Managing Complexity in Healthcare

A Healthspottr - Santa Fe Institute Collaboration
OCT 13-15 2016

Santa Fe
New Mexico

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WHY PARTICIPATE: The case for Complex Adaptive Systems Theory in U.S. Healthcare 

Many aspects of the U.S. healthcare industry make it difficult to manage with typical prediction and modeling tools. First is the industry’s scale, now one-fifth of GDP. Also vexing: nearly half of healthcare revenues still derive from federal, state or local governments; regulations are unevenly applied to critical inputs affecting performance across the industry; most financial incentives still incent care transactions over health outcomes; and finally, the vast majority of health data, whether from clinical or consumer sources, is neither reliable nor easily accessible.

The Affordable Care Act (ACA) had three main objectives, each of which, if achieved, should have made healthcare easier to predict and model: the ACA sought to broaden access to care by expanding health insurance coverage; it sought to elevate standardization and operating efficiencies through infrastructure and process improvements, such as the mandated roll out of electronic medical records (EMRs); and it sought to improve the quality of care by linking reimbursement for services to health outcomes. Instead, healthcare today is more difficult to predict and model than ever before. Why?

There are many explanations, of course, but the simplest may be that every constituent in the industry now shoulders more risk. Payers faced with legal coverage mandates can no longer select for risk in a market. Thus, some plans are abandoning markets where they say the risks of insuring a client base cannot be managed—modeled or predicted—to a profit. Other constituents shoulder risk for one another. In the old fee-for-service model, a provider had only to manage its own silo within the system. Today hospitals, ambulatory clinics and independent practitioners operate under collective models that share risk and reimbursement. This has benefits, but it also means they must comprehend and, at least indirectly, manage components of each other’s businesses at arm’s length. Few providers are up to this task. Consumers are now burdened with far more complex decision making about plans, engagement and use of services. Worse still, they continue to see their premiums and deductibles increase at an astonishing pace – giving the impression that their access to care is now less affordable. The result: many are reducing their use of healthcare services, and this makes their behavior more difficult to model over time.

Together with our partners at Santa Fe Institute, Healthspottr is proud to present this two-day workshop, Managing Complexity in Healthcare, focused on how to apply complexity science to improve risk management and decision-making in U.S. healthcare. Join complex systems experts and your fellow health industry leaders as we collectively explore how to create a new framework and methodology for applying the most advanced prediction and modeling techniques to U.S. healthcare. Our goal is to create a new framework that can help us discern the best business models, the right risk strategies, and the most innovative products and services to deliver higher quality healthcare to more people with greater cost-efficiencies in the years ahead.

Following a primer on COMPLEXITY SCIENCE, we will ask KEY QUESTIONS:

  1. How can we use complex systems theory to develop a decision making framework for U.S. healthcare? Such a framework would help us address:
  • business model design and development
  • risk modeling
  • systems management
  • complex networks
  • emergent properties of large agent-based simulations
  1. What other industries have benefited from complex systems thinking to address similar risk management and operational challenges?
  2. What can we learn from domains where prediction has proved challenging? Examples include weather, disease pandemics, and financial markets.
  3. What is the best way to establish a collaboration network between health industry leaders and SFI to cultivating participation and financial support of this decision-making framework overtime?

Agenda

  • 5:30-7:00pm Welcome Reception keyboard_arrow_down

    Join us on the patio at the Inn and Spa at Loretto to network with your fellow participants. We will also review the detailed structure of the two-day program.

     

    Loretto

    Inn and Spa at Loretto
  • 7:00 - 9:00pm Dinner & Keynote: Geoffrey West, PhD, Distinguished Professor and Past President, Santa Fe Institute keyboard_arrow_down

    Geoffrey West, PhD, Distinguished Professor and Past President, Santa Fe Institute

    Growth, Innovation, Economies of Scale and the Accelerating Pace of Life; Developing a Science of Cities, Companies and Sustainability

    Why do all companies and people die whereas cities keep growing and the pace of life continues to accelerate? Why do we stop growing, sleep 8 hours a day and live of the order of 100 years? And how are these related to innovation, wealth creation, social networks, urbanisation and global sustainability? Global urbanisation has emerged as the source of the greatest challenge the planet has faced since humans became social. Cities are simultaneously the hubs of innovation, engines of wealth creation and centers of power, but are also the prime source of crime, pollution, disease, climate change and the consumption of energy and resources. Despite this dual role and the threat to global sustainability, there is no integrated, quantitative, predictive, scientific framework for understanding their dynamics, growth and organization. Ideas for developing such a theory, inspired by a network-based framework for understanding diverse properties of organisms (such as growth, metabolism, cancer, sleep, aging, death, and ecosystems) will be discussed and extended to companies. Despite their extraordinary complexity and diversity, many characteristics of cities and companies, including wages, patents, assets, sales, diversity, crime, police, disease, pollution, and infrastructure, scale systematically and predictably with size suggesting that universal principles that transcend history, geography and culture underlie their dynamics and structure. This has dramatic implications for growth, development and long-term sustainability: left unchecked, innovation and wealth creation that fuel socio-economic systems potentially sow the seeds for collapse.

    Inn and Spa at Loretto
  • 7:30-8:30am Breakfast & Networking
  • 8:00-8:30am Welcome from Healthspottr keyboard_arrow_down

    Review of Objectives – Tom DeLay, COO, Healthspottr

    Inn and Spa at Loretto
  • 8:30-9:00am Welcome from Santa Fe Institute: David Krakauer, PhD, "From Complication to Complexity" keyboard_arrow_down

    David Krakauer, PhD, President & William H. Miller Professor of Complex Systems, Santa Fe Institute

    From Complication to Complexity

    Inn and Spa at Loretto
  • 9:00-10:00am Presenter: William B. Rouse, PhD, "Understanding and Managing the Complexity of Healthcare" keyboard_arrow_down

    William B. Rouse, PhD, Alexander Crombie Humphreys Chair in Economics of Engineering in the School of Systems and Enterprises, Stevens Institute of Technology

    Understanding and Managing the Complexity of Healthcare

    Inn and Spa at Loretto
  • 10:00-10:15am Break
  • 10:15-11:15am Presenter: Tanmoy Bhattacharya, PhD, "The Complexity of Big Data and Infectious Disease" keyboard_arrow_down

    Tanmoy Bhattacharya, PhD, Professor, Santa Fe Institute, TSM, Los Alamos National Laboratory

    The Complexity of Big Data and Infectious Disease

    Inn and Spa at Loretto
  • 11:15-12:15pm Presenter: Ross A. Hammond, PhD, "Obesity and a Complex Systems Approach to Solutions" keyboard_arrow_down

    Ross A. Hammond, PhD, Director of the Center on Social Dynamics and Policy, Brookings Institution

    Obesity and a Complex Systems Approach to Solutions

    Hammond will describe the problem of obesity from a complex systems perspective, outlining both the particular challenges it represents and what we have learned so far about solutions. He will draw on his work as part of several NIH-funded scientific networks focused on obesity prevention.

    Inn and Spa at Loretto
  • 12:15-1:15pm Luncheon keyboard_arrow_down
    Inn and Spa at Loretto
  • 1:15-2:15pm Presenter: Joshua M. Epstein, PhD, "Agent-Based Modeling for Public Health: From Playground to Planet" keyboard_arrow_down

    Joshua M. Epstein, PhD External Professor, Santa Fe Institute, Professor of Emergency Medicine, with Joint Appointments in the Departments of Applied Mathematics and Statistics, Economics, International Health, Biostatistics, Environmental Health Sciences, and the Institute for Computational Medicine, Director of Center for Advanced Modeling in Social, Behavioral and Health Sciences, Johns Hopkins University

    Agent-Based Modeling for Public Health: From Playground to Planet

    SFI External Professor Joshua M. Epstein will demonstrate his agent-based models of environmental health threats and infectious diseases from pandemic influenza to zika, at scales ranging from the Bronx to the entire planet. Epstein has pioneered the integration of human behavior into epidemic modeling, and will introduce the audience to Agent_Zero, the next-generation software person he developed under an NIH Director’s Pioneer Award.

    Inn and Spa at Loretto
  • 2:15-3:15pm Presenter: Benjamin Althouse, PhD, "Tracking and Curbing the Next Pandemic" keyboard_arrow_down

    Benjamin Althouse, PhD, Research Scientist, Institute of Disease Modeling

    Tracking and Curbing the Next Pandemic

    Inn and Spa at Loretto
  • 3:15-3:30pm Break
  • 3:30-4:30pm Presenter: Mirta Galesic, PhD, "Communicating Complexity in Health and Medicine to the Public" keyboard_arrow_down

    Mirta Galesic, PhD, Cowan Chair in Human Social Dynamics, Santa Fe Institute

    Communicating Complexity in Health and Medicine to the Public

    How well do people understand complex systems, including aspects such as different kinds of uncertainties, nonlinearities, feedback loops, and multicausality? I will present what we currently know about these issues and describe some promising ways to communicate about complexity to people with different levels of numeracy skills.

    Inn and Spa at Loretto
  • 4:30-5:30pm Presenter: Chris Kempes, PhD, "Dynamics of Beneficial Epidemics on Networks" keyboard_arrow_down

    Chris Kempes, PhD, Omidyar Postdoctoral Fellow, Santa Fe Institute

    Dynamics of Beneficial Epidemics on Networks

    Beneficial contagions, such as viruses that enhance host survival or technological innovations that improve quality of life, also have the potential to spread epidemically. How do the dynamics of beneficial biological and social epidemics differ from those of detrimental epidemics?

    Inn and Spa at Loretto
  • 5:30-6:15pm Free Time
  • 6:15pm Shuttle Service to Four Seasons Resort keyboard_arrow_down

    We will provide private shuttle service for our group to our evening program at the Four Seasons Resort.

    6:15 pm – Shuttle departs Inn and Spa at Loretto for the Four Seasons Resort

    Inn and Spa at Loretto
  • 6:30-7:30pm Reception keyboard_arrow_down
    Four Seasons Resort Rancho Encantado
  • 7:30-9:00pm Dinner Program and Closing Discussion keyboard_arrow_down

    Interest group debates over dinner and a concluding discussion moderated by Healthspottr.

    Four Seasons Resort Rancho Encantado
  • 9:00pm Shuttle Service to Inn and Spa at Loretto keyboard_arrow_down

    We will provide private shuttle service for our group back to the Inn and Spa at Loretto.

    9:30 pm – Shuttle departs Four Seasons Resort for the Inn and Spa at Loretto

    Four Seasons Resort Rancho Encantado
  • 8:30am Late Departure Activities keyboard_arrow_down

    For attendees with later departures or enjoying an extended stay in Santa Fe, we will offer a couple of morning activities:

    Private tour of the Santa Fe Institute campus

    Short hike around the Santa Fe Institute grounds

     

    More information to follow.

    Santa Fe Institute

Fees and Lodging

  • Program Tuition
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    All general sessions, workshops, meals and evening events are included in your program tuition. Please register by Tuesday, September 13th to secure your space at the retreat. Invitations are non-transferrable. Nearer to the course date, we will be posting a list of suggested readings to better prepare for the workshop.

    •     Standard: $3,750
    •     Government, Non-profit, Start-ups and Educators: $2,500

    A credit card is required to confirm your registration, and payment must be made in full before your registration is considered complete. Should you need to cancel your registration, we kindly ask that you do so in writing to alyssa@healthspottr.com so that space can be made available to invitees on our wait list.  Please note, program tuition is non-refundable for any cancelations received after Tuesday, September 13th or within thirty (30) days of the program.

     

  • Lodging
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    The Inn and Spa at Loretto is currently SOLD OUT. We suggest a few other properties listed below. Note, rates and availability are subject to change:

    As of 9/13/16:
    Drury Plaza Hotel (1 block away) – prevailing rates = $199+/night
    La Posada (2 blocks away) – prevailing rates are $569+/night
    Hilton Santa Fe Historic Plaza (4 blocks away) – prevailing rates = $189+/night
    Inn at Vanessie‎ (5 blocks away) – prevailing rates are $250+/night

    If you already have a reservation at the Inn and Spa at Loretto and need to amend or cancel your reservation, please contact Alyssa Ragsdale, Healthspottr, at 270-804-8284 or by email at alyssa@healthspottr.com.

  • Travel
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    Travel to and from Santa Fe and hotel accommodations are at your own expense.
    Participants may book flights into Santa Fe Municipal Airport (SAF), which is approximately 20 minutes from historic downtown Santa Fe. Direct flights to Santa Fe are available from Denver, Dallas/Fort Worth, and Los Angeles. You may also consider flying into Albuquerque International Airport and driving to Santa Fe. It is a beautiful drive through rolling hills and historic mining towns via the Turquoise Trail National Scenic Byway to Santa Fe! 

    Note, we will offer round trip shuttle bus service at the following times during the program:

    Friday, October 14th:
    6:00pm – 7:00pm – From the Inn and Spa at Loretto to the Four Seasons Hotel for our Reception & Dinner
    9:00pm – 10:00pm – From the Four Seasons Hotel back to the Inn and Spa at Loretto
    exact times subject to change

  • Cancellation Policy
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    Once your registration is confirmed, we reserve a space for you at the workshop. Should you need to cancel your registration, we kindly ask that you do so in writing to alyssa@healthspottr.com so that space can be made available to invitees on our wait list.

    Please note, program tuition is non-refundable for any cancellations received after Tuesday, September 13th or within thirty (30) days of the program.

     

  • Questions
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    For more information or answers to other questions, feel free to contact:

    Alyssa Ragsdale
    Associate Producer of Events
    Healthspottr
    270-804-8284
    alyssa@healthspottr.com

    We look forward to hosting you in Santa Fe!

Discussion

  • Reading Material
  • The Challenge of Complexity in Health Care

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121189/   (From the article) Newton's “clockwork universe,” in which big problems can be broken down into smaller ones, analysed, and solved by rational deduction, has strongly influenced both the practice of medicine and the leadership of organisations. For example, images such as the heart as a pump frame medical thinking, and conventional management thinking assumes that work and organisations can be thoroughly planned, broken down into units, and optimized. But the machine metaphor lets us down badly when no part of the equation is constant, independent, or predictable. The new science of complex adaptive systems may provide new metaphors that can help us to deal with these issues better. In this series of articles we shall explore new approaches to issues in clinical practice, organisational leadership, and education. In this introductory article, we lay out some basic principles for understanding complex systems.

  • General Features of Complex Systems

    General Features of Complex Systems (From the article) In this article we introduce concepts and key insights that guide our understanding of complex systems. We explain these concepts using simple discussions of fads, panics and cliques, and how memory and creativity works. We describe the interplay of collaboration and competition, and the origin of altruism and selfishness. We discuss the role of control in human organizations and how the growing complexity of human civilization is accompanied by a shift from central to distributed control leading to a transition no less important than the industrial revolution.    

  • Health Care as a Complex Adaptive System: Implications for Design and Management

    NAE Healthcare as Complex Adaptive System

    (From the article) Not all system design and management problems can be addressed through hierarchical decomposition. For example, decomposition may result in the loss of important information about interactions among the phenomena of interest. Another fundamental problem for very complex systems like health care is that no one is “in charge,” no one has the authority or resources to design the system. Complex adaptive systems tend to have these design and management limitations.