The Numbers

US Health Care System at a glance

In 2012, the US spent $3.5 trillion in health care (highest in the world)

Medicare spending in 2013 ~$500,000,000,000

• 3.6% of GDP
• ~14% of federal budget
• 10% of population accounts for 58% of Medicare spending
• Patients with chronic illness in their last two years of life account for about 32% of total Medicare spending

1% of the total population consumes 22% of medical care, 5% of the population accounted for 49%, and 50% of the population consumes only 3% of total health care expenditures

Chronic diseases such as heart disease, stroke, cancer, and diabetes account for 75% of the dollars spent on health care. That is approximately $8000 for every American with a chronic disease.

Currently, there are 140 million people in the United States with chronic conditions and that number is expected to rise to over 170 million by 2030. Over 30% of the Medicare population have a chronic condition, and 13% and 18% have two more chronic conditions, respectively.

Approximately 25% of cardiovascular deaths are avoidable

• ~60% of preventable deaths in ages < 65

The United States life expectancy of 78.4 years at birth ranks it 50th among 221 nations, and 27th out of the 34 industrialized OECD countries

Why the poor ROI? Misplaced focus?

Meta-analyses of health outcomes studies show that medical care affects long-term health outcomes by about 10%, genetics determine about 20%, and the other 70% is a combination of social factors – environment and behavior.

Social and behavioral factors contribute to more than 70% of colon cancer and stroke, more than 80% of coronary heart disease, and more than 90% of adult-onset diabetes.

On average in the OECD countries other than the US, for every dollar spent on health care, an additional two dollars was spent on social services. In the US, for every dollar spent on health care, less than 60 cents was spent on social services. Inadequate attention to and investment in services that address the broader determinants of health is leading to poor health outcomes.

Role of technology:

1. Scale social services & provider capacity (i.e. remote monitoring)

2. Integrated, connected, and non redundant access throughout the care continuum

3. Patient education, engagement, and empowerment

4. Provider decision support

5. Translate genomic data into discernible & actionable patterns

6. Facilitate movement of research from the bench –> academic medical centers –> community