Questions? |
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· Yes, you can use functions and what you have learned from other classes.
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What do we know? |
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Name: Pepperdine Hospital |
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Mission: “To Make Man Whole”. |
Committed to improving the health of the communities we serve through: |
Leadership and excellence in quality healthcare |
Striving to improve the health of the community |
Educating, equipping, and empowering knowledge, training, and research |
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Vision: Demonstrate leadership in providing high value healthcare |
Drive transformation and innovation in care delivery |
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Departments:
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Pulmonology, Cardiology (Heart) , Rheumatology, Digestive and Liver, Oncology, Neurology, Primary Care, Spine, Orthopedics |
Programs:
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Bariatrics, Congenital Heart Problems, Integrative Health, Pain, Preventive Heart Center |
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What are we trying to figure out? |
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Lifestyle as Medicine (LM) is known to be considered the gold standard of care. However, across the nation 20% of Hospital Systems have a LM clinic. Pepperdine Hospital is considering building a LM clinic. Dr. Sam (you) is the Medical Director. Dr. Sam has recently learned of a LM Telehealth solution. Dr. Sam shares right now the average patient who would avail of the LM clinic sees a specialist 1x/mo and has a follow up every 2 months assuming they are compliant. Dr. Sam shares 15% of these patients are compliant. 70% of these patients develop comorbid conditions, are on two or more medications, know of the value of LM but do not change within two years.
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Dr. Sam is interested in developing the LM clinic. He has developed a LM clinic on his own prior to joining Pepperdine Hospital. Pepperdine Hospital thought Dr. Sam could help us. Dr. Sam though LM was the future and he wanted to work with a Hospital to help him ‘brand’ and duplicate the clinics.
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Dr. Sam was assured that if the LM clinic is a success he will be the Medical Director overseeing the development of additional sites. There would be additional wages. He is currently on salary and signed a two-year contract at that time he has the option to continue on his own. Pepperdine Hospital suggested the intellectual property was theirs. Pepperdine Hospital offered Dr. Sam 5% ownership effective after the first year.
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If Dr. Sam leaves Pepperdine Hospital, he mentioned wanting to build a LM technology solution that he could ultimately take public.
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Pepperdine Hospital sat down with Dr. Sam and made him an offer. We have $2M to invest in this idea. We want $2M back in 5 years. We have the real estate and you can utilize some of our staff. Staff (Registered Dietitian (RD), Licensed Behavioral Clinician (PHD), MD, Front Office Staff (Operational), Back Office (Billing, Marketing, Human Resources), Nursing (RN). |
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Human Resources has shared their concern is nursing coverage. The LM clinic will be open Monday to Sunday from 7am to 10pm. There are 4 shifts. Monday, Wed, Friday require 10, Tu/Th require 8 and Sat/Sun require 12 Nurses. (Use similar constraints from Staffing ER problem) (Show me how you would work through this concern from HR.) |
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A Bit More About One Diagnosis |
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A patient was diagnosed with Type II Diabetes five years ago. Diabetes can be hard to manage. Untreated Diabetes can affect the heart, eyes, kidneys, nerves and ultimately life-threating metabolic crisis. Lifestyle Medicine can prevent and reverse Type II Diabetes. The patient’s prognosis will depend upon whether or not they sustain a healthy lifestyle. The patient could chose traditional care or Lifestyle as Medicine. Lifestyle as Medicine often begins with weekly visits for the first month sometimes 2x/wk. The ‘ideal’ LM program frequency is 2x/wk for 2mo followed by 1x/wk for the 3rd
month. 85% of the patients will complete 3months, 5% will drop out after 2 weeks, and 10% will complete 2months. Some Type II Diabetics see significant reversal in symptoms in as little as one-month vs 4 months in traditional care. Though approximately 30% will not enroll in the Lifestyle as Medicine despite knowing potential outcomes. The average cost to treat a Type II Diabetic per year in traditional care is $14K. The average cost to treat a Type II Diabetes per year in LM is $3.5K.
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Stay Tuned as I will present a Telehealth solution specific to Diabetes…. Use this for the Monte Carlo Simulation. I hope this will clarify.
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What would you recommend to the Pepperdine Hospital CEO?
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Understanding a bit more |
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Lifestyle medicine is starting to be recognized as superior treatment for conditions such as cardiovascular disease, obesity, and diabetes. People with medical conditions such as heart disease and diabetes are hospitalized six times as often as otherwise healthy individuals. Chronic disease is responsible for 70-80% of all health care expenditures yet most health professionals treat chronic disease the same way they treat communicable disease: will pills and injections. Most patients understand the reasoning for a healthy lifestyle. Still many do not sustain healthy habits.
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Interventions include: nutrition, culinary techniques, physical activity, stress management, behavioral change, group-based, addressing social-determinants of health, remote-monitoring, coordinated care, integrative team collaborations |
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A multiple linear regression approach for analyzing the effect of multiple variables on a Health Risk Score is common in LM. The assumption is the lower the Health Risk the healthier the patient. It is not uncommon to have baseline Health Risk prior to a LM program and post LM program. The outcome variable is the Health Risk Score. Some of the dependent variables are gender, marital status, number of chronic conditions, exercise frequency per week, positive for depression screening, and BMI. You created dummy variables in Case 2. We learned the average age was 67, mostly light exercise, most at least 2 chronic conditions, 20% were depressed, and 58% were married. You have Health Risk Assessment Scores. Assume those provided were pre LM program and you observed 50% reduction in Health Risk Score post LM intervention after 1 year of treatment. If you had pre and post Health Risk values how would you complete the multiple-linear regression?
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Understanding the Numbers |
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Dr. Sam has been conversing with a Telehealth platform. This platform focuses on providing Lifestyle as Medicine solutions that the patient can utilize anywhere anytime. The platform is a start-up that recently acquired their first outside venture raise. They are eager to demonstrate positive outcomes. They offer three programs, but Pepperdine Hospital has shared they would like to start with one program for the next six months.
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Dr. Sam would like to evaluate market demand numerically and provide the CEO with an estimate that aligns with his strategic plan. Dr. Sam is not concerned about demand for the service but has noticed volumes change throughout the year. Dr. Sam wants to introduce this new product because he believes he can reach a wider market but he knows he only has a two year contract, the Telehealth platform is a start-up and he needs to show first year net profits.
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Based on the Telehealth market research they have determined Slow, OK, and Hot markets. They expect to sell 30K units.
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Note: In 2018 26.8 million Americans were diagnosed with Diabetes. Estimates suggest 15 million in California have diabetes.
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Slow |
OK |
Hot |
Volume |
15000 |
30000 |
75000 |
Price |
50 |
75 |
100 |
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Product Cost |
Min |
Most Likely |
Max |
15 |
20 |
25 |
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Fixed Cost: $50K/yr |
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Note: Dr. Sam would like to see parameters, simulations, use Risk Solver, PSIINTUNIFORM etc. |
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What is Lifestyle Medicine? |
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LM is the evidence-based practice of helping individuals and families adopt and sustain healthy behaviors that affect health and quality of life. Examples include but are not limited to: eliminating tobacco use, improving diet, increasing physical activity, moderating alcohol consumption, sustaining behavioral change, reducing high blood pressure, reducing stress, interpreting tests to screen for things like cancers, reducing and sustaining weight loss, etc. |
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Lifestyle practices and health habits are among the nation’s most important health determinants. Changing unhealthy behaviors is foundational to medical care, disease prevention, and health promotion.
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Common Alignments: American Heart Association, American College of Preventive Medicine, American Diabetes Association, National Heart, Lung and Blood Institute, Harvard, Loma Linda, University of Texas, Stanford, Duke, etc.
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What Numbers We Provided? |
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What Am I To Do? |
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Task: Build a Decision Tree |
Decision Node, Uncertainty Node(s), Branching, Sensitivity Analysis etc. |
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Note: Regression and Staffing questions in the text.
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Task: Building the Lifestyle as Medicine Monte Carlo Simulation |
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Why: Forecast Profits |
How: Monte Carlo Simulation |
What: Box-Whisker & Triangle |
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