So…life’s been really busy – which has meant a hiatus from the blog. Moving forward, I’m committed to making this more of a priority and looking forward to writing about a range of health-related topics – not just US healthcare reform.

A couple weeks ago, I had the opportunity to spend some time in the UK meeting with folks from several hospitals, including University Hospital of South Manchester, Milton Keynes Hospital and Great Ormond Street Hospital Charity. Fun story about Great Ormond Street Hospital – JM Barrie gave them the rights to Peter Pan, so they get royalties every time the play is performed.

The UK is focused on some exciting ideas around transforming healthcare delivery. They think about health from end-to-end – including everything from subsidized child care for poor families to social services to elder care to General Practitioners (GPs) to specialists to hospitals – and are working to align incentives and reimbursements with integrated care models. As they look to reform the system, the government is focused on two core principles: creating a marketplace for healthcare services – so market signals determine who gets paid what for healthcare and how capital is invested – and a patient-centric approach that includes a personally controlled health record.

The changes will be dramatic. The government has already announced a plan to give GPs responsibility – and funds – for commissioning care for patients in their area by buying treatment from hospitals, charities and other doctors. Folks are taking a collaborative approach to building out these integrated systems – at South Manchester, they’re pulling together officials from public health, the hospital and community GPs to figure out how to get started.

It’s going to be really interesting to watch this over the next two to three years. There’s every chance the UK will move much faster than the US to a health system that’s more focused on value.

Last week, I was in Washington, DC. It’s a trip I haven’t made in a while, and it was fun to be back. A highlight of the week was a meeting at the Pentagon – my first time there. It was great to see and honor those that serve – especially a couple days before Veterans Day.

I was in DC – along with about 2400 others – for the mHealth Summit. The event was filled with lots of buzz and excitement around the transformative possibilities of cheap mobile devices and connected services for healthcare around the world. Health is inherently mobile – it’s about decisions you make and actions you take as you live your life, so I’m optimistic that ‘mobile health’ will become an integrated part of our healthcare system. What I don’t know is whether it’s going to take three years or thirty years for us to get there. In the US, we need to transform the incentive system – so doctors don’t just get paid when patients come to their office – before broad adoption of mHealth will happen.

In DC, there was of course lots of conversation about the election and its impact on healthcare reform. It’s unclear how the politics will play out, but payment reform to create value and drive out waste is a bipartisan issue – Democrats and Republicans both see the need, though they disagree on the means.

I applaud the attention on new delivery and payment models for healthcare – in the US, through the creation of accountable care organizations (ACOs) and in the UK through GP-based commissioning.  Both models support a holistic, integrated, patient-centric view of health and recognize the need to get the incentives right. It seems like healthcare reform will enable and may potentially accelerate experimentation.

As we talk to customers around the world, it’s clear that they aren’t waiting for results from all these reform experiments. There’s a distinct focus on finding information technology tools now that help them understand how to manage the care of populations in a very different way – not just when patients visit their facilities.

We’re just wrapping up our third annual Connected Health Conference, held in downtown Bellevue, WA. It’s where we get together with a few hundred customers, partners, thought leaders from the industry, policy makers -- and talk about the healthcare industry and the kind of positive change and innovation that’s happening.  I like to think of it as a “Community of Innovators.”

We’re seeing real progress.  At last year’s conference, much of what we talked about was still at the 'implementation' stages -- customers were deploying, beginning to use and see value from our products.  I won’t go so far as to echo what our conference moderator, Ian Morrison, said -- that the only place where a new vision for the industry seems to be alive is in PowerPoint -- but 2009 was an earlier stage of the business . Today, our vision about ‘liberating data’ and creating a ‘connected’ health system with patients at the center is becoming a reality, as demonstrated by the work our customers are doing with Amalga and HealthVault.

My Wednesday keynote focused on just that – driving a health system based on VALUE versus the system of today, which focuses on VOLUME.  You can see some of the highlights of my talk in the video below.  I shared some perspectives on the system as a whole, on organizations and their path forward to becoming more flexible, empowering, and adaptive and on consumers – and of course included some thoughts on how technology can be a tool at all three levels to help drive positive change and enable innovation.

My favorite part of the conference was a panel we had on the topic of driving innovation in health.  The panelists included Todd Park,  CTO of the U.S. Department of Health and Human Services , David Brailer,  Chairman of Health Evolution Partners, and Rod Hochman, CEO of Swedish Medical Center.  These folks are all innovators in different ways, and we had a very insightful and lively discussion.

Some of the more interesting thoughts:

• Actions to improve the system – Drive variability out of healthcare delivery, Get back to ‘community rating', Have the government create incentives and remove dis-incentives, Separate employment from insurance
• How to remove the barriers to innovation: focus on incentives (paying for VALUE not VOLUME) and information (data liberation).
• Driving demand-side ‘consolidation’ – Folks talked about how supply-side innovation and change are clearly happening, but what’s really needed to drive systemic change, including motivating and catalyzing politicians, is a different kind of aggregation on the demand side.  Historically, patient populations have coalesced around diseases and disease states, but there’s a need to aggregate differently – by age, sex, etc. – to really understand and communicate patient needs and wants. 

You can see more panel highlights in the video below:

We also had the opportunity to ‘zoom out’ and take a broader look  at how the field of computer science is advancing.  Microsoft’s Chief Research and Strategy Officer, Craig Mundie, shared some perspectives on how powerful client machines and the cloud, combined with a revolution in the ways people interact with computers, will define a new era of computing.  He demonstrated the kind of future that’s possible – you can see it in the video below.

I left the conference feeling very energized, excited and inspired!  While sometimes it feels like we are pushing a rock uphill, I believe we’re on the right path.  This ‘Community of Innovators’ will be catalysts for change.

For my latest thoughts on the business of health care, particularly the existing health care delivery system and payment framework, please see my contribution to the Harvard Business Review Conversation Starter blog.

Last June, I became a regular contributor to The Washington Post’s “Health Care Rx” blog, which provided space for me and other experts from across the industry to comment on the current state of the health system and offer real-world insights into how to improve health care. Now, given the recent passage of health reform legislation, the blog will come to a close. The final question came on Monday:

This week, President Obama plans to sign into law a budget "reconciliation" bill that includes the final changes to the new health-care overhaul. What is your assessment of the now-complete health law and its implications for the future?

My response, The First Mile on the Marathon of Reform, is below:

The mainstream reform debate has been primarily focused on access -- the millions of Americans who don't have insurance. We heard heartbreaking story after heartbreaking story day after day for nearly a year. And this bill tackles that enormous problem!

But there are the other big problems -- skyrocketing costs, misaligned incentives, inferior and inconsistent care, and so on -- all stemming from the fact that our health delivery model has remained what is essentially an acute, episodic care business model from the 19th century; a traditional fee-for-service model based on patients visiting hospitals and physicians' offices when they're sick. We have a system that hasn't evolved to keep up with the way our nation's health has changed -- toward chronic care. Nor has it progressed to use health data in an effective way to drive better decision-making and improved methods. It's not set up to enable the kind of broad-scale innovation and consumer-focus that has transformed nearly every other industry that touches our lives. Nor is it poised to keep up with and take advantage of advances in medicine, especially to deliver on the promise of personalized medicine.

In the context of these massive structural problems, while the bill is a positive step forward, it seems like it's just the first mile on the marathon of reform.

There are other good "ideas" from "experts" in the bill besides access to address some of these problems -- an Innovation Center within CMS to pilot payment reform, a Patient-Centered Outcomes Research Institute to identify and carry out national research priorities to drive "evidence-based" medicine, a Medicare shared savings program to pilot cost-savings for accountable care organizations, and so on. But these will require doing a fundamentally better job of running pilot and demonstration programs in Medicare. Right now, we evaluate the reforms over 8 to 10 years. We need to lower that dramatically to accelerate the path for these ideas to 'scale' and become common practice -- driving the kind of wholesale transformation needed.

Most people recognize that it will take several years to get reform "right"-- we have an opportunity to do even more to drive innovation and shift the system to drive real value for every dollar spent. I hope that we will continue to work at driving the right combination of structural change, innovation, and use of technology to create a better system for our generation and those to come.