networks and Communities Dis-intermediation Patient-centered Personalized

22 Health 2.0

23 Health 2.0... Evidence Challenge

24 Research 2.0 ???

25 Cross cutting values...Health 0.0 thru 2.0 The Trusted source Knowledge-based Values-based

26 An Oncology Patient in 2020...

27 An Oncology Patient in 1996...

28 Dont tell me what to do, doc...

29 An Oncology Patient in 1996... Dont tell me what to do, doc... Help me understand what all this information means for me.


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