Con Iber Fairview Health Systems University of Minnesota Health The Future of Sleep Health

Objectives To identify opportunities in transitioning from sleep medicine to sleep health To propose a snapshot of the future of the field To identify methods of transforming ourselves into what the future requires of us

Caveat There will be unanswered questions that we must all solve together

Harry: “OK……where’s the map?”

Harry, don’t check the map while your driving!! Where should we go and how should we get there?

Let’s get a higher altitude view

Health care cost/quality gaps History of perverse incentives Technical innovation Public accountability Pressures for Change

OECD Health data 2012

Unreasonable practice variation

Sutherland, Skinner, Fisher. NEJM 2009; 366:1227

AHA Trendwatch Chartbook

Medical economics July 2013

What are the opportunities for merging sleep medicine into sleep health? More adaptable to changing models diagnosis at home decreased reliance on complex testing increased utilization of evolving therapies More honest- shift work/insufficient sleep preventative methods are more powerful better alignment with driving forces

11.8 million Insufficient sleep and shift work: 49 million Behavioral Genetic Countermeasures Shift workInsufficient sleep 37 million

What are the opportunities for transitioning from sleep medicine into sleep health? More diversified- meets need for distributive model population/employee based flexibility of cross-training workforce More integrated – case finding->diagnosis->therapy population management

Home Sleep Studies [example of forced change] 2012 HomePAP N=373 randomized 2014 Health System N=4625 uncontrolled doi: /2014/ doi: /sleep.1870

Dental devices [example of change to be forced] Gap- underutilization of devices in the US Drivers- user preference guideline changes payer preference

Snapshot of the future

Where do we want to go? Change that will improve sleep health Quality and cost optimization Adaptable to predictable forces User satisfaction

Distribute care and maintain continuity Incorporate population management Develop and integrate collaborative networks Negotiate change consensus Leverage technology Strategies-high altitude

Reduce variation Virtual care Sleep therapy management Cross discipline collaboration Payer negotiation Stratified resource use Cross-training workforce Tactics-zoom lens [adopt new lexicon]

Sleep Therapy Management

Structural changes: reduce points of care and variation, expand comprehensive care, develop stem to stern pathways, partner, tune to outcomes Behavioral changes: team concept, monitor progress to achievable/meaningful goals, anticipate and manage failure, expand scope of practices Components of Change

Are we are here?

“Single visit”: initial diagnostic procedure for uncomplicated sleep apnea and insomnia moved to primary care with therapy determination made by sleep center and virtualization of >50% of point of care followup visits. Consolidation of laboratory studies to verify ambiguous home studies, serious comorbidities, parasomnias, suspected seizures.

Increased scope of onsite clinic operations to include partners in dental, otolaryngology, pediatric, and occupational sleep medicine. Population management to incorporate long term management, innovation, outcome monitoring, payer negotiation.