So far we've been talking about and many of your readings outline, many of the different trends and changes to the healthcare ecosystem. But what does that actually mean in terms of where the opportunities and needs are for innovation specifically in the context of digital health. There's really no simple answer to that, but what we can think about is a framework for organizing the various changes and opportunities ahead. So this is one framework and it's by no means the the only framework that is really intended to organize many of the different topics that we've been talking about in individual pieces. But really to put it together to see how they all fit together to define the current and future health care system. So this notion of care redesign is a term that many health system executives and suppliers such as pharmaceuticals and medical device organizations have been increasingly using. To basically refer to the concept of modernizing the entire clinical enterprise or how we deliver care and the underlying business model to support it. And the premise for that is that, the historical underpinnings of how we are programmed and built to deliver care. Is rooted in outdated kind of old form technologies and processes and traditions. And so we're finally at a point in the industry's history where there's been enough disruption and continued disruption that are forcing a change on the system. And many of those changes so that the left dark blue box really, is meant to summarize a lot of the changes that have already happened. Many of the players that are putting pressure on the system to say that things cannot be the same as they were. So whether that is the new entrance that we talked about, who are kind of coming in and coming up with new models of care, and new arrangements for employees to receive health care. To things like scientific discovery, and genetic testing, and discovering new genomes, and the impact that it has on treating disease. To financial pressures on the system and to actually lead to enough revenue to keep the lights on in the hospital. To discoveries from research that is coming about every day, from institutions like Hopkins. To things that are actually happening internally like the EMR, the electronic health record, and the impact that it's having on the workforce. So how does that impact what the physician has to do in terms of their traditional patient work up? How does that change the impact of what nurses have to do? So, there's a whole variety of changes that have been playing out and arguably there are others that are going to destruction back in the category. But ultimately in aggregate, they are putting pressure on the traditional health care system model to say that things are going to have to change. And the way to modernize and redesign the delivery system is really a function of five interdependent pillars. Risk assumption is essentially how do we take on financial risk to manage the total cost of care? So a lot of the conversations and the rhetoric around value based payment, and paying for outcomes as opposed to paying for volume. A lot of those discussions go under this notion of how do we incentivize higher quality care that is also efficient and cost effective? For the purposes of this course, we're not going to go too deep into value based payment. But if you have questions, feel free to send me a note and I'd be happy to direct you to some resources. Paralleling the risk assumption is this idea of how do we manage total population health? How do we move more upstream? So how do we change our focus from being so disease centric and reactive, to really building a system of well and health. How do we think about wellness and primary prevention so that when we're managing a population of diabetes patients for example. That we have done everything that we can as a health system to mitigate and minimize the risk factors for individuals that are most susceptible for developing diabetes later in life. How do we take that diabetic patient and reduce the risk of them developing additional comb orbited conditions. Right, so they don't also have heart disease, and high cholesterol, and other myriad of other subsequent conditions. So how do we think about the total end to end and there are a couple of resources that are provided in your readings this week. That really lay out a framework for the continuum of population health management which really hinges on having the appropriate risk based incentives. Connecting those two together, we also have to think about this notion of clinical reengineering. So how do we reconfigure the traditional frontline experience? The interactions between what the clinician and the physicians are used to doing at the bedside and working with the patient. So you throw in a innovation like the Alexa k technology that is sitting in patient rooms. How does that change how the patient interacts with the physician? Does it require new modes of training, new capabilities? What about point of care ultrasound? There are new technologies where the modern day stethoscope, there are some physicians who are using a portable ultrasound device as a new and improved stethoscope to quickly scan a patient at the bedside. Then as part of the routine work up and physical exam. How does that change the dynamics of what the physician and the patient are going to have to do to really optimize that care experience? And then the thing that will always be the case, is that we can't get settled in our ways of the traditional work up or care protocol or care pathway for different conditions. Because we will always have the treatment paradigms as a result of the innovations that are constantly coming out from new drug discoveries, to genetic testing and discoveries and the genome. So the minute that we have a new therapeutic introduced for a particular condition, then the system is going to have to figure out how to adopt and integrate that clinical innovation. In a way that is effectively paid for, it's disseminated to the right patients and their populations. The physicians and providers of care are trained to understand the use cases, and how to best deliberate administer the regimen and bundling it all together is data. So we can't effectively pursue any of these strategies of how we better manage total cost of care, population health. If we don't actually have an understanding of our patient populations and efficacy, and spending data, and cost data, and what are the trends and patterns that can predict behavior and disease outcome. So ultimately to be able to build a system that reflects the new realities of the environment and the continued evolution of all the disruption that will increasingly play out in the years ahead. We as leaders and entrepreneurs are going to have to figure out how to connect these five pillars together and build solutions that really take all of these components into account. And ultimately, if you build solutions that bring in these five factors together, then the end result will be enhanced consumer well being. Which we define as many of the concepts we discussed in the first lecture around affordability, convenience, accessibility, satisfaction, efficiency of care delivery. Are we actually able to deliver a high bar high quality clinical care, and the most efficient manner in terms of resource use and spend? And are we making the most effective use of our providers that are actually delivering the care? Are we having them practice top of license? Are there certain care actions that are best handled by nurse practitioners and physician assistants, versus other things that are best left for social workers. And the end the physicians and specialists, how do we actually think about the practice of care and the pathways that protocols to support that? And then ultimately we're all trying to improve the health of our population which is best achieved by the actual outcomes. And whether that is from a macro level in terms of reducing the prevalence of disease to the severity of disease. To actually specific clinical outcomes specific to that patients, diagnosis or treatment plan. So this is a mouthful and there are a lot of components to this and there are a lot of other factors that you could potentially with we've in. But ultimately this is meant to be a tool for you to think through as you're reflecting on the variety of change instruction happening in the healthcare environment is. How do you think about the relationships between them and ultimately, what are the goals of health care moving forward? And where are the places where technology and data solutions really can help drive meaningful change? And so you can imagine in any one of these components, there's really ripe opportunity for substantial innovation.
