Five months ago I posted a challenge on Linkedin titled, “Innovative Ideas for a Totally New Healthcare System?” and it generated a discussion that’s been active for 5 months now with over 900 responses from different perspectives worldwide.
As a fun exercise to stimulate creative, out-of-box thinking, pretend you have all been appointed to the new World Health Commission by the new King of the World (or whatever title you prefer). You have absolute power to determine health strategy, for the whole world. Think like a child, and forget the constraints you’re used to dealing with as adults. There are no financial hurdles, no political worries, no cultural barriers, no legacy to contend with, no managers looking over your shoulders, and no imposed time frames. What is it that patients, providers and society seek from healthcare? Why can’t they get that now? Starting with a completely blank canvas, what would be the objectives of the new System? Imagine potential roadblocks and how we might overcome them.
The discussion has evolved, and most participants have come in and out of it, but Clifford Thornton posted one of the longest and most thoughtful replies and gave me permission to reprint it here.
A Totally New Healthcare System
By Clifford Thornton
Wow sir, a blank sheet; this is a dynamic exercise.
I came into the healthcare field about 9 years ago from a marketing strategy business background in the cable/telecommunication industry. Let me say that I cannot think or even imagine a bigger contrast in terms of quality of service, efficiencies, level of customer satisfaction, duplication of service levels, delivery, and range/availability of services.
Most people love their cable and/or satellite TV/Internet/Phone service. They may not enjoy paying the bill, but they enjoy it; they utilize it with mostly a positive stance; it is there when they need it; and for the most part they like the services. Otherwise they’d switch to another service (say subscribe to a certain service to watch the Yankees games). This, in turn provides for a pretty good competitive, consumer driven market, where consumer tastes are, for the most part, directly reflected by the services and level of those services that are available.
For example, if XYZ cable company only offered dial-up Internet service in the tri-state NY metropolitan area, how well would it be able to compete and sustain itself? It probably wouldn’t and couldn’t.
The same can’t be said for healthcare. there are many many hospitals without either Cyberknife or DaVinci programs or telemedicine or a stroke program or cutting-edge specialties or services, but they still manage to carry forth (although this is changing more rapidly).
My point here is that until the healthcare landscape is subjected to the same economic/market competitive rules as other industries (i.e. telecommunications, auto, retail, beauty services, etc.), then it’s going to be hard for things to really change in any meaningful way in the healthcare industry. So then, we have to define what those hurdles are to a truly market driven system and how to remove those hurdles. I believe that some of these are:
1. Doctor compensation – As stated in this discussion thread, there is too much emphasis on pay-per-procedure as opposed to paying for treating the disease and proving a positive overall outcome. It’s like, would you hire an accountant to complete your private federal tax return without using any of the available deductions and applying the tax law in your favor? And would you pay him or her again and again every year, even though you find that you owe the federal government more and more money each year? (I’m not getting political right now, just making a general point.) Imagine if that accountant is paid for each form they complete as opposed to the overall result of the job they did, which boils down to how much that final tax bill or refund is.
We need to pay physicians for treating the disease or on a scale of how healthy the patient is each year and add or subtract points toward their reimbursements based on this. If we can find a way to pay them for healthy patients (or at least healthier), then everyone wins.
2. Health Insurer current models – As above, we need a new model that encourages physicians to treat the overall disease MORE EFFECTIVELY and get customers (patients) measurably healthier and ideally healthy. We need a model that’s more aggressive with preventative medicine, which the current payment model does not encourage.
3. Patient incentives – Doctors can only do so much for their patients. I’m sure there are thousands of doctors who really do want to see their patients get healthy. But, they can’t move in with their patient’s and get on their case every time they order a pizza or spend three hours lounging on the couch. So, we also have to find ways to incentivize patients and have them pay a real cost for being unhealthy. I live a very healthy lifestyle (run, lift, do calisthenics, prepare most of my meals) and I am tired of paying for other people’s laziness and bad health decisions. [I heard that a lot from others in the conversation.]
We are already seeing this incentive model evolve as some companies are offering insurance discounts for employees who enroll in health & wellness programs. They offer discounts, refunds or other rewards for achieving certain goals such as X number of pounds lost or for raising their HDL and lowering their LDL cholesterol levels. We must make people more accountable for their choices. Unfortunately, we need to do something more dramatic and impactful to really change public health of the United States.
In my opinion the situation is a complete disaster, especially the situation with childhood obesity. What’s the point of having great SAT scores if these kids will be in and out of hospitals by the time they’re 35-40? We’re so short-sighted. We must change things around quick; there is no other option. We need to change attitudes, behavior, and habits of Americans and the only real effective, long-lasting and timely way to do this is to incentivize people and make this easily measurable on a constant basis. We do the same for good driving, put security systems in our homes, get advanced education, and even choose to live in certain locales.
4. Food industry – A big part of the problem (no a huge part) is our diets. There are too many hormones in our food, and there’s too little food rich in whole grains and too much garbage on the shelves. Of course the reasons for this are consumer driven (and of course the food industries lobbyists who aggressively fight any new regulation). But, this will only change as public awareness changes (and it is) so they can vote accordingly. The problem is I don’t think this is a top issue in the political landscape. I don’t think people (most people) realize the huge link between the public’s health and domestic economic health. Like I said, all those diabetic kids now, how productive can they be as future workers if they are sick all the time? And will they have the energy and stamina to start and run companies, or lead teams at existing companies, or have the enthusiasm and drive to teach future generations the latest scientific findings?
Attitudes, Behavior & Lifestyle
Change public awareness; change public attitude; give it the proper weight; and people will start voting in a way that selects candidates who take this issue seriously. I want to see the food industry being more responsible, push less Doritos down our throats on TV, and instead promote more whole grain rice.
As far as the overall healthcare delivery model for the U.S. (Other countries may require a different model.), I think you need a variety of approaches, but again we definitely need a huge changes that allow for greater convenience for patients, better service and quality, lower costs, and one that can produce positive results.
We need to look at current successful models of business, such as Amazon. Why is Amazon so successful? There are many reasons, of course, but the one’s that pop in my mind are: convenience & speed of service, range & quality of products available, competitive pricing and easy comparison shopping, customization, innovative online tools (such as one-click shopping, which I think is the best thing since French Toast), and customer relationship building (goes back to customization). How often do we find these words/concepts attached to the healthcare delivery landscape? Definitely not enough.
I just went to a new Family Physician/Internist for a check-up and I still had to hand-write my medical history, with personal and insurance information, on four sheets of paper for 20 minutes. This drives me absolutely crazy in this day & age! There should always be a computer terminal in a Doctor’s office where you can type this in one time or a way to import your health records from a universally formatted thumb drive or Internet service.
Competition & Market Forces
So in essence, if I could create a totally new healthcare model it would encompass the values, goals, and philosophy of Amazon – customer driven, highly reproducible, a service that people find of very high value and utility, and that harnesses technology to achieve the desired results.
That’s easier said than done I know, but when you develop a battle plan, everything should work toward achieving that ultimate goal. That’s part of the problem with healthcare – sometimes there is NOT a clear goal, and we don’t know who is driving the ship or where they are steering it. And again, a big part of that is that healthcare service is not consumer driven to the extent it needs to be.
I’ve worked in various settings in healthcare – hospital systems, private physician’s offices and mobile outfits – so I have a perspective on all. They all have plusses and minuses. For instance, large hospital systems have the best equipment and are best geared to perform complex testing and procedures. They’re prepared for just about anything and have an excellent range of services. Where they lag is personalization, customized service, level of personalized customer service and patient follow-up.
Private offices usually have excellent personalized service but may not have the specialized services to treat the disease effectively. And then some physicians horde patients by not referring them to appropriate specialists.
Mobile services offer great convenience but lack a relationship with the patient, and even the physician’s office and medical information can slip through the cracks. You often have a third party physician reading the studies and disconnect can occur. The reading doctor doesn’t have the full patient history when reading the study (maybe just the diagnosis code for the study), so many under-read a study. For example, they may have one patient, a 22 year old athlete with heart palpitations, but no other history and another patient, also with a diagnostic code of heart palpitations, but with a history of mood altering drugs, some kind of chronic syndrome and a significant family history of early heart attacks. This information is going to possibly change how the physician views the study and the comments that are made in the report.
Electronic Medical Records
Now, I believe that all these types of healthcare delivery entities are valid, needed, and can succeed, but with an infrastructure that links them. And that infrastructure is a universal healthcare information records system that can bring the information together amongst these entities in a seamless, efficient, standardized and effective manner. I think a big part of the gap lies in information. And as much we need to find better ways to get the information to the patients. I think we need to re-look at HIPPA and find a way to keep patient’s health records secure, while allowing patients easier access to the information they need. I see growing frustration amongst patients and their families over how difficult it is to get a simple report. I feel they should have this information with ease, they paid for it, it’s is theirs.
One idea is a central secure healthcare records account (saved on a secure server at a certified Healthcare records server farm) accessible online by private entities which conform to uniform federal standards. For each test (be it heart catherization, blood work, CT, etc.), the healthcare establishment would be required to send all test results to this account in the proper format so the patient and her physician (or whomever has permission) can access it. Let’s get rid of this “testing black hole” in healthcare. I feel that the patient has the right to own this information. Just as we have the right to our tax documents, investment reports, utility bills, and property tax assessments.
A lot of dynamic ways of delivering healthcare services have been mentioned by others, and this tells us that we all see a need for this and that it can actually be done effectively. I am definitely on-board with new ways of approaching patient care. One of these is:
This can be done in a number of settings and for a number of specialties and even testing.
From a private home – via either an existing cable/telecommunications provider or application service provider through the Internet, patients can have video meetings with their primary doctor between regular visits or with specialists prior to a visit. Regular video calls with the physician’s assistant, nurse practitioner, or specialty nurse can also be very useful for patients with chronic conditions or traumatic injuries. To make the session diagnostic, connect a blood pressure cuff, digital thermometer, or even a catheter if the patient has a port. Include some kind of laser scanner for the skin, eyes, etc., some kind of listening device such as an ultrasound transducer, something to read brain activity, or other types of devices that haven’t been invented yet. Who knows what future scientists and entrepreneurs will develop?
From a private physician’s office – A three way video conference could be very fruitful between the patient, patient’s primary physician, and the specialists. A 4 or 5 way call can be used for more complex conditions (say a patient with a congenital heart condition with metabolic as well as neurological problems) or to include family caretakers. Information can be collected and analyzed quickly by the primary doctor and specialist as the patient communicates their symptoms. I believe a multi-party video call would work much more quickly toward arriving at a diagnosis and effective treatment plan and save the patient endless drives, wait-times, time off from work, and time spent filling out form after form for each separate office.
From a hospital or clinic – My hospital performs teleneurology for patients at the facility where they are initially so that a diagnosis can be worked toward even prior to them arriving at the specialty hospital for the specialized care. This can be used for something as simple as an information-collecting video call between the patient and specialists or as complex as a physician controlling a DaVinci system from Newark, NJ and the patient and DaVinci robot is in Des Moines, Iowa. This could also be useful for say a videoconference or even live data transfer between the specialist doctor at the facility where the patient resides and a specialized genetic testing lab. Other possibilities are real time collaboration between a general surgeon and a specialist surgeon during a complex surgery or multiple specialists viewing and collaborating on an endoscopy for a rare condition. There are endless possibilities.
No doubt, telemedicine is on the rise and it will usher in an unprecedented level of cross-specialty collaboration and possibly by documenting and analyzing these sessions with special software may be able to better understand and combat difficult-to-manage diseased.
Finally, I foresee an army of well-experienced, very capable nurses who make visits to private homes, rural clinics, nursing homes in a type of “medical van” where she/he can do everything from taking and analyzing blood work and sending the data wirelessly, to performing ultrasounds, to pacemaker checks, and who knows what else. These visits can be combined with the regular teleconferencing sessions, possibly requiring the patient only an annual or bi-annual visit to their doctor’s office.
About Clifford Thornton, RDCS, BS
Clifford is a registered Adult Echocardiography Technician and has worked at several major hospitals in New Jersey, Maryland, Florida, and North Carolina. He also worked as an Echo Technician for hospitals, private cardiology offices/groups, and mobile firms (including a short travel assignment in the Hawaiian Islands), giving him a broad healthcare perspective.
Prior to moving to healthcare, Clifford was a Program/Product manager for Lucent/Avaya, Director of Custom Market Research and Sr. Telecommunication Analyst for Probe Research, and a Business Analyst for MediaOne Group. That marketing and telecom experience shapes his perspectives on telemedicine. He served in the US Navy and is a graduate of New York University, Stern School of Business, with a B.S. Business Administration/Marketing. Clifford can be reached here by email.