This is a Revolution (not a Transformation) – Five Key Areas for Disruptive Innovation in Healthcare

If you are like me, when you hear the word innovation you imagine big things … putting a man on the moon … flying cars … low cost renewable energy … even a cure for cancer.  I can hear The Jetsons music playing in my head as I write this.

We are only limited by our imaginations.  I bet you have never considered how postal workers might participate in delivering healthcare?  In fact, you could make the case that postal carriers are contributing some of the most innovative ideas to transforming healthcare.  YES… Postal workers.  NO… I am not kidding.  Keep reading.

We are on the precipice of a new age in healthcare.  Like the industrial revolution that shaped America in the 1800s … the healthcare industry is entering that same type of business revolution.  Are you frenzied by this yet?  You should be.  The most aggressive and innovative organizations will win … and reap the benefits.

Clayton Christensen defined innovation in specific terms when he wrote the The Innovator’s Dilemma in 1997. Christensen’s book suggests that successful organizations put too much emphasis on current needs, and fail to adopt new technology or business models that will meet unstated or future needs. He argues that such organizations will eventually fall behind. Christensen calls the anticipation of future needs “disruptive innovation”. The concept of disruptive innovation is contrasted in the book with smaller, more obvious, incremental or “sustained innovation”.

Look around and count how many healthcare companies are making this exact mistake. Too many organizations are focused on current needs only. Both types of innovation are needed for ongoing growth and a healthy organization (pun intended).

Why is this relevant?  The fact is … healthcare organizations will have to compete, based on the value they deliver, in the not too distant future.  We haven’t seen this type of transformational business opportunity since the industrial revolution days of Cornelius Vanderbilt, Nelson Rockefeller, Henry Ford, Andrew Carnegie and J.P. Morgan.  These men all understood what was happening and then transformed their industries through innovative business techniques and approaches.  Most just watched them do it.  In healthcare, the organizations innovating now will lead this revolution and reap the spoils.  This is a completely different way of thinking about healthcare.  New markets and segments will seem to appear out of thin air.  It will be fueled by innovation … disruptive innovation.

Cleveland Clinic CEO Dr. Delos Cosgrove gets this.  98% of the people that request a same day appointment at the Cleveland Clinic get one, and there were over one million such appointments last year.  Focusing on costs doesn’t have to come at the expense of the patient.  Do you get that level of service from your local provider?  Why not?

Led by Joe Dickinson, postal workers on the small island of Jersey (off the coast of France) get this too. The island of Jersey has the same aging population issues as the rest of the world but the postal workers in Jersey have come up with an incredibly innovative way to extend their role and value through a new “Call & Check” service.  This is easily the coolest thing I’ve seen in quite some time.

By using postal delivery people in a community care model, any citizen can request a “Call & Check” at their home … and the postal delivery person whose has that route will stop at the home of the frail elderly person and do a “call and check”.  Here is a person who’s job it is to visit every house everyday any way, why not leverage that?

In other words, a friendly face comes by when needed to help, provide company or just look in.  The check can be — do you have the medications you need, is there a rug you could trip over, can you reach the top shelf without failing. Is there a nick in the skin of the lower extremity, can someone take you to see the doctor for your appointment scheduled this week. These “call and checks” are many of the things that make it possible for us to keep seniors in their homes longer.  It’s well-documented that “in-home” senior care is the optimal model and this type of service seems like a sensible and needed component.

Check out the video on how the “Call & Check” service works.

I am a big fan of Dr. Atul Gawande. In 2009, he published the breakthrough book: The Checklist Manifesto: How to Get Things Right. This book was a bestseller and lauded as an effective way to innovate and improve things.  Since then, Dr. Gawande has gone on to write several other books and is clearly an expert in his field.

However, at the time I read his book I did not have the same reaction as the rest of the industry. I was actually quite shocked that key healthcare processes like pre- and post-surgical processes weren’t already rigorously managed by checklists (or other proven methods) to ensure that surgical sponges, or instruments, weren’t going to be forgotten about and left in patients.  After all, there are published references to the use of checklists dating back to the 1800s and quite possibly earlier than that.  Quality approaches to processes (such as ISO 9001, Six Sigma, etc.) have existed for decades.  It’s a sad state of affairs, that nearly two centuries later, the adoption of checklists in healthcare is seen as innovative.  Maybe this isn’t a fair example, but it’s hard to see the industry as being innovative when so many people got that excited over checklists.

Score one for the postal workers!

The reality is that those who invest in and embrace technology today will be the leaders of tomorrow.  Many physicians are embracing new technologies like IBM Watson Oncology Advisor … but sadly, some are still resisting using checklists.

When you look around the healthcare industry today, there is not enough disruptive innovation. There are examples of sustained innovation but very little is going on that would qualify as disruptive.  Most of the efforts that get labeled as innovative in healthcare are in support of the “triple aim”.

If you are not familiar with this term, the IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance (simultaneously) in three dimensions:

  • Improving the patient experience of care (including quality and satisfaction).
  • Improving the health of populations.
  • Reducing the per capita cost of healthcare.

The IHI website highlights that The US healthcare system is the most costly in the world, accounting for 17% of the gross domestic product with estimates that percentage will grow to nearly 20% by 2020.  At the same time, countries with health systems that out-perform the US are also under pressure to derive greater value for the resources devoted to their health care systems.  Aging populations and increased longevity, coupled with chronic health problems, have become a global challenge, putting new demands on medical and social services.  Only technology-enabled innovation can enable this fundamental and simultaneous degree of change.

Of course, there are numerous barriers making this incredibly difficult to achieve … not the least of which is the continued widespread use of fee-for-service-based payment models.   This is a core business model, process and foundational problem. The wrong incentives cause the wrong behavior and actions that lead to poor (and costly) outcomes.

The Center for Medicare & Medicaid Innovation (The Innovation Center) is helping by supporting the development and testing of innovative health care payment and service delivery models. These are important incremental steps, to transforming the industry … but we have to go faster in five key innovation areas.  The current rate of innovation is being measured with calendars when it should be measured with a stopwatch.

  • Business and payment model innovation such as shared risk, capitation, bundled payments, self insuring and more is starting to happen but taking too long.  Every payer and provider should have multiple experiments going in these areas now.  Acquiring this experience now is essential so that when the big money is at stake you’re not starting from scratch.  Continued industry consolidation will eventually help enable new forms of business model innovation but only after these acquisitions get integrated and are made to work functionally.  Too much consolidation could actually slow down business model innovation.  Net-net … We need to be much more aggressive in moving away from fee-for-service. Ultimately, it will be innovative technology solutions like practice management analytics and care (case) management that factor in process level care delivery costs that enable this to happen.
  • Business process innovation is not getting very much attention anywhere in healthcare.  When Lou Gerstner turned around IBM in the 1990s, one of his top initiatives was to blow-up and re-engineer the core business processes.  Hanging onto the fee-for-service business model is a slow lethal poison.  It’s toxic.  A fee-for-service business culture breeds ignorance of how to control costs effectively (and still deliver quality care).  In other industries, key organizational processes are measured by using techniques like time and motion studies to understand costs at a very granular level.  Not in healthcare.  Many core processes aren’t well understood at all.  This disables any chance to innovate through processes, which can reduce operating costs significantly.
  • Care delivery model innovation is also taking far too long to reach the mainstream.  Community care models and telehealth are examples of things that should be much farther along then they are.  The notable exception to this is the adoption of Patient Centered Medical Home as driven by organizations like the Patient-Centered Primary Care Collaborative.  Every payer and provider should have a population health management solution deployed today.  The ability to organize and manage based on population health … and to use that information to personalize care delivery is a major enabling piece of innovation.  The value of these solutions are well proven and anyone who is not using one of these is already well behind.  Phytel even offers a guaranteed Return on Investment of at least 3x.  That’s pretty innovative all by itself.  What have you got to lose?
  • Organization innovation is laughable.  The United States is the only major economy where healthcare and social programs are two separate things.  The connection between the social determinants of health and delivering good patient outcomes is undeniable … yet politics, system silos, and other overcome-able obstacles prevent our caregivers from using this critical information to deliver low cost care and better outcomes.  By some estimates, over 60% of the best healthcare outcomes are derived by using social determinants.  What are you doing to integrate social determinates into your systems, processes and decision making?
  • New technological innovation is perhaps the most obvious way to think about innovation.  If you have not already invested in cognitive computing, analytics, mobile, cloud, population health and care management solutions then you are in the stone ages and well behind … because your competition has.  George Jetson didn’t have Watson at Spacely Sprokets, but he did have R.U.D.I. (Referential Universal Differential Indexer). R.U.D.I. was George’s work computer and one of his best friends (next to his dog, Astro).

This is a revolution .. not an evolution !! 

Vanderbilt, Rockefeller, Ford, Carnegie and Morgan didn’t wait for the next round of incentives .. they SEIZED on their opportunities .. you should too.  It will be the pioneers of today who are the winners in tomorrow’s competitive healthcare industry

Spacely Sprockets may have had R.U.D.I. but we (at IBM) are taking disruptive innovation seriously with our growing family of Watson Healthcare solutions, innovation in population health analytics, IBM Smarter Care solutions (including care management) and new joint mobile healthcare solutions from our strategic alliance with Apple.

NOW is when is the disruptive innovation needs to happen … what will yours be?

I will be at HIMSS in Chicago on April 12-16th. (IBM Booth 1425).  Stop by and say hello.

Healthcare Delivery Innovation Needs to Happen Faster

I was recently asked to chair a panel and moderate a roundtable at the upcoming 2015 State Healthcare IT Connect Summit in Baltimore, MD on March 23th and 24th.

I am hosting a roundtable entitled Turning Insight into Action with Patient-Centered Care Management on Monday the 23rd at 1:00pm … and the panel is entitled Community Analytics, Care Coordination and Managing Complex Conditions takes place on Tuesday the 24th at 10:10am. I will be joined by an impressive list of State IT Executives for the panel and we will all be sharing our respective points of view. Judging from the attendee list, this is shaping up to be a terrific conference.

As I started to prepare for these sessions it started to bother me that this transformation (using analytics to enable better care delivery) is taking too long. Not enough organizations are aggressively embracing this model despite the types of outcomes that are now within our reach.

It’s been over four years since Doctor Atul Gawande opened everyone’s eyes to the power of combining community (social) data with clinical data to identify which patients are the most in need of care.   In case you were lost in Antartica, that New Yorker Article The Hot Spotters was groundbreaking. It opened our eyes to the value of non-clinical sources and types of information. As an example, if you are trying to reduce infant mortality, it would certainly be handy to analyze which infants live in buildings that still have lead paint.

It goes without saying … that the sooner you figure out who is in the most need, you can intervene to get the best possible outcome. This might seem simple but the real magic comes from combining different types (structured, unstructured) and sources of data (clinical, social programs, environmental) that can unlock new and powerful insights.

In her recent book The American Health Care Paradox: Why Spending More is Getting Us Less, Dr. Elizabeth H. Bradley from Yale University asserts that when you combine social services spending with healthcare spending you can achieve more. Unlike the rest of the world, the United States archaic division of health and social services is hurting our outcomes. The book offers a unique and fresh perspective on the problems the Affordable Care Act won’t solve. She also asserts that 60% of outcomes can be attributed to social, environmental and behavioral.

At IBM, we have seen similar eye-popping results when combining different types and sources information. I have blogged about some of these examples:

I plan to talk about these examples, and more, at the conference. As we talk to State healthcare officials, it seems while almost everyone is embracing some flavor of analytics and care management … many seem to assume they only have limited access to data though, usually claims data.

It’s time to start thinking outside of the box. State governments are in a unique position. Tthey have access to unique sets of data (social programs, environmental, safety, crime, others), that when combined, can deliver the kind of outcomes that Dr. Gawande was talking about over four years ago. The extra effort required to collaborate and share data is well worth the opportunity to achieve these types of outcomes.

I hope to see you at the upcoming 2015 State Healthcare IT Connect Summit in Baltimore, MD on March 23th and 24th.

Trick or Treating for State Healthcare Innovation Treats

When I was a wee lad, I loved to go trick or treating each Halloween. Nothing was better then dressing up in a great costume and walking door-to-door to get my plastic orange pumpkin filled up with candy. My favorite was those little root beer barrel hard candies … YUMMY!

I think my best costume was the year I went out dressed as Elvis. Imagine a 12 year old dressed as Vegas Elvis, with the white jumpsuit, big lapels and the mutton chop sideburns. I got alot of root beer barrels that year. This year I went to the 27th Annual NASHP Conference in Atlanta dressed as a confused IBM Executive.

As part of my role in IBM Smarter Care, I have recently been focused on understanding the government healthcare transformation strategies of the US States in the wake of the Affordable Care Act.

What a better place to get the goodies then the NASHP Conference. The event attracts a “who’s who” of state healthcare policy people who also drive the content and focus of the conference. I may have gone confused but came back armed with answers (my treats).

My plastic pumpkin was filled with goodies by the end of the pre-conference on the first day. The best treat (for me) was the keynote delivered by Dr. Elizabeth H. Bradley from Yale University. Her keynote was based on her new book The American Health Care Paradox: Why Spending More is Getting Us Less. Her point of view asserts that when you combine social services spending with healthcare spending you can achieve more. Our archaic division of health and social services, and our allergy to government programs, is hurting us. The book offers a unique and fresh perspective on the problems the Affordable Care Act won’t solve.

There were other treats as well. The pre-conference on care coordination was led by NASHP Program Manager, Dr. Barbara Wirth. It featured an all-star line-up of state executives sharing how they were using CMS Innovation Funding to improve state healthcare outcomes on behavioral health, infant mortality, long-term care and supporting services using care models such as Patient Centered Medical Homes, Health Homes and more.

The one treat that I really wanted … I didn’t get (and it wasn’t root beer barrels).  It was an understanding of the technology being used to help achieve the outcomes being cited in the sessions. Software is essential to enabling care models where patients are crossing care settlings, caregivers, locations and even care programs. There is no way this can be done economically using the good old fashioned way of paper, folders, faxes and phone calls.

Realistically, it’s too early for many of these new programs to expect a lot of detail on this. On the other hand, the omission(s) makes me scared (get the pun) that this may not be on the radar screen of those making policy decisions … and those responsible for rolling out these innovative programs.

Healthcare reform is not just about innovative payment models, policy design and care delivery models. It must also include innovative technology to deliver on the promise of consistent quality, scalable delivery and affordable care. The use of big data (not just EMRs), analytics and care coordination software all help enable the benefits Dr. Bradley spoke about where social programs and healthcare come together to enable better outcomes at lower costs. Dynamically linking these technologies to health policy is where innovation can and will happen. Not linking them may cause your programs end-up like an old Haunted House where dust and cobwebs cover up ghoulish and ghastly looking programs (ok, really sorry for the pun).

Maybe next year I’ll pull out my Elvis costume when I go to NASHP in Dallas (October 19-21, 2015) even though I know it’s far too small for me.

In the mean time, I’ll urge NASHP to push this technology agenda, along with all of those implementing reform through government healthcare transformation. Start thinking and planning for the technology that will power your initiative now.

For me, Halloween comes twice this year. The IBM Health and Social Programs Summit is being held October 20-21st in Washington, DC. This event convenes a global network of thought leaders, industry experts and practitioners to discuss industry trends and directions, and compare best practices and leading technology innovations in the fields of Health and Social Programs. I will be speaking, as will Dr. Barbara Wirth from NASHP, along with The Honorable Patrick J. Kennedy, Dr. Paul Grundy, Dr. Stephen Morgan and many more. I hope to see you there … and bring some root beer barrels!  There will be plenty of treats for you too.

Amputations or Analytics … a Call to Action for Entrepreneurs and Intrapreneurs Alike!

Doctor George Shearer practiced medicine in central Pennsylvania from 1825 to 1878 (in the Dillsburg area). He was a pillar of the community and is believed to have been an active surgeon during the Civil War. He was 61 at the time of the Gettysburg battle.

According to the National Library of Medicine, the exact number is not known, but approximately 60,000 surgeries, about three quarters of all of the operations performed during the Civil War, were amputations. Although seemingly drastic, the operation was intended to prevent deadly complications such as gangrene. There were no anti-biotics during this era.

Back then, amputation was the recommended treatment for major injuries, such as damage from gunshots or cannonballs. These amputations were performed with a handsaw, like the one Doctor Shearer used (shown below). During the war, surgeons prided themselves in the speed at which they could operate, some claiming to be able to remove a leg in under one minute. Ouch! Literally!

Image

(Photo: Doctor George Shearer’s Actual Surgical Kit)

Keep in mind that local anesthetics were not invented until the 1880s and many procedures were performed without ether or chloroform … the only real anesthetics during the era.

In 1861, this was the best standard of care for those injuries. I think we can reasonably conclude that better treatment options (and outcomes) exist today.

Recently, The Mayo Clinic published an eye-opening report entitled, A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices. The report focuses on a published medical practices and how effective they are. Things must have improved since 1861 … right?

The report examines published articles in prominent medical journals of new and established medical practices (such as a treatment guidelines or therapies), over a recent 10 year period (2001-2010). 2044 medical practice articles were reviewed. The findings are fascinating but one section of the report jumped off the page at me. Of the 363 articles that tested an existing standard of care, 40.2% reversed the original standard of care … and only 38.0% reaffirmed the original standard of care. The rest were inconclusive.

In other words, (in this case study) the current published medical standards of care are wrong MORE then often then they are correct. Wow!

I do feel obligated to point out that this is a very limited slice of the overall published standards of care … but still. It is just me … or is this mind-blowing!

I am not talking about gulping down some Jack Daniels so I don’t feel my leg being sawed off. This is researched and tested medical standards of care within the last 13 years. And yet … over 40% of the time, it’s WRONG. In fairness I should point out that they were right 38% of the time. No wonder the US Healthcare system checks in as the 37th best worldwide despite outspending everyone else by a huge margin (per capita).

It’s 150 years later, has the standard of care improved enough? We may not be sawing legs off at the same rate these days, but maybe it’s time for a new approach. Why are other industries so much farther ahead in leveraging their data with analytics to improve quality, reduce costs and improve outcomes? What could be more important then saving life and limb?

Years of data have been piling up in electronic medical records systems. Genomics is not new anymore. Isn’t it about time we brought analytics to this set of opportunities?

Some leading organizations already are … innovative solutions and companies are popping up to meet this opportunity. Entrepreneurs like Scott Megill, co-founder and CEO of Coriell Life Sciences, is a great example. Coriell Life Sciences is an offshoot of the Coriell Institute for Medical Research, a 60-year-old non-profit research organization. In 2007, the Institute launched an effort to bring genomic information to bear on health management. Coriell Life Sciences was established to commercialize the results of that research. Vast amounts of genetic information about individual patients has been available for a number of years, but it has been difficult to get at and expensive. “This company bridges the gap,” said Dr. Michael Christman, the Institute’s CEO.

Coriell’s approach is so innovative, they recently walked away with the coveted “IBM Entrepreneur of the Year” award.

Intrapreneurs at IBM have been busy commercializing the breakthrough innovation, IBM Watson – that originally debuted on Jeopardy! in 2011. Watson is based on a cognitive computing model.

Grabbing a few less headlines is IBM Patient Similarity Analytics, which uses traditional data driven predictive analysis combined with new similarity algorithms and new visualization techniques to identify personalized patient intervention opportunities (that were not previously possible).

These are a couple of obvious examples for me, but in reality we are just at the beginning of leveraging big data. New analytics and visualization tools must become the “handsaw” of today. We need these tools to be at the root of today’s modern standards of care.   If Dr. Shearer were alive today, you can bet his old surgical kit would be on the shelf, having been replaced by analytics that he could bring to the point of care.

For many Entrepreneurs and Intrapreneurs, the journey is just beginning, but there is a long way to go. A 2011 McKinsey report estimated that the healthcare industry can realize as much as $300 billion in annual value through analytics. Yowza!

What are you waiting for?

As always, leave my your thoughts below.