Insights Series Issue 6: "Standardization and personalization: Lessons from other industries"

In this paper, Professor Michael T. Modic gives practical recommendations that can help healthcare organizations lead the way to greater standardization and more effective personalization.

Siemens Healthineers Insights series Issue 6 Standardization and personalization: lessons from other industries A paper on effectively managing variations in healthcare with Prof. Michael T. Modic, Vanderbilt University Medical Center SIEMENS Healthineers About Siemens Healthineers Insights series Today, every health system struggles with rising costs and varying quality. Diagnoses and treatments are designed for typical patients. Delivery of care is fragmented and focused on volume. The patient experience journey is in its infancy. And healthcare doesn’t leverage the full potential of data. How can we change that? At Siemens Healthineers, our insights make it possible to turn challenges into opportunities. Our purpose is to enable healthcare providers to increase value by expanding precision medicine, transforming care delivery, improving patient experience, and digitalizing healthcare. As your partner for better outcomes in healthcare, we strive to provide a forum for addressing these issues, and to offer insights and new approaches. By joining the conversation with industry thought leaders and change makers, we are sharing forward-thinking ideas and solutions. We are also establishing a platform for leaders in healthcare to connect and exchange with peers. The Insights series offers actionable insights on how to tackle challenges and create solutions that work. Be inspired by best practices and engage with experts at the interface of technology and care. Please visit Paper Standardization and personalization: lessons from other industries Executive summary Manufacturing offers lessons on how to lower costs and reduce unwarranted variations by focusing more strongly Today, healthcare providers and on standardization, which is highly effective in improving their executives worldwide are under quality, safety and efficiency. Retail, with its emphasis on increasing pressure to generate higher segmentation and customer service, can help healthcare value and reduce costs. In order to executives to understand patients in a more multidimen- sional and individualized way, making it easier to focus successfully pursue these two goals, on meaningful variations. Banking, transportation and this paper identifies lessons from hospitality have been transformed in recent years through other industries on how to effectively digitalization and interoperability, resulting in lower costs manage variations in healthcare: and an improved customer experience. reducing unwarranted variations and Historically, the fields of medicine and healthcare have enhancing warranted, or necessary, been somewhat insular, often thinking of themselves as variations. By assessing numerous unique. In today’s competitive, consumer-driven, global- industries, including manufacturing, ized marketplace, we believe this attitude must change. Other industries have important insights to offer – and we retail, banking, transportation and can learn to accelerate the delivery of higher-value care. hospitality, we suggest best practices This can significantly help to expand precision medicine – on how to deliver and bring together removing waste while at the same time helping to custom- standardization and personalization. ize and personalize healthcare. Siemens Healthcare GmbH, 2019 3 We believe these three approaches – standardization, personalization, and the better use of digital data – can be more effectively deployed throughout the healthcare system. The challenge by practitioners, and by healthcare policy-makers, and can contribute to significant benefits for patients as well The need to reduce unwarranted variation as providers.The business and care models for managing is a fundamental challenge facing health- lives over an open-ended time is distinct from the specialty care systems and providers worldwide. care model which is most often aligned with the moment or episode. Take the case of primary care. Today’s primary care model in the U.S. is based on volume and Relative Variations in care delivery – variations not justified by Value Units (RVU: Medicare reimbursement formula). This specific patient conditions – are undesirable for several model is not sustainable. Managing lives is becoming reasons: they drive up costs, they result in an inefficient more important than just seeing patients. Expectations to allocation of healthcare resources, they fail to improve provide meaningful preventive care, management of acute outcomes, and they frustrate patients. These can also be and chronic conditions, closure of care gaps that vary by called “bad” variations. Differences in how care is delivered payer, educational, care coordination and payment/care among similar patients with the same disease in different navigation needs overwhelm the traditional capabilities of locations, or in different departments or by different clini- small and large primary care practices. cians, serves as an illustrative example. On the other hand, not all variations are bad. There are also “good” variations. Specialty care, on the other hand, continues to focus on For example, those that take into account a specific patient the episode and in most volume-driven models continues and his or her condition. These types of variations permit to be the major component of the revenue stream. This can individualized care, which enhances patient comfort result in conflicts. In the eyes of one executive, it’s relevant and improves outcomes. The challenge is distinguishing to highlight that even in the current volume-driven model, between these two categories of variations and applying in most elective and episodic procedures, for example this knowledge. Two techniques or practices that can pro- hip replacement, understanding the variations in critical vide assistance in identifying and distinguishing warranted steps during this procedure does deliver higher value variations (“good” variations) from unwarranted variations by driving down costs and improving accuracy. Change (“bad”) are standardization and individualization. to value will not happen at once and thus it is critical to preserve the success of the existing model while gaining Effective decision-making can also be greatly enhanced market relevance by adopting a new one. Fortunately, the by digitalization. Much of the digital data that currently blocking and tackling approach of combining lessons from exists within the healthcare system is currently not being manufacturing, retail and other industries supports both leveraged as well as it could be. Much of this data is the old and the new. not connected, making it inaccessible to those who can benefit from it. Consequently, the data we already have often fails to deliver actionable results. We believe these three approaches – standardization, individualization, and the better use of digital data – can be more effectively deployed throughout the healthcare system, by hospitals, 4 Siemens Healthcare GmbH, 2019 The solution As healthcare leaders look at the task ahead of them, we propose that they look beyond the parameters of the Solving these problems in hospitals and healthcare sector to other industries, where important other healthcare organizations requires advances have been made: leadership from the top. CEOs must lead • Manufacturers know how to reduce unwarranted this effort and be willing to take the variation, improve quality, enhance efficiency, and necessary steps to revamp their operations, keep unit costs low. especially in terms of evolving business • Retailers know how to add warranted variation models. through market segmentation and personalized customer goods and services. • The changes that have taken place in industries such as banking, transportation and hospitality provide insight on how to manage and use data more Learning from other effectively and can make it easier to identify both industries: warranted and unwarranted variations. Manufacturing Retail industry industry Digitalization enabled industries Siemens Healthcare GmbH, 2019 5 1. Lessons from manufacturing: a hospital to home or to a nursing facility are well known standardization and best practices have been identified and established. The challenge is to consistently follow the procedures The success of the world’s leading manufacturers rests in place. This has proven to be challenging. In order for in large part on their ability to provide consumers with a standardization to be effective in a healthcare environ- consistent level of quality at a reasonable cost. Whether it’s ment, it is essential that evidence-based guidelines are one of the 200 million iPhones purchased annually, or one developed, accepted and implemented. Only then can the of the 4 billion cups of coffee sold by Starbucks every year, highest quality outcomes and the most effective forms of the customers who purchase these items do so with con- standardization be achieved. fidence that they know what they are buying. Maintaining this customer confidence – and doing so at a reasonable Local conditions at each healthcare provider setting need cost – requires an extremely high level of standardization. to be considered, together with an individual organization’s Processes, materials, and quality control protocols must be culture of self-improvement. The move to global standard- consistent, wherever in the world the products are being ization in healthcare would not be an incremental change offered. This standardization, this drive for consistency, can but would be highly disruptive. It must, therefore, be man- be classified as the elimination of unwarranted variation. aged effectively and sensitively. Once in place, a focus on standardization will benefit from continual incremental The working environment of leading global manufactur- improvement. That is something that the most successful ers offers a valuable insight into how this is achieved. manufacturing industries value to a high degree. Evidence- The factory floors of these organizations are organized, based guidelines can only be executed consistently if they efficient and calm. The routines and processes they are customized, agreed to and adapted by the leaders and have in place have been designed to do the same things their teams in an organization. This approach isn’t just the right way, day in and day out. Workers understand good for patients, who benefit from improved care, but their roles, processes have been refined and optimized, also for the bottom line of healthcare providers. A second equipment and machines operate at peak efficiency. To area where leading global manufacturers have been very replicate this in healthcare delivery would require greater successful is in their ability to ensure the reliability of their standardization in three broad categories – disease-based, products and of their operations, including a strong focus procedures and processes. Disease-based standardization on quality and safety. In the medical field, one speaks would include changes in the way patients with acute of “never events” – things that should never happen but or chronic conditions such as acute stroke or COPD are sometimes do, for example wrong level spinal surgery. cared for. Standardization has already contributed to When asked about this, one industrial manager responded, significant improvements in procedures such as total joint “What is it that you don’t get about never events?” In his replacement. In the context of processes, standardization view, never events should never happen. Manufacturers can help to ensure that best practices are followed, and implement norms and procedures to make sure they don’t that compliance, variations and outcomes are measured happen, ever. In healthcare, we treat these occurrences as in order to contribute to a continuous improvement cycle. inevitable, instead of taking the necessary steps to ensure The actual steps of a patient’s transition from, for example, they never happen. 6 Siemens Healthcare GmbH, 2019 200 million iPhones purchased and 4 billion cups of coffee sold by Starbucks every year demands rigorous standardization. Learning for overcoming challenges: life into it. Such guidelines and processes do not need If one accepts the value and benefits of greater standard- to be reinvented, but efforts must be made to ensure ization in healthcare, the question can be asked, “If guide- that measures are adopted and adapted locally to ensure lines already exist, why can’t they just be implemented?” acceptance and effective use. Posing this question in this way overlooks a number of essential challenges – challenges related to human nature, • Reforming healthcare organizations: an end to the organizational behavior, and to the differences that exist “medieval guild system”: Embracing a more multidis- among patients and within healthcare organizations. ciplinary approach can run counter to the traditional operating principles that still exist in many healthcare • Every patient is different: The goal of Apple is to ensure organizations, which can be likened to the “medieval guild that every iPhone that rolls off their assembly lines is iden- system”. This is evident when issues cross profit and loss tical. With patients who leave a hospital or clinic, the goal structures in traditional accounting systems, for example. is not that simple. Even when standards are in place for CEOs need to work with their teams across pedigrees to one or more conditions, healthcare providers must be sure open space for this cultural shift. For example, instead of which one is the right one to use for each specific patient. handing a patient back and forth between departments, a In that sense, reliance on the accuracy of the patient seamless team should deal with someone suffering from diagnosis is essential. As in manufacturing, the quality of a condition that crosses disciplines. Another related barrier the input is important. In healthcare, this can be reached to greater standardization throughout the healthcare by reducing diagnosis variations with technology adapted system are the established professional habits of medical to the patient, reducing operator bias, and providing access practitioners. Many caregivers are used to doing things in to relevant patient data. This permits the reduction of a certain way, the way they have always done them, and variations across the continuum of care. not all practitioners followed guidelines consistently. This is a result of their training and of the professional environ- • Getting buy-in throughout an organization/ stake- ment and culture in which they work. Overcoming this can holder engagement: Implementing greater stan- be a significant challenge. dardization throughout an organization can result in a corresponding decline in the decision-making power of some employees. This can be perceived by some as a loss of authority or freedom. In order to be successful, any standardization approach cannot be treated as a one-size- fits-all off the shelf solution. Instead, it must engage all stakeholders. This demands a multidisciplinary approach to create a sense of ownership. New guidelines must be workflow friendly and adaptable to the environment in which they are actualized. Teams must be ready to work together on end-to-end care and hand-offs. If practitioners create the system themselves, they are more likely to put Siemens Healthcare GmbH, 2019 7 Cleveland Clinic reduced total cost of care for stroke patients by 20% with increased standardization over different venues. • Greater discipline and oversight: Successful implemen- consistent and effective. This resulted in better outcomes tation of standardization measures also requires a higher with reduced costs through more consistent adherence to level of internal discipline and transparency. Procedures evidence-based standards. The number of invasive proce- and measurements for documentation, care, and outcomes dures dropped, fewer people went through intravascular must be more clearly defined. Health Status Measures thrombolysis, and the number of related complications fell (HSM) and Patent Reported Outcome Measures (PROM) substantially. Additionally, the total cost of care decreased are important tools for measuring validated outcomes by 20%. This wasn’t a result of a new discovery. It was the to assess the efficacy of treatment and process. These result of doing what should have been done in a more should be constant over time, venue, and provider. Patient consistent way with a stronger focus on measuring compli- and provider outcomes need to be validated, accurately ance and variability. The Mayo Clinic saw similar results. reported and, ideally, embedded in the patient’s electronic More effective application of its existing stroke pathways medical record (EMR) whenever possible. The patient expe- resulted in a net cost reduction of nearly 10%, with no rience needs to be analyzed, measured, and factored into adverse impact on outcomes. the evaluation, and we can see PROMs increasingly being adopted in the clinical practice in various centers around Looking at specific procedures, hip and knee replacement the world. Accurate costing also needs to be factored into has been the poster child and national programs such as the process at each stage. All of this will help physicians BPCI have shown significant impact. Baseline evaluation to develop new defined processes and tools that can help has determined significant variability in care around ensure continuous improvement. length of stay in the hospital, type of implant and use of post-acute care. Using best practices and evidence-based • Implementation: As in manufacturing, the implementa- standards, multidisciplinary groups developed standard- tion of standards requires specific design and organiza- ized approaches that focus on these known variations and tional changes. Measuring the impact of these changes agreed to follow them. The results have been significant through appropriate KPIs is relevant in the manufacturing cost reductions while maintaining or improving outcomes world, both to monitor the effectiveness and for engaging (total hip arthroplasty pathway has reported a decrease in the teams in how their effort is influencing critical results. LOS, increase in discharges to home, and cost savings of Standardization of care is not new and there is ample $2,533 per patient).¹ evidence that it works, for example with acute diseases such as stroke. Accepted guidelines already exist and the accreditation efforts of stroke centers have improved care. Yet even in this situation, where everyone should know what to do, significant variation can and does still occur. At the Cleveland Clinic system, embedding the stroke care path in the EMR across different care settings 1 Implementation of a Total Hip Arthroplasty Care Pathway at a (for example outpatient sites, emergency rooms, hospital High-Volume Health System: Effect on Length of Stay, Discharge floors and ICUs) increased standardization over different Disposition, and 90-Day Complications. Featherall J et all. J Arthroplasty. 2018 Jun;33(6). [Online] URL , [Accessed: 21. August 2019]. 8 Siemens Healthcare GmbH, 2019 Personalization takes a full multi- dimensional view of patients Medical Patient’s clinical record and dispostitions Cognitive and behavioral Patient’s ability to understand the sitution and act accordingliy Social Patient’s social network of help and support 5 Functional Patient’s ability to move and carry out procedures independently 2. Lessons from retail: is not utilized effectively. If we look at healthcare, patients’ personalization medical records can be an important source of relevant data, helping practitioners to tailor their care. Patient The manufacturing sector, as we have seen, owes much of Reported Outcome Measures (PROMs) are questionnaires its success to standardization. Successful manufacturers designed to characterize health status by asking patients have been able to significantly reduce, or even eliminate, to self-report their symptoms or conditions. Other social, unwarranted variations resulting in greater efficiency, functional and behavioral characteristics of patients can higher quality control, lower costs and greater customer also be helpful in ensuring that treatment options are satisfaction. optimized, for example a patient’s level of health literacy, whether they live with a partner or on their own, their The retail industry offers a different lesson: successful cognitive status, or transportation barriers they face. retailers have moved in the opposite direction. What they People’s attitudes towards the healthcare industry can have mastered is personalization. Customization. Precise also be factored in. Can they be classified as convenience individualization of products and services. This approach seekers? Frequent fliers? Experience-driven deciders? also offers valuable ideas for healthcare providers and Knowing this about them can be extremely helpful in practitioners. Simply reducing costs and introducing personalizing their healthcare experience as well as in greater standardization is not always an effective or building customer loyalty. appropriate approach in a healthcare setting. Two of the criticisms that are leveled against embracing a wholesale Looking at the totality of this data suggests that the com- manufacturing best practice standardization mindset are: mon term population health is somewhat misleading. 1) patients are not widgets in a factory, and 2) within There is no one homogenous, uniform population. Instead, the practice of medicine there is an element of ‘art’ that there are multiple populations. It would, therefore, be must be acknowledged. Both points are valid to a degree. more accurate to speak of populations’ health. Reducing unwarranted variability is essential. But it is equally important that the right kind of variability is added back into the equation. The retail sector uses market segmentation of populations to better understand their unique needs and preferences, for example in product design. The fashion retailer Zara offers multiple variations of clothing, styles, and fabric patterns. Starbucks offers their customers an almost bewildering range of options to customize their coffee. This type of segmentation adds value and can be classified as warranted variation. Retailers understand the importance of customer variables. In the healthcare industry, however, these data points have, in the past, not been effectively factored into individual or population care. Extensive patient data does exist – but it Siemens Healthcare GmbH, 2019 9 Digitalization must be understood as an enabler for the bigger and more fundamental goals of the organization, not as an end in itself. 3. Lessons from banking, transportation and about their own travel priorities and preferences. Those hospitality: digitalization hotels that clung to the old way of doing things – waiting for guests to arrive at the reception desk or for a travel Over the course of the past two decades we have agent to call – were at risk of being left behind. Forward- witnessed massive disruption to numerous established looking hotels, however, adapted to this disruptive industries including banking, retail and logistics, travel development. These hotels responded by improving their planning, personal transportation, and hospitality. Banking own online services and by competing directly with the has been transformed by online financial services; retail various travel booking websites, for example by offering and its logistics have been upended by Amazon; travel their own “Best Price Guarantee”. They gained a deeper planning has been fundamentally altered by services like understanding of what customers were looking for and Expedia; personal transportation has been revolutionized made corresponding improvements. In order to accommo- by Uber and others; and the hospitality industry has been date guests’ range of desires they began to offer a broader re-defined by companies such as Airbnb. What these range of room categories, and offered more customizable transformations all have in common is their technologi- options that guests could choose from to personalize cal foundation: digitalization. Consumers have clearly their visit (breakfast variations, extra beds, choice of room made their decision – they have come to demand the location, even choice of pillow types, etc.) In this way, convenience, choice and flexibility digital services offer. the disruption of digitalization was turned into a force for Within organizations, digitalization and the use of data positive changes. have also led to transformative changes and significant improvements in efficiency and quality. But the healthcare Digitalization is a tool, not an end in itself sector is only now beginning to fully embrace the possibili- The second lesson healthcare providers can learn from ties of digitalization. Several lessons can be taken from observing the impact of digitalization on these other indus- a review of the changes that have taken place in these tries is that an organization’s digital strategy must be part industries – lessons that offer actionable insights for the of their overall corporate strategy. Digitalization must be healthcare sector. seen as a tool, as an enabler, for the bigger and more fun- damental goals of the organization not as an end in itself. Digital disruption is inevitable Amazon, for example, stated very early that their goal was First: digital transformation will be disruptive. There is no not to be an “online company” or an “internet business”. way around this fundamental truth. As in each of these Their goal was much bigger: they set out to transform the industries, established ways of doing things will change, entire retail experience: everything from the way shop- and many traditional processes will have to be abandoned. pers compare products, to how items are delivered, to The travel and hospitality industries, as an example, were how they are customized, to support and follow-up were initially unprepared for the radical changes brought about re-evaluated and re-designed. The role of digitalization and by Expedia and Airbnb. Customers were suddenly no big data in healthcare must be treated similarly. As Amazon longer in direct contact with hotels or travel agents but did with retail shopping, the entire healthcare “customer were, instead, looking at multiple options online, compar- experience” must be transformed. ing prices, evaluating features, and thinking more carefully 10 Siemens Healthcare GmbH, 2019 Throughout the care path continuum • Structured documentation • Health status measures • Process / alerts • Cost • Patient satisfaction + Hyperacute Hospital course Discharge planning Post acute Outpatient Digital transformation must be interoperability and sharing of data would not necessarily company-wide effort compromise this. As we can see in the financial sector, The third important point to be learned from each of these standardized information and common platforms (for industries is that a successful digital strategy must encom- example those supporting ATMs) have not undermined the pass all aspects of an organization; it cannot be treated as ability of banks to compete and to use their own brands “a job for the IT department” while all other departments to attract customers and build loyalty. A healthcare model simply carry on as before. In this effort, effective leadership could operate on similar principles. particularly at the executive level is essential. The scale of the transformation must be understood on two levels: Unlike the world of retail, healthcare works with much internally, and externally, in interaction with customers more sensitive data and in a much more rigid regulatory (patients). In healthcare, digitalization would ideally be environment. Nonetheless, the essential concept of using supported by comprehensive, end-to-end, optimized data about specific patients as well as aggregated data and standardized digital platforms where data can easily about entire populations to enhance a patient’s experience be shared and assessed. Here, the lesson of Amazon is and improve outcomes is an essential step. If existing instructive. Amazon uses its rich trove of data on custom- healthcare organizations and providers do not take this ers’ buying and browsing habits to personalize and improve step, others are already developing their own concepts to their specific shopping experience. Similar possibilities move into the healthcare realm. Google, for example, is exist in healthcare. developing processes to use AI to help with disease detec- tion, manage data infrastructure, and potentially become One example of relatively low-hanging fruit: embedding active in health insurance. Like Amazon, Google does not patients’ care paths within their medical records. If a see itself in a small, restricting box; it regards itself as much patient’s medical history were no longer compartmental- more than a search and advertising company. ized by location of service or system it would be much easier to effectively measure compliance, offer real-time clinical decision support, and to track outcomes across time, venue and provider. This in turn would further drive rapid-cycle improvement and innovation. One way to proceed with this would be to select archives that are open and platform-neutral. Systems could talk to each other, much as ATMs are networked allowing customers to use any terminal at almost any branch to access their own account. Ideally, a patient’s medical history would be similarly accessible to those who need access. This would also enhance measurement of compliance, real time clinical decision support and the ability to track out- comes. Hospitals and clinics gravitate to see themselves as unique and differentiated. The move toward greater Siemens Healthcare GmbH, 2019 11 Conclusion Challenges like these are not unique to the healthcare sector. Other industries have faced similar threats and The global healthcare sector stands at transformations, with some businesses identifying new an important crossroads. Patients are opportunities and capitalizing on them while others were increasingly approaching their medical care caught off-guard and stumbled. We believe it is essential as “empowered consumers”, seeking good for the healthcare sector to understand and respond to these challenges. And we are of the view that developing value as well as treatment and services effective strategies to remain successful and competitive that correspond to their personal needs and demands that healthcare organizations approach their preferences. This has added a new element work in a more strategic, pragmatic and result-oriented of competition throughout the industry. way. One essential building block of these efforts must be an effort to manage variations more effectively: to Cost pressures and the ongoing struggle distinguish variations that add value from those that add for resources are also intensifying. Finally, no value and simply misallocate resources – warranted technology is transforming the entire variations from unwarranted variations. Within the health- healthcare sector often at breathtaking care sector, it is clear that unwarranted variations are a significant problem. Meanwhile, healthcare providers and speed.These changes are creating new institutions have been slow to identify where warranted challenges as well as new opportunities. variations can be helpful – helpful in enhancing the patient How healthcare providers respond to these experience and in reducing costs. This paper proposes that challenges could be the difference between the experiences of other industries can be instructive in this effort and offers an analysis of how the manufacturing success and failure in the years ahead. sector effectively relies on standardization and how the retail industry effectively deploys personalization and cus- tomization. We also offer proposals on how similar efforts can be undertaken in a healthcare context. Finally, digitalization has been a tremendously transforma- tive – and disruptive – force over the course of the past two decades, in healthcare and far beyond. This transfor- mation will continue; to resist it is a futile as resisting the force of gravity. The challenge is not to search for ways to escape from this digital disruption, but to learn from it; not embracing digitalization as a gimmick or an end in itself, but recognizing its potential. Again, other businesses have demonstrated that utilizing digital capacities and data in these ways can yield great dividends. 12 Siemens Healthcare GmbH, 2019 Creating higher value in healthcare by implementing lessons from industries on managing variations: Healthcare value PERSONALIZED DIGITALIZED AND STANDARDIZED Lessons from retail STANDARDIZED Lessons from Lessons from manufacturing digitalization Baseline Warranted variations Unwarranted variations The delivery of value over time is increased with standardization (by reducing unwarranted varia- Effective and visionary leadership is essential in this tions), and with personalization on top of that (by adding appropriate patient variations). Diverse effort. A cultural shift is also imperative. For too long, industries provide learning on how to standardize healthcare professionals have seen themselves and their (manufacturing), how to personalize (retail), and work as uniquely specialized and exceptional. Of course how to use digitalization as key enabler (digital medical care is more specialized than the preparation enabled industries). and sale of a cup of coffee. But this does not mean that healthcare providers cannot learn from other industries, especially those that have achieved remarkable success in earning customer loyalty, sustaining strong profit- ability, and developing highly effective business models. To pretend that healthcare is not, or should not, be Suggested follow up on concerned about issues like customer loyalty, value, and developing sustainable business models is, in our view, an news/expanding-precision-medicine unhelpful misconception. • Siemens Healthineers Insights series, issue 1: “Five steps every hospital CEO should start today” The coming years will place significant pressure on our • Harvard Business Review: “Expanding Precision healthcare resources, with demographic changes, rising Medicine – The Path to Higher Value Care” standards of living, and increasing globalization driv- • The Economist: “Reducing Unwarranted Variation: ing much of this pressure. We are confident that these Increasing Value of Care” • The Economist: “Standardisation in healthcare – pressures can be successfully managed and overcome. But What is the impact of standardisation on hospital this effort will demand strong and visionary leadership efficiency, cost-savings and patient outcomes” combined with disciplined and creative thinking. Siemens Healthcare GmbH, 2019 13 Insights series, issue 6 About the authors Michael T. Modic, MD Co-first author Senior Vice President Population Health, Luis Lasalvia, MD, MIB and Professor of Radiology and Co-first author Radiological Sciences Vice President, Global Medical Officer Vanderbilt University Medical Center Siemens Healthineers Michael T. Modic joined Vanderbilt University Medical Luis Lasalvia focuses on driving high-value, clinically and financially. Center in 2018 as Senior Vice President Population Health He has been leading numerous teams and large enterprise partner- ships around the globe, including more than 30 programs in five and Professor of Radiology and Radiological Sciences. He continents. He distinctively connects multiple domains in medicine and is working with the Population Health team integrating technology, from innovation and direct clinical practice, into strategy, clinical activities and in establishing and enabling evidence commercialization, and leadership. based clinical standards across diverse network based Luis Lasalvia has been keynote speaker, panelist, and moderator at about 500 events and conferences around the world. He authored ambulatory and inpatient settings. more than 35 peer reviewed papers and publications, and submitted multiple patents. He's a medical doctor from the Republic University Prior to joining Vanderbilt Michael T. Modic practiced in Montevideo, holds a Master in International Business from Pompeu for more than 35 years in Cleveland primarily at the Fabra University in Barcelona, and executive education at The Wharton Cleveland Clinic where he also served as Chairman of the School of Business, New York University, and Harvard Business School. Division of Radiology from 1989 through 2006, Chairman of the Neurological Institute from 2006 through 2015 and as Chief Clinical Transformation Officer through December of 2017. He has been a member of the Board of Trustees of the Cleveland Clinic Foundation, Society of Magnetic Resonance in Medicine and Board of Directors Reto Merges of the Society of Magnetic Resonance Imaging. He is Global Head of Expanding Precision Medicine a Fellow of the American College of Radiology and a Siemens Healthineers recipient of the Gold Medal of the Society of Magnetic With more than ten years’ leadership experience in healthcare market- Resonance in Imaging. ing, Reto Merges has a strong track record in building effective teams for clinical and innovation marketing. In addition, he has four years of Michael T. Modic earned his medical degree from Case work experience in China, ramping up efforts for research collabora- tions in China and South Korea. Western Reserve University (CWRU) School of Medicine Reto Merges holds a degree in electrical engineering and information in 1975. He completed a Diagnostic Radiology Residency technology from the Karlsruhe Institute of Technology, Germany, and and Neuroradiology fellowship at the Cleveland Clinic. His has studied at the Nanjing Normal University, China. His scientific back- clinical practice and research interests have been focused ground is in the field of medical imaging where he has authored many on Neuro Imaging with a special interest in degenerative publications, while submitting multiple patents. disease of the spine and its natural history. He is a member of the Neuroradiology section within the Department of Radiology and Radiological Sciences. 14 Siemens Healthcare GmbH, 2019 Siemens Healthcare GmbH, 2019 15 At Siemens Healthineers, our purpose is to enable health- care providers to increase value by empowering them on their journey towards expanding precision medicine, transforming care delivery, and improving patient experi- ence, all enabled by digitalizing healthcare. An estimated five million patients worldwide everyday benefit from our innovative technologies and services in the areas of diagnostic and therapeutic imaging, laboratory diagnostics and molecular medicine as well as digital health and enterprise services. We're a leading medical technology company with over 120 years of experience and 18,500 patents globally. With about 50,000 dedicated colleagues in over 70 countries, we'll continue to innovate and shape the future of healthcare. Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Phone: +49 913184-0 Published by Siemens Healthcare GmbH · Online · ©Siemens Healthcare GmbH, 2019

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