• A Milestone on Many Levels: Publishing a Joint Op-Ed with Google

    Over a year ago, a dialogue started about the rules surrounding ‘meaningful use’ – and with anything like this, there are always lots of voices, lots of opinions.  Given our history, we were in the ‘faction’ of folks focusing on ensuring that consumers were at the center of this discussion – and along with us was Google.  This was surprising to some given that we compete in so many areas.  But in this case, we all recognize that reforming healthcare is so important that it will take a lot more than just one or two companies rallying around the cause.  And so, we worked together with Google to respond to the Meaningful Use definition through an Op-Ed for The Hill, which can be read below.

     

    Adopting electronic health records will cut costs

    By Peter Neupert and Alfred Spector

     

    http://thehill.com/opinion/op-ed/83267-adopting-electronic-health-records-will-cut-costs

     

    As described in a report from the Robert Wood Johnson’s Commission to Build a Healthier America, “For the first time in our history, the United States is raising a generation of children who may live sicker, shorter lives than their parents. We must act now to reverse this trend.”

     

    The good news is that the Congress and the Obama administration have taken significant actions that could help.  In February 2009, Congress included in the American Recovery and Reinvestment Act $36 billion in funding that will provide incentive payments to healthcare providers and organizations to encourage them to adopt health information technology. This technology aims to transform healthcare by improving quality and reducing costs, most significantly through the adoption of electronic health records.

     

    In late December, the Obama administration issued proposed regulations governing the distribution of this funding. The administration and Congress wisely perceive the tremendous opportunity to transform the health system through widespread adoption of electronic health records, while also recognizing that the adoption of technology by itself is not a silver bullet.

     

    A recent study conducted by Harvard Medical School and published by the American Journal of Medicine stated, “As currently implemented, hospital computing might modestly improve process measures of quality but does not reduce administrative or overall costs.” To address this issue, the government is working to finalize a formal standard of “meaningful use” of electronic health records that will require things like the electronic exchange of data and reporting of clinical quality measures to ensure effective use of technology in healthcare.

     

    But if we are to successfully bend the cost curve on healthcare — and improve our health at the same time — the government needs to focus on two core principles as it finalizes the meaningful-use standard: putting consumers at the center of the solution, and focusing rules about the use of health technology on the outcomes we want to achieve, rather than on the technology itself. How do we do this?

     

    First, it is essential that the definition for “meaningful use” of health information technology includes enabling consumers to have convenient, electronic access to their own medical data. This would guarantee that stimulus dollars are spent on health IT that would engage consumers in managing their own health and their family’s health.  Our current system has been built around providers, insurers, the government and employers — not around consumers. But the majority of health decisions are made at home, and the daily choices individuals make can affect what everyone in the system pays for healthcare. By empowering consumers with the right information, they can make more informed decisions and work with healthcare providers to more effectively manage their health.

     

    Second, the rules around the use of health technology should set objective goals and criteria — focused on better outcomes, chronic care management and hospital effectiveness — without mandating the use of specific technologies or development models. This approach is similar to the government’s involvement in other industries. For example, automobile safety is regulated, but the shape of the car and its features and functions are generally not regulated — which spurs ongoing industry innovation.

     

    The power of technology lies in its potential to transform industries, enabling new ways of working and communicating, new economics and new business models.  As consumers, we’ve experienced how technology impacts nearly every area of our lives — how we manage our finances, travel, communicate, shop and so on — with more self-service, more control, more convenience and ultimately better value for what we spend.

     

    No one said this road would be easy.  We are trying to change a system that is deeply ingrained in our country’s way of life, and it will take all of us — patients, physicians, hospitals, health insurers and technology companies — working together to achieve real reform. The current focus on healthcare gives us an opportunity to do what America does best — innovate to improve productivity and efficiency. As we continue our debate on healthcare reform, we commend the Obama administration for supporting consumer engagement and a focus on health outcomes in the proposed regulation, and we encourage continued commitment to these core principles.

     

    Neupert is the corporate vice president of the Health Solutions Group at Microsoft.  Spector is the vice president of Research and Special Initiatives at Google
  • Change Agents at Work; Catalysts to Improve Our Health System

    There are days that I love my job (not every day yet), and last week I had one of those special days.  I participated in the Forum for Sustainable Health, an event hosted by Arizona State University’s Biodesign Insitute with a bunch of incredibly smart people -- all change agents in their respective areas -- talking about the policy, scientific, clinical and consumer changes needed to transform the health delivery system and leverage the knowledge coming from scientific discoveries to predict and prevent disease.  I was there because many of the stakeholders recognize that scale software is a critical component to enabling discovery and transformation and because consumer engagement is critical.

    At the center of the event was the launch of an effort called the Global Biosignatures Network, a global network/confederation of public and private sector groups -- clinical care sites, clinical research investigators, academic research laboratories and medical technology and biotechnology companies in the US and elsewhere -- all collaborating to drive better diagnostics and accelerate applied research. Imagine the world’s best and brightest working together to share knowledge about the science and how to apply it to solve real world problems quickly…that is the goal of the GBN.

    The forum was basically a brainstorming session (with a lot of big brains -- Lee Hartwell, Denis Cortese, David Lawrence, Alan Nelson, Spyro Mousses to mention a few) around how this network could help drive the use of information more effectively to enable earlier detection, intervention and ultimately the prevention of disease.

    We talked about a lot of the issues… When you think about healthcare today, most systems -- whether in the U.S. or elsewhere -- dedicate most of their resources to what David Lawrence calls “sick care” and the late stage treatment of disease.  And in those areas -- we apply pretty generic “treatments,” which produce a wide variation in terms of outcomes.   We don’t have very good feedback loops and therefore can’t drive “continuous improvement.” So, we end up with poor health outcomes and skyrocketing costs.  Not to mention that we’re totally not set up to handle or deliver on the promise of personalized medicine

    And we talked about solutions….  We have to develop better diagnostic capabilities to transform our ability to prevent and respond to disease -- being able to identify diseases at their earliest and most curable stage, and for those who develop disease, be able to have tests that predict who will respond to which therapies before they are given.  As part of this, we have to be able to connect and engage with consumers in new ways -- to accelerate research, to educate on how lifestyle actions affect health and disease and on their role in engaging with the medical community around “shared decision making.”   As is pointed out in The Innovator’s Prescription, with greater precision and predictability, we create the opportunity to develop innovative and disruptive ways to deliver less expensive and more reliable care using non-physician health professionals, consumer “self-serve” models and other types of technology services and solutions.  

    And for an old philosophy major, it was interesting to me that the discussion also traversed into the areas of Epistemology and Philosophy -- really fascinating to think about the intersection of bio-medical science and philosophy.  I even added a few books to my list of upcoming ‘reads’:  On Intelligence and The Origin of Consciousness in the Breakdown of the Bicameral Mind

    The science is really exciting (at least what I could understand from it) -- there is a ton of exciting work advancing our understanding of how the body works and the efforts are really spread out around various centers in the world -- which is a good thing.  The conversation amongst the stakeholders was powerful, and there were frank discussions about the challenges in implementing the kind of changes necessary to accelerate real world solutions -- changes in the regulatory environment, in the incentives of stakeholders, funding, business models, aggregating/sharing this data, and other policy issues.  Often I feel that the most significant barriers are those around policy, and ironically,  I had the opportunity to spend some of the day talking to Aneesh Chopra and Todd Park on the phone -- they are true change agents, trying to push the envelope inside our government in so many ways. While I’m often a skeptic, I couldn’t help but leave this meeting hopeful -- with all these incredibly smart people working to find practical solutions to make improvements to our systems, I can’t help but feel that we can make a better health future for our kids. 

  • Health Care Reform is About Improving System Performance

    I was asked to contribute to the sequel to the award-winning book, Paper Kills.  The New Edition (released just last week)  is called Paper Kills 2.0, How Health IT Can Help Save Your Life And Your Money.  In the Book, Newt Gingrich, Tom Daschle, and other national industry leaders explore the leading information technologies that can and will transform our health system.  I was pleased with how our chapter turned out -- it's the first chapter of the book and is called 'Re-charting Healthcare:  Innovations to Drive a New Delivery Model for Tomorrow's Health System'.

    As part of the launch of the book, I was asked to comment on last's week Health Summit with other folks who spend just as much -- if not more time -- thinking about health reform.  My post -- Health Care Reform is About Improving System Performance is below. 

    Health Care Reform is About Improving System Performance

    I commend the Administration for continuing to try to keep healthcare reform in the spotlight -- it affects all of us in so many ways, and we all have to keep trying.  The President kicked off  today’s summit with a great summary of what’s happened with reform over the past year --  lots of people on both sides of the aisle have worked hard with good intentions, but somehow the whole effort/discussion/debate turned into an ideological and partisan battle in which politics seem to have trumped common sense.

    What we need now is to take the opportunity to get back to a ‘common sense’ approach and get to the ‘basics’ of what we want reform to do and then figure out the best way to achieve those desired outcomes.

    Everyone (citizens and politicians) wants more and better 'health' -- a better health delivery system, more prevention, more therapies to cure complex diseases, more and better doctors. In addition, there seems to be a large focus on ensuring that everyone has access to health insurance.  But more 'health' is not free, and more health insurance does not necessarily equal more 'health’.  Our challenge is to reduce the waste in our current system to get more 'health' for the same amount of money. This is clearly very hard, from both a legislative and practical implementation perspective, but it needs to be done.

    If we look at today’s system performance, in our best case scenario (Breast Cancer), we’re only ‘getting it right’ approximately 85% of the time, and at a cost that will bankrupt our nation.  We have massive variation in practices, costs and outcomes – at the root of which is a fee-for-service payment model that has locked us into the past inhibiting the kind of broad-scale innovation that has transformed nearly every other industry that touches our lives.  If any other business were to run this way, common sense would tell us that it would fail -- people would lose their jobs and consumers wouldn’t get their products.

    With healthcare, it’s more serious.  When the system fails, people die.  We can and need to do better.  We need to create a new system -- transitioning healthcare from unmanaged care (show up when you are sick, fee for service) to informed, coordinated care (population focus and pay for outcome), and from unmanaged processes (treat in office/hospital, based on physician) to managed processes (assuring that patients follow a care pathway; drug and test regimen across time and location).  To do this, we must:

    ·         Take the Variation Out of Care By Creating Feedback Loops.  If we do a task differently every time, we won’t be able to improve the result.  In health, this is about using data to see what works or not, and then educating medical professionals and consumers pervasively to put the best methods into practice.

    ·         Encourage and Stimulate Supply-Side Innovation.  Our current fee-for-service payment model does not reinforce and reward provider innovation nor does it facilitate new industry entrants to drive better, more efficient, convenient, and cost-effective delivery methods.  The current model rewards ‘doing more’ versus ‘doing better’.

    ·         Shift the Value Chain.  We need to let consumers and other health professionals like nurse practitioners or even software do some of the work that the most educated (and therefore, most costly) physicians should not and cannot be doing anymore.  Physicians should be focused on using their unique expertise and skills on the things that require very specialized knowledge and skills like treating top priority, chronic diseases

    Just making the system bigger -- adding more people -- doesn’t solve the problem.  We have to change the health delivery system -- real reform is about ‘doing health’ differently.  Once we figure out how to reform the health delivery system -- to get the most out of it, then we can turn our sights on how to design the right insurance programs and regulations to expand access. Regardless of how we do that, one point is clear –we need to decouple health insurance from employment so that it’s portable and open to all. 

    Today’s discussion focused on four main areas -- controlling costs, reforming insurance, expanding coverage, and reducing the federal deficit.  At the end of the day though, we won’t be able to tackle these issues until we fundamentally change the system -- how care is delivered and individuals manage their own health.      

     

     

  • The Way Forward

    This week's question for the Washington Post Health Care Rx blog was:

     

    In a Feb. 2 conference call, House Speaker Nancy Pelosi talked about starting small. She indicated she wants the House to vote on elements of health-care reform, such as repeal of McCarran-Ferguson Act, which exempts insurance companies from antitrust laws. Is this a smart strategy or just political show?

     

    My response, The Way Forward, below:

     

    It seems like this is more of a move to revive the momentum for larger health reform. The Senate can't pass a repeal of McCarran-Ferguson and in the grand scheme of things, it's hard to see what the practical implication of this would be on improving health outcomes, increasing access, or slowing skyrocketing costs.

     

    While some may think that the Massachusetts election has caused health-care reform to grind to a halt, I think we need to treat this as an opportunity to take stock of what we've learned and what we want reform to achieve. At the end of the day, citizens are the ones responsible for their health - they make decisions every day that affect their own health and can increase costs to the entire health system. Reform has to be about empowering consumers to understand and take charge of their health and we need a system that will allow that to happen.

    A thoughtful commentary on a path forward is the Wyden-Bennett Healthy Americans Act. It is, by definition, bipartisan and takes a big step forward by separating health insurance from employment, which will guarantee that individuals will not lose their insurance even if they change or lose their jobs. Most importantly, it will encourage new innovation in the health insurance industry. The bill provides some solid thinking and solutions to improve outcomes by focusing on prevention, wellness and disease management, and tying accountability and incentives appropriately.

    By creating a system driven by innovation with consumers at the center (versus providers) we can move forward with meaningful change.