Stratis Health Leadership Strategy Developing Future Scenarios to Describe Health and Health Care MAPS Board of Directors January 25, 2018

Leadership Strategy: Lead With Vision Goals: Be bold about Stratis Health’s vision for the future of health care Inspire commitment and lead with accountability Outcome Measure: By September 2018, a concrete and actionable set of critical next steps and investments that will enable Stratis Health to realize our future vision of health and health care and Stratis Health’s role in it.

Why? To assure that Stratis Health is well positioned as a leader into the future Explain or articulate a future world to leaders, especially in an uncertain policy and program environment Demonstrate thought leadership to our partners, collaborators, funders, policymakers

How do we get there? Create alternate plausible “futures of health care” To envision dramatically different health and health care in 2025 and beyond, and to signal to community leaders that Stratis Health is a thought leader about the future. Use scenario planning as a tool to create the plausible futures, and how we envision quality in each future scenario and prepare for our role in it

What is Scenario Planning? Method to define possible and plausible future scenarios, identify the conditions in each scenario and then plan around those conditions Start by identifying “pre-determineds” (what we know will exist) and “critical uncertainties” (what could happen that would have big impact)

Scenario Planning – Impact and Uncertainty Impact – to what degree will the factor impact the future Uncertainty “Low” means we are reasonably certain that it will play out or continue in ways that are fairly well understood “High” means that we have no clear idea which of a number of plausible ways it might go

Building Blocks Gathered information and insight on health and health care in 10+ years: Board breakout groups (October 2016) and ongoing board input Coral Initiative CEO focus group (December 2016) Key informant interviews (April – July 2017) Medical sociologist interview (December 2017) Various articles and resources

Themes from Building Blocks Pre-determineds: High impact and low uncertainty Increase in number of both older adults and Millennials New technologies to collect data and access care (real time) Proactive mining and use of ‘big data’ Sharing economy (e.g., Lyft, Airbnb) Changes in access points for health services

Critical Uncertainties Identified from Building Blocks Critical Uncertainties: high impact and high uncertainty 1. Health services value system 2. Source of decision making and accountability

Critical Uncertainty #1 – Health Services Value System How will we as a country view our health system and services in 2027? Basis for and ability to access to coverage, care, services Payment for healthcare and role of the employer Impact of globalization and immigration Balance of investment between medical and social services

Critical Uncertainty #2 – Source of Decision Making and Accountability Who will be responsible for health care decisions in 2027? Level of economic power by consumers Shifts in control for decision making How “quality” or “health” is defined Patient defined or technology calculated Illness focus or wellness focus

Critical Uncertainties Scale Access to care and services is a public good Need to qualify or achieve access to care and services Health services value system Individual personal responsibility, individual initiates interactions with healthcare system Population based, individuals are community investments, health system or public health initiates interactions with individual Source of decision making and accountability Keep in mind that critical uncertainties must have two distinct endpoints.

Four Future Worlds Public Good Health services value system A: “Free for all” or “Come and get it” B: “ Community investment” or “U.S. healthcare starts to look like the rest of the world” C: “Figure it our for yourself” or “The have’s and the have not's” D: “If you have a ticket” or “If you’re not in a group, you don’t count” Health services value system Population Based Individual Source of decision making and accountability Need to qualify or achieve

Elements of Each World Pre-determineds help build out descriptions. Quality and safety Technology Workforce Money transactions Relationships between patients and healthcare team members Politics Access points Influencers of health Pre-determineds help build out descriptions.

How will we use the scenarios? To clearly articulate and define Stratis Health’s role in the scenario, what gaps exist currently, and the business considerations relevant to moving toward these futures.

Strategic Planning Next Steps Use the four worlds to identify and plan for Stratis Health actions today to prepare for tomorrow’s scenarios Staff input sessions (3) in Feb and March 2018 Synthesis and implications Action recommendations Continued board and staff engagement

Questions for MAPS Board Will safety still be a primary core value, or will it be supplanted by other values like privacy, autonomy or convenience? What are the emerging challenges for safety given the changing environments (e.g., will more fragmented access result in increased opportunity for diagnostic error?)? How will safety improvement work be funded under the various scenarios?