This is the executive summary of the Initial Prize Design which was released for public comment on April 14, 2009. These draft provides an overview of what the Healthcare X PRIZE is, some of the detail of the competition, and how you can get involved in to help create a Prize that moves us toward a new health paradigm focused on individual vitality and increasing the health care value in communities.
2. Introduction to effort
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Initial prize design—for public comment: www.xprize.org/wellpoint
3. INTRODUCTION TO X PRIZE APPROACH
• Vision: “Bring about radical breakthroughs for the benefit of humanity through the power of
incentivised competitions to stimulate innovation”
• Mission: We design and conduct X PRIZE competitions to address the grand challenges of our times.
• Attributes: Highly leveraged investments, efficient by only paying the winner, and sparks a new industry
as a by product of the competition
- Target market failures; Define the problem, let teams compete to create the solution
g ; p , p
- Clear, objective & simple rules in a hard but attainable grand challenge (3‐8 year horizon)
- Assure that a “back end business” is viable and an industry can be created
- Global competition that yields a telegenic finish
Global competition that yields a telegenic finish
• Example: Ansari X PRIZE
- $2.5M startup, $10M prize purse, $100M invested, and $1B industry created
- 26 teams, 7 nations, and global interest generating 5B media impressions
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Initial prize design—for public comment: www.xprize.org/wellpoint
4. INTERVIEWS WITH EXPERTS HIGHLIGHTED IMPLICATIONS FOR A HEALTH PRIZE
Problem Statement:
Problem Statement: Expected Breakthroughs:
Expected Breakthroughs:
• Financial incentives not aligned with doing • Payment needs to re‐align to desired
the right things outcome
• We don't know holistically what works • Outcome tracking needs to occur holistically
relative • Solutions need to be holistic and steer
to other things consumers to best performers
• Fragmented system with substandard
Fragmented system with substandard • Focus on engagement / behavior
/
distribution of best practice modification
• Need to move to quot;healthquot; system vs. sick • Need to focus both on public health and a
system more efficient system
• We have a very short term focus in terms of • Consumer need choices that are engaging
addressing future needs (pull)
• Consumer not engaged in care even if they • Providers accountable for autonomous
want to be
want to be approaches via transparency of outcome
approaches via transparency of outcome
• Best providers not rewarded for better
performance
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Initial prize design—for public comment: www.xprize.org/wellpoint
5. WHERE WE ARE IN THE EFFORT
Healthcare Prize Development Timeline
Healthcare Prize Development Timeline
Ideation Phase Design Phase Planning Phase
Nov 08 Dec Jan 09 Feb Mar Apr May Jun Jul Aug Sep
Initial Design Announcement
April 14th
Next steps in the design phase:
1. Announcement of initial prize design to engage interested parties and gain access to more
experts/ ideas
2. Public comment utilized to test and refine goals and initial design
3. Experts engaged for deep dives in areas critical to prize development effort
4. Validated prize design moves into planning phase
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Initial prize design—for public comment: www.xprize.org/wellpoint
6. The Initial Prize Design
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Initial prize design—for public comment: www.xprize.org/wellpoint
7. HEALTHCARE X PRIZE DEVELOPMENT OBJECTIVES
We seek to improve the value of the current health system by:
W kt i th l f th t h lth t b
• Rewarding entities who optimize health value
• Reinvesting resources to enhance individual vitality by encouraging activation and
Reinvesting resources to enhance individual vitality by encouraging activation and
personal responsibility for health
• By increasing the vitality of individuals, we seek to advance the health of community
overall
ll
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Initial prize design—for public comment: www.xprize.org/wellpoint
8. GOAL OF HEALTHCARE X PRIZE:
To create an optimal health paradigm that
To create an optimal health paradigm that
empowers and engages individuals and
communities in a way that will dramatically
improve health value
improve health value
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Initial prize design—for public comment: www.xprize.org/wellpoint
9. PROPOSED COMPETITION:
Goal: Community health
50 %↑ in
Total cost
Draft Guidelines:
• Health value = Improvements in Community Health Index and Total Cost
• Teams create mechanisms to engage, coordinate, advise, evaluate, and influence individuals and
relevant care providers in their assigned test community in ways that generate health value
• Each finalist competes in a pre‐selected community/ employer test community of ~10K individuals;
results compared against an equivalent control group in a similar/adjacent community
results compared against an equivalent control group in a similar/adjacent community
• Aggregate results over 3 year contest determine winner. 50% threshold required to win purse.
Competition and results audited by independent panel of judges
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Initial prize design—for public comment: www.xprize.org/wellpoint
10. DIFFERENCE FROM OTHER EFFORTS:
1. Focus on health outcomes and value at community level:
1 Focus on health outcomes and value at community level:
Community Health Index tracks outcomes across a community; Total Cost tracks expenditure
across all parties
2. Consumer Engagement:
2 Consumer Engagement:
Consumer engagement required to generate results
3. Payment Incentives:
Teams may create payment innovations to improve incentives for consumers, providers,
vendors to demonstrate desirable behaviors/ outcomes
4. Comprehensive and Proactive Outlook:
p
Teams responsible for health across all care settings and multi‐year time horizon. Increased
focus and investment in proactive, longer‐term health improvement programs
5. Local partnerships:
Teams must develop relationships with at least some local health care providers and/ or
community organizations
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Initial prize design—for public comment: www.xprize.org/wellpoint
11. IMPACT POTENTIAL
Successful implementation of the Healthcare X PRIZE could create within 10 yrs:
1. A new model and system of health that demonstrates a >50% improvement in healthcare value
(
(HCV).
)
2. A measurable and globally accepted population health metric, tentatively called the “Community
Health Index” (CHI), which becomes a benchmark for measuring future improvements in health at a
pp
population level
3. An individual health metric, tentatively called the “Individual Vitality Score”, which can helps
individuals (and providers helping them) understand and benchmark their current health status and
potential for improvement
4. A personalized “Vitality Dashboard” where consumers will be able to understand current health
status, “portfolio” of improvement options, projected return from health improvement efforts
5. A new Optimal Health paradigm that helps consumers optimize their health and rewards providers
5 A new Optimal Health paradigm that helps consumers optimize their health and rewards providers
that can demonstrably create improved health value
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Initial prize design—for public comment: www.xprize.org/wellpoint
12. WE LOOK FORWARD TO YOUR INPUT AND PARTICIPATION
Visit our website: www.xprize.org/wellpoint
Add your comments to the proposed approach/ guidelines
•
Add yourself to the mailing list for updates
•
Follow the conversation on our blog, twitter, facebook, etc.
•
Let us know if you d be interested in creating a team as the effort moves forward
Let us know if you’d be interested in creating a team as the effort moves forward
•
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Initial prize design—for public comment: www.xprize.org/wellpoint
13. Details in development
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Initial prize design—for public comment: www.xprize.org/wellpoint
14. PHILOSOPHY FOR MEASUREMENT
Measures will contain desired outcomes only (no intermediate or process metrics)
•
Status improvements we want to happen
–
Clinical events that we want to remove from the human experience
–
Where possible, measures tracked will be objective and come from established collection tools
•
Measures will be at the community/population level
•
Measures will be actionable. There are case examples available that suggest teams can influence outcomes
•
in a significant way
Costs will be captured across as many payment alternatives as possible and reflect the payment owed at
•
time services rendered
“Test‐group” communities will be actuarially equivalent across demographics, socio‐economics, and health
•
status. We will divide similar or adjacent communities into 2 equivalent groups, with the team selecting
status We will divide similar or adjacent communities into 2 equivalent groups with the team selecting
control vs risk groups
Data will not be projected. Specific sub‐populations may be oversampled to make absolute results
•
comparable
Weighting will place functional improvement at equal stature with sick care
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Initial prize design—for public comment: www.xprize.org/wellpoint
15. COMMUNITY HEALTH INDEX ‐ DEFINITION
Draft category
Draft category Draft metric
Draft metric
• Hospitalization/ Rehospitalization • Days hospitalized
• ER visits • Number ER visits
Eliminate acute
• Communicable disease • CDC surveillance report of prevalence
exacerbation
• Major morbidity • Incidence
Prevent • Disability (Long Term) • Prevalence of LT Disability
long term • Long term care • Prevalence LTC usage
impairment
p • Mortality • Incidence by age
Incidence by age
• Sick days • Total days unplanned absence (school, work)
Reduce • Disability (Short Term) • Total days ST Disability
short term
impairment
p
• Functional Fitness • TBD
Optimize • Self Reported • SF‐12
Individual
Vitality
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Initial prize design—for public comment: www.xprize.org/wellpoint
16. TOTAL COST – DEFINITION
•$ h
$ through existing claim system, or otherwise processed by claims
h l h db l
Direct
• $ assigned to medical care (HSA codes) going through debit card
• $ submitted for reimbursement on other OOP spend
• $ spent on communication / coordination with individuals
• $ spent on consumer or provider activation (e.g., lottery, rewards, incentives)
• Sick and disability pay added to total cost
• Not counted in cost, many improvements included in vitality index
, yp y
Indirect
No • Costs are all direct and accounted for
pj
projections
Phase in /out • Team gets operating budget for first 6 months “dry run” which doesn't count
against total cost
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Initial prize design—for public comment: www.xprize.org/wellpoint
17. INDIVIDUAL VITALITY SCORE– DEFINITION
• Scoring system to help consumer summarize current health status
• Approach developed by each team to best engage consumers; team
pp p y gg ;
innovation
• Individual vitality score used to engage individuals in their health and health
actions
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Initial prize design—for public comment: www.xprize.org/wellpoint
18. WHAT IS THE PHILOSOPHY BEHIND THE PRIZE DESIGN GUIDELINES?
• Tracking of Community Health Index and Total Cost audited by trusted third party
• Open sharing of results and implementation experiences by sponsor
Transparent
• Regular and detailed public updates on team progress
and Objective
j
• Independent judges oversee team down‐selection to finalists
d d d d l fl
• Teams may enter from anywhere as long as able to compete in test beds
• All funding sources are ok for development of team platform
g p p
Open contest;
Open contest;
global idea • “Salary cap” on operating expenses to ensure equal playing field between finalists in test beds
recruitment • Limited use of existing, controlled facilities within a test bed to maximize potential entrants
• Broad population health spectrum to maximize relevant approaches, and limit non‐systemic
solutions
Demonstrable
• High target: need to generate radical change
impact w/in
• Large enough / long enough to demonstrate real sustainable value
Large enough / long enough to demonstrate real sustainable value
3 year window
3 year window
• Teams need to prove consumer and/or provider engagement
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Initial prize design—for public comment: www.xprize.org/wellpoint
19. WHAT ARE THE PHASES OF THE COMPETITION?
Entry Concept Pilot Finalist
• Registration document • Intervention model • Demonstration • Intervention model and
Requirements
– Concept
p – Targets
g successful pilot of key
p y p
pilot exceed targets
g
•
– People – Interventions assumptions (50‐100 pts Team in place
• Beta product / interface
– Resources / Assets – Engagement network test)
•
– $10k – Modeled impact Alpha product
• Execution strategy / • Business plan, modeled
high‐level plan financials
• Concept sketch
• Concept that’s • Model showing target • Pilots exceeding • Matching / selection into
Proof
reasonable impact requirements test‐beds
• Likely mergers between • Testable key • •
Evidence of consumer Actual progress in test‐
complementary assumptions and provider beds (live competition,
concepts engagement reported monthly,
detailed quarterly
reports)
t)
• Fall 2009 • Summer 2010 • Spring 2011 • Early 2015
Timing
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Initial prize design—for public comment: www.xprize.org/wellpoint
20. WHAT CAPABILITIES MIGHT TEAMS DEPLOY?
• Financing/ Payment: • Incentives that promote optimal outcomes/ desired behavior/ allocation to optimal treatments
g/ y p p / / p
• Behavior modification: • Programs that successfully change behavior
• Outcomes/ Comparative • Population‐level record of outcomes vs. treatment and understanding which approaches deliver better outcomes
Effectiveness:
• Personalized decision • Decision support helping consumers compare different treatments and select best for them (outcomes, risk, $)
support:
• Measurement/ tracking/ • Database/ records captured over time, allowing for feedback loops and suggestions/ reminders
feedback:
• Coordination of care: • Programs that create oversight/ handoffs that ensure a holistic view of consumer across providers
• E‐Health: • Communication tools allowing for an extended interaction/ conversation (e.g., email, chat, video, home monitoring)
• Information and programs that create leverage of provider expertise (e g teleconsult physician extender home monitor)
Information and programs that create leverage of provider expertise (e.g., teleconsult, physician extender, home monitor)
• Convenience: • Removing the barriers to seeing a provider (e.g., convenient location, extended schedule, home visit)
• Care Experience: • Changes to the type of care offered (e.g., 60 minute visit, prescription for exercise, reduced use of referrals/ tests)
• Others???
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Initial prize design—for public comment: www.xprize.org/wellpoint
21. WHICH POPULATIONS WILL BE INCLUDED?
Recommended
Comment
• Ethical considerations
Ethical considerations
End of life
End of life
• Coordination and best practices through acute illness will prevent error. Use of
Acutely ill home health / remote monitoring likely to reduce “fragmentation”.
Chronically
• Coordination puts “care” back in healthcare and saves lives
ill
Disease Severity
• Behavioral / lifestyle foundational to avoiding preventable illness (e.g., smoking,
At‐risk /
obesity, fitness, etc.) but poorly executed today
y, , ) p y y
lifestyle
lif t l • No scaled, proven solutions today
Early health
• Similar goals to at‐risk, but costs likely to be additive in short‐term
risks
• All costs additive
No risks
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Initial prize design—for public comment: www.xprize.org/wellpoint
