Disqus - Latest Comments for hxp

Re: Demonstration Division: True Communities versus Geographically Concentrated Employers

vijaygoelmd — Wed, 08 Jul 2009 16:55:16 -0000

Jim,
The issue we face is that physician-hospital organizations like Geisinger and Kaiser have grown slowly relative to the need to fix the health issue. One of our goals is a scalable solution...which is why we're looking for successful programs that can be brought to areas that don't have a unified payor/provider.

These organizations already have the incentives to make the required changes...and we're seeing some great innovations coming out of places like Geisinger, like their warranty programs, embedded care coordinators, etc. We're looking to prove that these innovations can be broadly adopted (and show great success) in the rest of the country--the barriers you cite are the ones we need to show can be broken.

Re: 9. Contact / Comment

vijaygoelmd — Fri, 26 Jun 2009 15:59:02 -0000

Scott,
We're looking at creating a "demonstration division" that would allow communities to enter and self-report data. One of the reasons we're assigning teams to communities is a goal of a solution that would scale across geographies. Therefore, one of our requirements is that a team is able to move to a community and adjust its programs to reflect the needs of that community.

Re: 8. Teams

vijaygoelmd — Fri, 26 Jun 2009 15:57:31 -0000

Joe,
We're open to all innovations and are hoping for some surprises.

I would say that the existing spend is currently going at a little over 50% for the sickest 5% of people. My sense is that the care those people are receiving would need to be addressed in some way (hopefully in avoiding acute issues) to move the overall needle.

Re: 1. Introduction

vijaygoelmd — Tue, 16 Jun 2009 11:43:02 -0000

Sherry,
Feedback loops are really important. The airline industry shows what an attention to safety (and spread of best practices) can accomplish over time via checklists and iterative learning.

Its amazing to me that we don't capture (or even if we capture, don't then utilize) much of the relevant data or practices anywhere today in health.

Re: 7. Philosophy of Prize Design Guidelines

vijaygoelmd — Wed, 03 Jun 2009 23:28:05 -0000

Fred,
We were already planning on making a comprehensive 10,000 record database with 3 years of information available as part of the concept model.

Your suggestion is a good one. We'll see what type of research queries in addition to the data model we can make available-- we're trying to figure out if this is something that we should look for from WellPoint or if we should look to others in the market to step forward as team members or vendors (we don't want WellPoint to crowd out alternatives in the market either).

Any suggestions on what would be the best way to proceed?

Re: 2. The Grand Challenge

vijaygoelmd — Fri, 29 May 2009 13:55:03 -0000

I would somewhat challenge the assertation that eliminating admin costs improves the impact of the healthcare dollar by itself...

For example, Medicare, which provides limited admin oversight, has a rehospitalization rate of >50% in the first year with a limited number of those people seeing a doctor in the interim. I'd rather pay for more management to reduce the total amount of hospitalizations than simply pay when people go

Re: 5. Impact Potential

vijaygoelmd — Fri, 29 May 2009 13:31:42 -0000

Great comment on "statistically significant" vs. making an absolute difference.

We believe the focus on outcomes, at an individual level, is where health delivery needs to go. We hope the competition will help to create the infrastructure that makes this possible in the real world.

Re: 3. Prize Design Approach

vijaygoelmd — Fri, 29 May 2009 13:28:32 -0000

Prevention and early intervention are important components of the prize, but as you noted, the results can take a while.

I think we often forget about care coordination, engagement, matching of individuals to appropriate interventions, investigating root causes to drive solutions (rather than mask symptoms), and transition between different care settings. Many of these things could be done significantly better today and would have a faster impact.

Re: 6. Measurement

vijaygoelmd — Fri, 29 May 2009 13:24:24 -0000

Giuseppina,
Appreciate your comment. The complexity is something we've wrestled with.

At the end of the day, we keep coming back to the fact that the underlying measurements and incentives don't make much sense, which impacts the care for everything.

When we look at things from a disease perspective, this becomes medical problem-solving

When we look at things from an "optimizing health" perspective, this becomes more about fixing the incentives and identifying the types of things that should work-- and partnering with providers and community resources locally to make them happen. We think this will be the approach that can scale nationally and create the most impact, as the integrated systems report many of these benefits (as they can change the incentives, e.g. Geisinger's "Warranty"), but grow slowly.

Re: 7. Philosophy of Prize Design Guidelines

vijaygoelmd — Fri, 29 May 2009 13:19:54 -0000

We welcome teams from across the world, so AZ is certainly a good place to enter. If you don't have established physicians in the test community that is chosen, you are welcome to set them up as the competition gets started and the communities made public.

You may want to look at this competition from 3 lenses:
1) Team participant in one community
2) Vendor to teams in multiple communities
3) Demonstration community (we're trying to define how we can incorporate and promote local successes outside the test communities against some of our metrics). Let us know what you would want this to look like

Re: 4. Initial Prize Design

vijaygoelmd — Fri, 29 May 2009 13:14:44 -0000

We're trying to keep the actuaries out of this during the actual running of the competition (they'll be important in setting up the test communities in the right way).

If we want to redirect dollars in new ways, the dollars need to be real...its the only way the project can fund itself. Theoretical dollars aren't all that helpful to anyone in the long run (derivatives and finance bubble fees--we're trying to create a better system here).

The types of calculations Dr. Raheman proposes will go into the "Individual Vitality Score", kind of like a FICO score for your health, that we hope will be a long-term benefit that comes out of this. For the purposes of our competition, objectivity is making us focus on real outcomes that are proven...

The net result is that a team looking to "game" the competition needs to identify the sickest people that they can help the most (so that they won't experience a poor outcome) and find the most cost-effective way to engage the rest in healthier behavior to improve their health status classification.

I'm ok with teams figuring out how to do this...I think it ushers in a new generation of personalized healthcare approaches. Do you agree?

Re: 2. The Grand Challenge

vijaygoelmd — Fri, 15 May 2009 03:37:43 -0000

We'll be creating an innovation ecosystem to connect ideas with teams...we'll look to share that information in the coming months as we roll it out.

Appreciate your ideas!

Re: 4. Initial Prize Design

vijaygoelmd — Sun, 10 May 2009 23:17:36 -0000

Ronald,
This is a very interesting insight. We will need to have some determination of the test communities in order to deploy all the pieces required to make teams in those communities successful.

To your point, those communities will have certain characteristics (e.g., cultural, provider community, etc) that will also influence success. We will need a mix of both-- community involvement as well as selection to make this work.

Re: 9. Contact / Comment

vijaygoelmd — Sun, 10 May 2009 23:14:48 -0000

Lisa,
Empowered, responsible individuals are a core element of healthier communities...we hope to make tools available that would help people to improve their chances for success (via information, tools, and incentives) and reward those who took (and stuck with) the steps to improve their health.

Re: 8. Teams

vijaygoelmd — Tue, 05 May 2009 02:43:26 -0000

WellPoint is the largest health insurance company in the US, with 34M members in 14 states. We are recruiting employers as partners in the communities. We're really trying to do a lot of work in setting things up so teams can be successful.

Re: 8. Teams

vijaygoelmd — Mon, 04 May 2009 03:15:38 -0000

Akash,
I think you've confused a few issues...let me attempt to clarify:
A team registers and works on their plan. They will be given a population sample of 10K, with which they will need to be able to model their system and submit to judges (not WellPoint).

The top ideas, as demonstrated by their modeled performance and their ability to prove out key assumptions in real life (via small pilots) will be selected as finalists.

The teams will be required to fund their back-end development. In the current concept, an employer/payor relationship will allow teams to pay for operations out of the total funds going into the system. Therefore, operating expenses in the field will be covered as part of the trial (but also counted against total cost). This could be via a "staff model' that resembles a Kaiser, an "asset allocation" model more similar to a mutual fund or Fidelity, a "recommendation" model like Mint.com or RealAge or Zagat, an "employer benefit" model, etc. So many of the (non-development) operating costs will be covered under the contest and we will be recruiting sponsors who will make some of their assets available to teams.

In addition, contestants will receive significant amounts of publicity and exposure as contestants in the competition. And WellPoint is committing to deploy the winner in their membership. Frankly, if you believe you can create significant scalable and demonstrable improvements in the current system, the $10M isn't the primary reason why you enter...

As an entrepreneur in this space, we're designing this to be as entrepreneur-friendly as possible. I'd be salivating to enter if my role in developing the prize didn't exclude me from competing...

And why wouldn't these teams also be using this exposure to build their businesses?

Re: 9. Contact / Comment

vijaygoelmd — Mon, 04 May 2009 03:02:58 -0000

Nancy,
We are certainly looking to create the design in a way that teams can offer better alternatives to providers and consumers that may be different than the current, claims-based model.

As we're focusing on delivery issues and thought that the administrative needs may change as the model changes, we haven't focused on the "soft" costs...we do expect that incentives that cause people to switch to a better alternative may include better approaches that make the switch enticing.

Re: 9. Contact / Comment

vijaygoelmd — Fri, 01 May 2009 05:24:51 -0000

Rich,
We're working on creating the "suggestion box" and different ways in which individuals can share their skills and interests and create teams.

We can't determine how winners will share their prize money. Perhaps, as with one of our other prizes, someone can create an "open-source" style team with many contributors.

My sense is that the teams that can consistently deliver small things will see some pretty interesting results. After all, in aviation we've found its much better to have average pilots deliver consistent results using checklists rather than depend the heroism of individual pilots.

Re: 9. Contact / Comment

vijaygoelmd — Sat, 25 Apr 2009 15:40:38 -0000

Russ,
Those arrangements are still to be determined. We will use reputable third parties to ensure fair audit/judgement.

Re: 9. Contact / Comment

vijaygoelmd — Wed, 22 Apr 2009 15:09:22 -0000

Joseph,
We still need to clarify the IP questions (and will likely need the help of counsel to do so).

The intent is that teams will need to publicize their approaches sufficiently for the competition to highlight real innovation, but retain IP in a way that allows them to become ongoing entities (which is why the investments would be made). For example, in the Ansari Space PRIZE, IP from the winning entity was purchased by Virgin and Northrup Grumman.

You're right in that population factors will be key in both the competition phase as well as post-competition applicability to the nation at large.

Local buy-in is an important element of the selection of test entities...we think an anchor entity (employer/community) will be important. What elements of the provider community will also be important in evaluating sites?

Re: 9. Contact / Comment

vijaygoelmd — Wed, 22 Apr 2009 02:25:42 -0000

Dee,
You've hit on one of the reasons that we've made the prize look at much broader definitions of "health" and "cost" than we've seen previously...you need to combine the responsibility and rewards across multiple silos. We believe that we've baked this transformational requirement into the design of the prize itself. Does it need to be called out and if it does, how can we do it in a way that will be sustainable and meaningful over time?

Re: 9. Contact / Comment

vijaygoelmd — Sat, 18 Apr 2009 20:36:31 -0000

Interesting clarification. The proposed format is that operational costs of the care for individuals in the trial will continue to be paid for by our insurance/ employer/ community partners in the finalist markets...they're paying today and programs should at least be the same cost if not lower. This includes claims processing and tracking of the metrics used to judge the competition.

Re: 9. Contact / Comment

vijaygoelmd — Sat, 18 Apr 2009 18:48:19 -0000

If we could help put interested people together to create new organizations would that be of interest?

Re: 9. Contact / Comment

vijaygoelmd — Fri, 17 Apr 2009 21:53:51 -0000

We look forward to your entry after the competition gets launched.

In the interim, do you have any feedback on the guidelines and objectives for the prize as currently laid out?

Re: 4. Initial Prize Design

vijaygoelmd — Fri, 17 Apr 2009 21:48:38 -0000

Arlan,
We will be creating the test communities that participants will need to compete in. This is the only way we've been able to think of to ensure that the competition between the different teams is occurring in a comparable way.

One of the major goals of this prize is to have a solution that can scale...and we felt that making people bring their solution to a community and implement it quickly would help to ensure a portable solution.

Would you suggest an alternate approach?