OP-ED

Healthcare Innovation Is Not Just About Cutting Costs

Aspiring healthcare entrepreneurs could be forgiven for assuming our most significant challenge is the need to reduce the cost of care.  Investors and policy wonks alike seem to agree on the overriding need to focus on innovations that will improve efficiency and take costs out of the system.

The appeal of this approach is easy to understand: rising healthcare costs are a real problem, and business process improvement feels like something we already know how to do.  Large companies like GE and Oracle are thrilled by the opportunity to apply their process methodologies to healthcare.  Management journals love the idea of improving healthcare through operational excellence.  An increasing number of foundations have also joined the fray, focused explicitly on supporting innovations that reduce the cost of care.

Yet, as much as operational improvements are urgently needed, they should not represent the primary goal of healthcare innovation.

If we’re truly interested in high value healthcare, we’d do well to keep in mind that for many, if not most serious or chronic diseases, at least in the absolute sense, high value care simply isn’t an option.  We have embarrassingly few therapeutic approaches that can really do much to restore the lives of these patients.  Sufferers afflicted with Alzheimers Disease, pancreatic cancer, brain tumors, and so many other conditions desperately require transformative breakthroughs, not the mucking around the edges that passes for treatment today.

Make no mistake: it’s critical we do the very best we can to provide compassionate, evidence-driven care for patients who are sick right now, and innovations that contribute to the identification and humanistic delivery of the best available care are vitally important.But we must also acknowledge that for many conditions, even the very best options are often tragically limited.  We shouldn’t become so obsessed with optimizing these relatively poor choices that we lose sight of the urgent need and opportunity to think about how emerging technologies can be brought to bear to yield truly transformative change, the sort of advances we’ve witnessed in the treatment of diseases like polio and diptheria, hepatitis C and testicular cancer.

While healthcare stakeholders universally profess an interest in improving the quality of care, this ambition seems almost universally understood as an effort to reduce bad and ineffective care, rather than improve upon our potential to do good.  It’s as if we’ve focused so much on improving the average health of populations we’ve lost sight of the need to improve upon the very best care we can offer to each individual.
Quality improvement shouldn’t only consist of removing the negative, and eliminating what clearly doesn’t work in healthcare; excellence in quality should also require us to continuously ask how we can use emerging technologies to advance the frontiers of knowledge, especially in areas where the very best evidence based-care is clearly not good enough.

There is a silver lining here: even if the initial applications of new healthcare technology seem rather limited, they may yet provide the foundation for more substantive future advances.

 


Consider, for instance, the proliferation of mobile technologies.  While activity trackers, for example, are essentially an entertaining consumer product today, mobile technologies and sophisticated sensors also provide the means to expand our conceptualization of medicine in time and space, and move care beyond the four walls of a hospital and yearly physician visits.   Health is continuous and everywhere, and new technologies provide the opportunity for researchers, working in partnership with patients, to develop more nuanced understanding of patients’ longitudinal, real-world experiences and needs.

Ensuring the data from mobile devices actually contribute to our personal medical records is a second challenge.  The health information ecosystem is absurdly fragmented; record systems struggle not only with remote data, but also with data from core hospital devices like infusion pumps and ventilators.   As Johns Hopkins quality expert Peter Pronovost, recently wrote in JAMA, “None of these technologies communicate and share data.”

This is starting to change, however, amidst the recognition that improved interoperability could save lives.  The hope is that efforts to enhance data integration will not only reduce medical mistakes, but will also generate dense, comprehensive databases that will enable researchers to extract novel insights about the causes of disease, and glean empirical clues into potential therapeutic strategies.

A third opportunity lies in the area of sophisticated analytics — computer programs that search healthcare data for meaning.  Much of the initial effort here has focused on “descriptive” analytics – algorithms that review datasets to figure out who’s not following established protocols: Has every patient evaluated for a suspected heart attack received an aspirin?  Has each diabetic patient been sent for an eye test?

As useful as these approaches are for enhancing patient care and improving clinical decision-making, the real excitement will be the use of sophisticated analytics to yield fundamental disease insights, and ultimately, we hope, point the way to radically new treatments.

Medical scientists have been chastened by our disappointing experience with human genomics.  Curing disease is a lot harder than it looks.  Yet unless we keep this worthy aspiration in sight, we risk settling for low value medicine — served with marvelous efficiency.

David Shaywitz is co-founder of the Center for Assessment Technology and Continuous Health (CATCH) in Boston. He is a strategist at a biopharmaceutical company in South San Francisco. Shaywitz is also co-authored of recently published book, Tech Tonics: Can Passionate Entrepreneurs Heal Healthcare With Technology, available from Amazon here. You can follow him at his personal website.

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7 replies »

  1. Dr. Rick Lippin writes:

    “The fundamental mistake is that we are using the word “cure” for the chronic degenerative diseases of aging- trying to apply an infectious disease (single agent -single outcome- reductionistic) model.”

    Dr. Paul Ewald of the University of Louisville argues that all the real progress we have made against cancer in the last 30 years has come from pursuing the single-agent -> single-outcome reductionist model. REF: cervical cancer, liver cancer due to hepatitis B. See:

    http://www.isteve.com/infectious_causation_of_disease.pdf

    Dr. Lippin further writes:

    “There is NO CURE for aging and death. Yes, we can die healthier but we will still die.”

    Agreed. So what’s your point? There is no final cure for totalitarianism, but the United States still fought WW-II and the Cold War. According to:

    http://stm.sciencemag.org/content/2/28/28cm13.full

    As of April 2010, America had spent $100 billion on Nixon’s “War on Cancer”. Compare that in constant dollars to the cost of America’s nuclear weapons effort back through and including the Manhattan Project and tell me if you are impressed.

    Disease, injury, and the incapacitation that comes with aging are mankind’s oldest and most-remorseless enemies. Budget-wise, we are currently treating them with supreme tenderness. I would *love* to fight an election with David Shaywitz’s position in opposition to yours! Indeed, doubling federal funding on cancer was one of Obama’s campaign promises back in 2008. So why do the cancer researchers I randomly sit next to on airplanes tell me that they are spending all their time on grant applications rather than research?

  2. There is a confusion between Evidence Based Medicine that solely focuses on patient health outcomes and as a culture promotes clinical acumen, pt education and the expensive, time consuming development of a long term healthier culture with patient empowerment and Administrator Based Medicine, a mixture of cost cutting and sales that increases dependency and lowers the quality of care to the lowest common denominator http://clinicalarts.blogspot.mx/2013/12/when-evidence-based-medicine-was-best.html

  3. I enjoyed your views and the post. Working in healthcare on the provider side and on the vendor side, along with a clinical background has allowed me the fortune to see what occurs and what is possible. In general, HCP & vendors focus on the cost and process improvement because that is the easy tangible input that we can measure. The challenge lies in focusing on the output and the appropriate metrics to show improvement in that space. Some HCP like to rely on the rules, regulations, and certifications versus looking at what is possible and making it happen.

    It starts with a dialogue, begining and ending with consumers, and then sprinkling the various moments of care needed to lead to healthier, longer, and higher quality lives. Balance is shifting, its no longer about consumers going to the big box hospital, but about expanding beyond the walls and making it simple that it is a part of daily life.

  4. David

    Sure hope so – but may not justify the expenditures and dashed false hopes

  5. It’s a mistake to conflate the limitations of reductionism (a point with which I 100% agree, and about which I’ve written extensively, including in many of the links above) with the idea that we’re basically screwed as far as diseases like cancer and neuro degeneration, and should focus (I guess?) on dying efficiently. Neither digital nor biological tech magic answer, but I’ve great belief we can substantial raise the bar here, and have profound impact on dreadful chronic disease.

  6. The fundamental mistake is that we are using the word “cure” for the chronic degenerative diseases of aging- trying to apply an infectious disease (single agent -single outcome- reductionistic) model.

    There is NO CURE for aging and death. Yes, we can die healthier but we will still die. When we accept that reality we will begin to mature

    To promise “cures” for these diseases is actually a cruel hoax

    A strong dose of humility as it relates to the limits of bio-medical technology is in order

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