Rapid technological advances, regulatory reform, and the new science of personalized medicine are the three primary factors driving unprecedented levels of innovation in the healthcare industry. These factors are forcing convergence among all members of the healthcare ecosystem in ways that enable all members to create greater value through extensive coordination, collaboration, and competition. Increasingly, providers, payers, products, and patients are leveraging mobile information technology to participate in M2M (mobile-to-mobile) digital healthcare delivery. Some of the key questions facing healthcare organizations, and particularly their CIOs, are: Where in the healthcare innovation ecosystem should we focus? What types of innovations create the most value for our organization? How do we enable greater levels of innovations from a strategic, process, and infrastructure perspectives? What are the barriers to developing and adopting innovation in the healthcare industry, and within healthcare organizations, and how do we overcome these barriers?
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Business Model Innovation in Healthcare by Chris Wasden
1. Draft
The Business of Revolutionizing Healthcare
Innovation Opportunities and Challenges
4 December 2009
Mobile
2 Mobile
2. Table of Contents
Page
1 Three Primary Forces are Driving Innovation in Healthcare 1
2 Focus at the IT intersection in the Healthcare Innovation 7
Ecosystem
3 Innovation Focus Should be in Areas of the Greatest Value 12
Potential
4 Overcoming Barriers to the Adoption of Innovation Presents 16
Challenges
3. Draft
The future is already here. It’s just not
very evenly distributed.
William Gibson
The Business of Revolutionizing Healthcare • Innovation Opportunities and Challenges
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1 Three forces appear predetermined to drive the transformation of
- the healthcare industry towards convergence
T
h
r
e Forces driving convergence Key issue/question
e
P 1 • Are you placing the patient (as opposed
r
i
Technology is driving a revolution to the provider, product, physician, or
m
a
in healthcare delivery payer) at the nexus of all technology
r solutions through M2M medicine?
y
F 2
o • Are you providing innovative technology
r Regulatory reform is transforming solutions for high volume, low margin
c
e industry structure healthcare in the M2M model?
s
a
r 3
e • Are you linking payments and value to
Personalized medicine is disrupting personalized, preventative, predictive
D
r the practice of medicine and participatory care?
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1 Two models of consumer interaction with healthcare are emerging
- – both demand significant increases in HIT and M2M medicine
T
h
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e Empowered consumer Integrated medical home
e
P
r
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m
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y
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Source: PwC analysis
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1 80% of healthcare is currently provided in the home – technology
- will continue to push care delivery in this direction
T
h
r 100%
Healthy, Independent Living
Healthy, Independent Living
e Healthcare IT is the
e Community Clinic
Community Clinic “glue” that ties
HOME disparate healthcare
P Chronic Disease
Chronic Disease CARE
r services together and
i
Management
Management Doctor’s Office
Doctor’s Office
enables service to be
m provided outside acute
Healthcare IT
a facilities
Healthcare IT
r
Quality of life
y
Assisted Living
Assisted Living
F
o RESIDENTIAL
r
Specialty Clinic
Specialty Clinic
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CARE
e Skilled Nursing
Skilled Nursing Facility
s Facility Community ACUTE
Community Hospital
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Hospital CARE
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e
D ICU
ICU
r
i
v
i 0%
n $1 $10 $100 $1,000 $10,000
g
I
Cost of care per day
Source: Intel Corp. 2006
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1 EMRs and HIEs provide the infrastructure to move the system
- away from a utilization paradigm and towards a value paradigm
T
h Current state of EMR Likely future state (5-10 years)
r
e 17 Percent of US physicians that use 90 Percent of physicians will use EHRs that
e
computerized records populate PHRs & claims data
P
r 1.5 Percent of US hospitals that have a
i comprehensive EHR system (i.e.
m
a present in all clinical units)
r
y 7.6 Percent of US hospitals that have a
F basic system (i.e. present in at least one
o clinical unit)
r
c
e Current state of Payment Models Likely future state (5-10 years)
s
80 Percent of Massachusetts physicians 85+ Reimbursement will require healthcare
a
r
paid under fee for service models outcomes (P4P), will be bundled, and
e non-fee for service
D 279 Percent growth in P4P programs
r
i between 2003 and 2007
v
i 26 Compounded Annual Growth Rate Is the current IT infrastructure sufficient to track
n
g (CAGR) of P4P programs between outcomes for a pay for performance system?
I
2003 and 2009
n Source: NEJM (2008), IDC (2007)
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1 Wellness is a key area for increased focus, and is driving a shift
- from remedial to personalized, predictive and preventative care
T Today’s world
h
r
e Wellness Healthcare
e
P
r
i
Personal Communication/ Preventive Education Physical Exams Disease Clinical Diagnostics
m Coaching Information Services Management & Therapeutics
a Services
r
y Healthcare today
F
o
r
Healthy Vulnerable Affected Sick
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e
s
Future healthcare
a Future system
r
e
D
r
Wellness Healthcare
i
v
i
n Consumer Products Medical Health Spas Complementary and Integrated Health
g
Alternative Medicines Solutions
I
n Source: CDC, PwC analysis
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10. Section 2
Focus at the IT intersection in the Healthcare
Innovation Ecosystem
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2 The healthcare innovation ecosystem extends from internal
- patient care all the way through the external environment
F
o
c
u
s
a
Community
t
t
h
e External Device
I
T
i
n Patient
Ingestible
t
e
r
s
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c Implantable
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i
o
n
i
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t
h
e
The Business of Revolutionizing Healthcare • Innovation Opportunities and Challenges
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2 Healthcare has become an information technology driven industry
- reflected in much of the innovation
F
o
c
u
s
a
t
Data Information Intelligence
t
h
e
I
T
i Lab on a Chip
n tests microliters
Pacemaker that of blood in Genome-enabled
t communicates minutes using EMR analyzes
wirelessly with a
e monitoring
microfluidic risk of disease
channels and therapeutic
r device
outcomes
s
e
c
t
i
Sensei iPhone
o app delivers
n Ingestible customized meal Business
camera that plans, fitness intelligence
sends out tips, and solutions
i images incentives
n
t
h
e
The Business of Revolutionizing Healthcare • Innovation Opportunities and Challenges
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2 Providers have rich opportunities to integrate innovations at the
- intersection of IT and the innovation ecosystem
F
o
c
u
s
Ingestible
a
Suggested
t
t
h
e
I Implantable
strategic
T
i
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r
External
Device
focus
s
e
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Community
i
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h No link Data Information Intelligence
e
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2 Case Study: Focus Areas vs. Opportunity Areas for Large
- Healthcare Provider
F
o
Opportunity presented in previous slides
c
u Illustrative Area where Client has a presence
Key area for Smartphone application integration
s
a Ingestible Sensors
t
t Implantable Devices Devices
h
e Imaging Imaging
I
T
External Treatment Treatment
Device
i
n Monitoring Monitoring Monitoring
t
e
r Genetic Testing Genetic Testing
s
e
c Surgical
t Environment of Environment of Care Environment of Care
i Care
o
n Health Information Health Information Health Information
Community
Systems Systems Systems
i
n Health 2.0
t
h Data Information Intelligence
e
The Business of Revolutionizing Healthcare • Innovation Opportunities and Challenges
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3 Ten Types of Innovation – look across the entire value chain
-
I
n
n 1.Business Model 5. Product performance
o how the enterprise makes money basic features, performance and
v functionality
a
t 6. Product system
i extended system that supports an offering
o 2. Networking
n enterprise’s structure / value chain 7. Service
& partnering how you service your customers
F
o
c Finance Process Offering Delivery
u
s
Business Networking Enabling Core Product Product Service Channel Brand Customer
Model process process performance system experience
S
h
o
u 8. Channel
l how you connect your offerings to your
d customers
3. Enabling process
b assembled capabilities you typically
e buy from others 9. Brand
how you express your offering’s benefits
i and ideas to customers
n
4. Core process
A proprietary processes that add value 10. Customer experience
r how you create an integrated experience for
e customers
a
s
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3 The vast majority of innovations, as measured by volume, occurs
- in the area of products
I
n Leading to a shift in value creation…
n
o
v
a Finance Process Offering Delivery
t
i Business Networking Enabling Core Product Product Service Channel Brand Customer
o Model process process performance system experience
n
Volume of Innovation Efforts
F Last 10 Years
o
c
u
s Hi
S
h
o
u
l
d
b
e
i
Lo
n
A
r
e Source: Doblin analysis
a
s
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3 Few innovations create the most value, and those in the product
- segments of the value chain produce the lowest yield
I
n Leading to a shift in value creation…
n
o
v
a Finance Process Offering Delivery
t
i Business Networking Enabling Core Product Product Service Channel Brand Customer
o Model process process performance system experience
n
Cumulative Value Creation
F Last 10 Years
o
c
u Pareto revisited:
s Hi
Fewer than 2% of projects produce
S
h More than 90% of value…
o
u
l
d
b
e
i
Lo
n
A
r
e Source: Doblin analysis
a
s
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4 The US healthcare industry is the most innovative in the world,
- but obstacles have made remaining problems difficult to
O
v overcome
e
r Problem
Problem
c
o
m
i • The US represents the most • However, failure to implement
n
g
innovative healthcare industry in innovations to improve quality of
the world care and decrease costs has limited
B
a success
r – Most patents
r
i – Most expensive healthcare
e – Most new drugs
r – Spend 50-100% more on
s – Most new devices healthcare per capita
t
o – Most clinical trials – Lowest life expectancy
t
h – Most new ventures – Highest infant mortality
e
A – Poor coordination of care
d
o
p – Lack of universal coverage
t
i
o
n Source: Nembhard, Alexander, Hoff, Ramanujam: "Why Does the Quality of Health Care Continue to Lag? Insights from Management Research" (2009)
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4 There has been significant spending in healthcare innovation, but
- four obstacles have made the successful implementation of
O
v innovation difficult to achieve
e
r
c
o
Reasons
Reasons
m
i
n • Over past 10 years, leading • However, four obstacles have
g
pharma, biotech, device made innovation success difficult to
B
a companies, VCs and angel achieve:
r
investors spent over $1 trillion on
r 1) Nature of the work
i
e
innovation
r 2) The workforce
s • $250 billion spent over 50 years
t verifying effectiveness of 3) Leadership-workforce relations
o
innovations in healthcare
t
4) Performance measurement and
h
e
control systems
A
d
o
p
t
i Source: Nembhard, Alexander, Hoff, Ramanujam: "Why Does the Quality of Health Care Continue to Lag? Insights from Management Research" (2009)
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n
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4 National healthcare companies have been unsuccessful in
- realizing their innovation goals, showing only a 1.5% increase in
O
v
15 quality measures since 2000
e
r
c Obstacle #1: Nature of Work
Obstacle #1: Nature of Work
o
m
i
n Obstacles Description Case Study
g
B High procedural Healthcare professionals Cedars-Sinai Medical Center:
a
r variance are reluctant to change
r Multi-million dollar
because of high risks
i Clinician discretion computerized physician order
e and degree of
r central entry program was cancelled
s uncertainty in diagnosing
after 3 months when staff
t Risk aversion to patients
o protested
patient harm
t Innovations often come
– IT director concluded that
h
with learning curve that
e program was introduced
can cost lives and
A too quickly for staff to
d reduce quality of care
o acclimate
p
t
i
o Source: The National Healthcare Quality Report (2007), Nembhard, Alexander, Hoff, Ramanujam: "Why Does the
Quality of Health Care Continue to Lag? Insights from Management Research" (2009), Fiercehealthcare.com, The Commonwealth Fund (2009)
n
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4
National healthcare companies have been unsuccessful in
- realizing their innovation goals, showing only a 1.5% increase in
O
v
15 quality measures since 2000
e
r
c Obstacle #2: Workforce
Obstacle #2: Workforce
o
m
i
n Obstacles Description Case Study
g
B Strong Physicians feel only Children’s Hospital Boston:
a
r professional loose tie with employing
r In 2003, a 5 year-old boy
identification/weak company and are
i died, having received no care,
e organizational reluctant to collaborate
r because his physicians never
s orientation with others for
communicated with each
t organizational growth
o Professional other
t hierarchy of Opinions of healthcare
– Each falsely assumed
h
healthcare employees with lesser
e another was in charge
employees credentials are often
A
d stifled
o
p
t
i
o Source: The National Healthcare Quality Report (2007), Nembhard, Alexander, Hoff, Ramanujam: "Why Does the
Quality of Health Care Continue to Lag? Insights from Management Research" (2009), Fiercehealthcare.com, The Commonwealth Fund (2009)
n
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4
National healthcare companies have been unsuccessful in
- realizing their innovation goals, showing only a 1.5% increase in
O
v
15 quality measures since 2000
e
r
c
o
Obstacle #3: Leader-Staff Relations
Obstacle #3: Leader-Staff Relations
m
i
n Obstacles Description Case Study
g
B Transactional Disjointed nature of Carilion Health System:
a
r nature of transactional relationship
r In 2006 a group of physicians
relationship often involves trade-offs,
i resisted the $100 million plan
e which prevents unified
r Perceived to reorganize operations,
s growth
discrepancy in which included new facilities
t
o goals Lack of shared goals and increased employment
t creates maladaptive
– Physicians were skeptical
h tensions
e of plan’s impact on care
A
d
o
p
t
i
o Source: The National Healthcare Quality Report (2007), Nembhard, Alexander, Hoff, Ramanujam: "Why Does the
Quality of Health Care Continue to Lag? Insights from Management Research" (2009), Fiercehealthcare.com, The Commonwealth Fund (2009)
n
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4
National healthcare companies have been unsuccessful in
- realizing their innovation goals, showing only a 1.5% increase in
O
v
15 quality measures since 2000
e
r
c Obstacle #4: Performance Measurements
Obstacle #4: Performance Measurements
o
m
i
n Obstacles Description Case Study
g
B System Current performance St. Mary’s Health Center, MT:
a
r underdeveloped measurements lack
r Medical staff viewed new
adaptations to specific
i Compliance not performance guidelines as
e needs of leaders and
r rewarded “extra” and “imposed” and
s staff
were reluctant to comply
t Relationship
o Current systems fail to
based on action, – Physicians who achieved
t cultivate organizational
not trust positive results without
h unity
e new guidelines felt justified
A in their resistance
d
o
p
t
i
o Source: The National Healthcare Quality Report (2007), Nembhard, Alexander, Hoff, Ramanujam: "Why Does the
Quality of Health Care Continue to Lag? Insights from Management Research" (2009), Fiercehealthcare.com, The Commonwealth Fund (2009)
n
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4 Given these obstacles, six solutions can be implemented to
- prevent innovation failure, motivate success, and foster growth
O
v
e
r
c
o
Solutions
Solutions
m
i
n 1
1 4
4
Create opportunities for staff
Create opportunities for staff
g Use transformational leadership
Use transformational leadership
experimentation and innovation
experimentation and innovation
B processes
processes
a adaptation
adaptation
r
r
i
e 2 5
2 5
r Involve the workforce in
Involve the workforce in
s Frame innovation implementation as
Frame innovation implementation as performance measurement and
performance measurement and
t a learning challenge
a learning challenge
o system development
system development
t
h
e 3
3 6
6
Measure and reward
Measure and reward
A
Promote organizational identification
Promote organizational identification
d
o
implementation efforts
implementation efforts
p
t
i
o
n Source: Nembhard, Alexander, Hoff, Ramanujam: "Why Does the Quality of Health Care Continue to Lag? Insights from Management Research" (2009)
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4 Six solutions can be used to create innovation implementation
- success
O 1
1
v
e
Create opportunities for staff experimentation and innovation adaptation
Create opportunities for staff experimentation and innovation adaptation
r
c
o Case Study Obstacle Avoided Solution
m
i
n Frequently changing Hospital and nurses
g
nursing staff via agency agreed that nurses
B
a
or float pool was would self-organize
r
r
disorganized and staffing 24 hours/day
i expensive with 10% added pay in
e
r place of overtime
s
t
o Doctors felt constricted Allowed doctors to
t
by guidelines, while deviate from guidelines
h
e
management feared if they documented
variation procedures in order to
A
d enhance organizational
o
p learning
t
i Source: Nembhard, Alexander, Hoff, Ramanujam: "Why Does the Quality of Health Care Continue to
o Lag? Insights from Management Research" (2009),
Delos Cosgrove “The innovation imperative”, The Journal of Thoracic and Cardiovascular Surgery
n (2000), Company websites
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4 Six solutions can be used to create innovation implementation
- success
O 2
2
v
e
Frame Innovation Implementation as a Learning Challenge
Frame Innovation Implementation as a Learning Challenge
r
c
o Case Study Obstacle Avoided Solution
m
i
n Development exercises Development exercises
g
may feel burdensome framed as “Continued
B
a
to employees who may Education” and use an
r
r
be skeptical of job interactive TV-like
i losses resulting from medium via the internet
e
r low performance
s
t
o Researchers may be Lilly’s CSO instituted
t
risk averse to avoid “failure parties”,
h
e
failure, which can honoring hard work that
prevent innovation ultimately fails, thereby
A
d cultivating a learning
o
p environment
t
i Source: Nembhard, Alexander, Hoff, Ramanujam: "Why Does the Quality of Health Care Continue to
o Lag? Insights from Management Research" (2009),
Delos Cosgrove “The innovation imperative”, The Journal of Thoracic and Cardiovascular Surgery
n (2000), Company websites
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4 Six solutions can be used to create innovation implementation
- success
O 3
3
v
e
Promote Organizational Identification
Promote Organizational Identification
r
c
o Case Study Obstacle Avoided Solution
m
i
n Difficulty creating MDVIP is a self
g
organizational acclaimed “fraternity of
B
a
identification as individual physicians…
r
r
physician offices are inherently linked.”
i separate and remote - Company website
e
r
s
t
Difficulty creating The HMI “walking
o organizational challenge” creates
t identification between company unity by
h
e employees from encouraging employee
A
different focus areas socializing, while using
d
o
(e.g. managers, IT and company’s product
p healthcare staff)
t
i Source: Nembhard, Alexander, Hoff, Ramanujam: "Why Does the Quality of Health Care Continue to
o Lag? Insights from Management Research" (2009),
Delos Cosgrove “The innovation imperative”, The Journal of Thoracic and Cardiovascular Surgery
n (2000), Company websites
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4 Six solutions can be used to create innovation implementation
- success
O 4
4
v
e
Use Transformational Leadership Processes
Use Transformational Leadership Processes
r
c
o Case Study Obstacle Avoided Solution
m
i
n Transformational Our specialty has been
g
leadership is essential and should be one of
B
a
to company growth, but constant
r
r
difficult to cultivate/train innovation…. Changes
i in current leadership must be viewed as
e
r opportunity.”
s
- Delos “Toby” Cosgrove, CEO
t
o
t
h
e
A
d
o
p
t
i Source: Nembhard, Alexander, Hoff, Ramanujam: "Why Does the Quality of Health Care Continue to
o Lag? Insights from Management Research" (2009),
Delos Cosgrove “The innovation imperative”, The Journal of Thoracic and Cardiovascular Surgery
n (2000), Company websites
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4 Six solutions can be used to create innovation implementation
- success
O 5
5
v
e
Involve the Workforce in Performance Measurement and System Development
Involve the Workforce in Performance Measurement and System Development
r
c
o Case Study Obstacle Avoided Solution
m
i
n Organization members A peer-to-peer review
g
can be apprehensive system for nurse
B
a
and distrustful of practitioners and
r
r
performance physician assistants
i measurement being allows employees to
e
r controlled only by learn from each other
s
senior management and share ideas for
t
o
improved care
t
h
e
A
d
o
p
t
i Source: Nembhard, Alexander, Hoff, Ramanujam: "Why Does the Quality of Health Care Continue to
o Lag? Insights from Management Research" (2009),
Delos Cosgrove “The innovation imperative”, The Journal of Thoracic and Cardiovascular Surgery
n (2000), Company websites
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4 Six solutions can be used to create innovation implementation
- success
O 6
6
v
e
Measure and Reward Implementation Efforts
Measure and Reward Implementation Efforts
r
c
o Case Study Obstacle Avoided Solution
m
i
n Staff members’ Provided financial
g
disinterest in rewards for staff
B
a
implementing member groups and
r
r
healthcare innovations individuals for uptake of
i due to lack of incentives a Patient-Centered
e
r Medical Home model.
s
Admissions fell 20%
t
o
and costs were cut 7%
t
h
North Shore-Long Affiliated network Provided financial
e Island Jewish members’ disinterest in rewards, $40K over 5
A Health System implementing EMRs years to 7000 affiliated
d
o network physicians to
p
t contribute to their EMR,
i Source: Nembhard, Alexander, Hoff, Ramanujam: "Why Does the Quality of Health Care Continue to
o Lag? Insights from Management Research" (2009), receive subsidize
Delos Cosgrove “The innovation imperative”, The Journal of Thoracic and Cardiovascular Surgery
n (2000), Company websites between 50% - 85% of
The Business of Revolutionizing Healthcare • Innovation Opportunities and Challenges
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f
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4 How do you use technological innovation to increase your Patient
- Value Ratio (patient satisfaction/quality outcome)?
O
v
e
r Are you an iPhone or a
Are you an iPhone or a Are you configurable or
Are you configurable or Are you a concierge or
Are you a concierge or
c
o
BlackBerry?
BlackBerry? one-size fits all?
one-size fits all? a silo?
a silo?
m
i
n
g
iPhone provides simple, Do you force your Do you provide the
B
a easy to use, fully patients to do business patient with a point
r
r integrated products and with you on your terms, person that can solve all
i
e
solutions because the based upon your their problems?
r iPhone is a consumer structure and your
s Do you provide online
electronic device (not a workflow?
t concierges?
o phone) that has many
Do you leverage
t apps, one of which is a Do you anticipate patient
h personalized medicine?
e
phone. needs and push?
A
d
o Reconceptualize your
Reconceptualize your Allow mass
Allow mass Provide seamless
Provide seamless
p
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34. Draft
Technological progress is like an axe
in the hands of a pathological criminal
… because … everything has
changed, except the way we think.
Albert Einstein
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4 Christopher Wasden, Managing Director, Strategy & Innovation
- Practice
O Chris Wasden is a managing director and leader in our Strategy and Innovation practice. He advises
v private equity firms, venture capital, governments, and corporate clients on strategic and commercial
e risks, uncertainties and opportunities associated with their growth and innovation strategies including:
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mergers and acquisitions, divestitures, corporate venturing, entrepreneurial ventures, and new product
o and business development.
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i Chris has a rich and diverse background of experience that gives him a unique perspective when assisting
n clients on their strategic initiatives. He spent nearly a decade on Wall Street as an investment banker
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doing M&A and corporate finance work around the world for JP Morgan and Union Bank of Switzerland
B where he executed over $12 billion in transactions. He spent several years in C-level positions with multi-
a billion dollar private and public companies leading their corporate finance and strategic initiatives. Prior to
r joining PwC, he spent nearly a decade as a medical technology entrepreneur starting four separate
r companies, becoming a named inventor on 20 issued and pending patents, evaluating over 100 different
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medical technologies, raising over $50 million in angel and venture capital commitments, being named by
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(646) 471-6090 (office) Inc. Magazine as a runner up in their annual Entrepreneur of the Year competition, and taking new
christopher.wasden@us.pwc.com ventures to liquidity events.
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t He is a highly sought after public speaker and university lecturer on strategy, entrepreneurship, and
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innovation, and he has taught undergraduate and graduate courses on these topics at several universities.
t His proprietary strategy and innovation framework, referred to as Innovation Lifecycle Management,
h represent the foundation of his practice and enables organizations and leaders to transform maladaptive
e tension into creative and adaptive ones to accelerate innovation and growth. He successfully leads and
advises both small teams and large organizations to achieve strategic growth and innovation objectives
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through organic, de novo, new venture, and M&A strategies and tactics.
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p Chris holds a doctorate (EdD, abd) in organizational strategy from the George Washington University, as
t well as an MBA in finance and strategy from the Anderson School at UCLA, and a BA in Asian Studies
i and a BS in Accounting from Brigham Young University.
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