Cancero

A web-conference, entitled ‘The Future of Care Delivery: Relentless Redesign’, organized by the American group NEJM Catalyst was produced on 19 January 2017 and hosted by Providence St Joseph Medical Center (United States).

During this event, various industry players shared their perceptions of US health industry of yesterday and tomorrow, pointing to the development challenges of the health tech, past mistakes and lessons learned from these failures but also the significant opportunities available to healthcare professionals though big data management.

These interventions were focused on a central idea: build a patient-centered system from through high tech innovations emerging on the market.

The conference was divided into three parts:

• Technology Disruption: What Matters;
• Lessons Learned: Failed Experiments in Care Redesign;
• Meaningful Data: Meeting Patient Needs.

New technologies in the healthcare system: are they allied or disrupter?

Healthcare systems are now faced with the development of new technologies. They supposedly help practitioners to provide better health care but they can also cause a waste of time and a waste of energy. How to deploy the right technology, improve care and add value without burdening the patient or the medical team? So many questions put forward by Aaron Martin, Executive Vice President and Chief Digital Officer, Providence St. Joseph Health; Victor Montori, Professor of Medicine, Mayo Clinic, and Molly Joel Coye, Executive in Residence, AVIA and former Chief Innovation Officer, UCLA Health.

« The healthcare sector has so far been slow in integrating new technologies, » says Dr Coye. According to her, one of the first behavior to adopt is to observe what is happening in other fields, such as banking sector or self-driving food to « bring health care in houses. »

Aaron Martin insists that the principles of success basics are the same, whatever the sector. « I worked for a long time for Amazon in the area of e-commerce, there are things that will never change, including three principles:

• offer lower prices than the competition;
• broader choice of products;
• convenience.

I have realized that this is the same in the health sector: ensure lower costs, better outcomes and improve the patient and clinicians experience are part of the foundations for success. »

« Most solutions do not have to be created but to be discovered » (Aaron Martin, Providence St Joseph Health Center)

« Most solutions do not have to be created but to be discovered, they already exist somewhere, » adds Mr. Martin. The idea, he said, is to recruit the right team of health professionals and the right team of experts in technology to find the most interesting innovations and then demonstrate that they work in the health system. Secondly only, you will have to think of a way to get customers online and engaged.

Victor Montori, meanwhile, focuses on a central problem according to his observations: the invisibility of the work of patients. « The Times have changed. Today, many patients are suffering from chronic diseases. They are not in the hospital, do not consult a doctor every day. They have to struggle with their disease every day by taking a certain medication list, questioning their lifestyle (diet, physical activity) to improve their condition or at least slow the progression of their disease. »

It raises several underlying telemedicine issues:

• How to understand the notes sent by their doctors? ;
• How to decipher the medical jargon? ;
• How to know if the alternative medication proposed by the pharmacist will be as effective as the one prescribed by their doctor?
• etc.

« All this patient’s work is invisible. We need to improve communication between health professionals and patients to overcome such problems. »

According to the expert, the key is the attention given by the physician to patients. « As health professionals, we must not seek to make money but above all to listen to the patient, help him understand his disease, encourage him to invest in its care. New technologies must be a support to improve this relationship and not a source of remoteness between doctors and patients. « 

« The technology is there to help us fight against the tensions between health professionals and consumers, » agrees Aaron Martin.

Transforming the health care system: lessons learned from mistakes made in the past

« The American health care industry is sick, analyzed the Harvard Business Review in an article published in 1989. Its huge fraction of our GNP – one out of every eight dollars – is double that of Japan and at least 50% higher than that of other developed countries. Because it is growing at rates 50% higher than the GNP, the industry’s cost hampers control of our disastrous trade deficit. »

Benjamin K. Chu, President and CEO, Memorial Hermann Health System, points to a first mistake made in the 1980s-1990s: leaving aside the feelings of patients.

« At that time, we tried to find a business model to restore the healthcare market economy. Industry players were primarily focused on the desire to turn the corner from the economic point of view. Nobody asked the opinion of the patients. It is not surprising that they revolted at some point », by questioning more often the quality of the care delivery and the diagnosis of their doctors.

Over the past twelve years, the focus was on the creation of a new culture of health care delivery. New business models are sought, new technologies are emerging to try to improve the delivery of care. « Gradually, the economy of the healthcare sector got better but we were still too focused on monetary issues. »

It is only recently that the interest around the patient has increased, Dr. Chu said. Refocusing on devotion, that’s the key. »

Chronic disease management: forty years of learning

Arnold Milstein, Professor of Medicine, Stanford University School of Medicine, talked about the chronic diseases management, whose significant progression makes it one of the current and future main concerns. In the US, 86% of American healthcare expending is incurred by people with chronic illness, the expert recalled (official figures).

He went back forty years ago to better understand the evolutions in this specific area and to identify the bad paths taken by the care providers.

• In the 80’s-90’s: « Doctor knows best.  »
  The tool available was generally phone, that is it: « If you were lucky, you could get an appointment in fifteen minutes with a doctor in the day to deal with a specific problem, if not, you should leave a message on the answering machine that advised you in most cases to go to the ER. A basic and simplified system that of course did not meet the needs of patients with multiple chronic disease problems ». Result: failed.
• Late 90’s – early 2000: the beginning of telemedicine. Add insurer’s 1 800 nurse case manager.
  Nurses from a remote location contacted patients to find out what is going on and take care of them. « It seemed like a good idea. This kind of intervention still persists today although a CBO report had demonstrated that there was no positive impact on health expenditure. » Result: failed.
• Around the 2000s: The improvement of the telemedicine system.
  The interactions between nurses working remotely and patients become more sophisticated, caregivers were particularly interested in the psyche of the patients and the importance of the social in the process of healing. « Real medical teams have been created. Investors were very enthusiastic but most have failed because most of these interventions did not include an actual face-to-face with the patient, they did not established a deep relationship between the patient and the care manager and between the care manager and clinicians. Everything was more or less managed remotely.  » Result: failed.

In its report on these efforts to reduce health spending while improving the quality of healthcare delivery, the CBO concluded « that between 33 and 34% of these experiments have failed ». They ultimately cost the government more. « This is a high failure rate!, Aaron Martin said. The ones who worked were those centered on the sickest patients, called « the high-spending patient demo » but in the end, it seems logical that they resulted in more money coming in because patients were very ill and forced to spend more. The idea is to find a way to reduce costs and earn money even when we have to deal with less serious and complex diseases. »

« How the United States is begin to learn from sequential failure of experiments in managing chronic illness care? » is the question that interests Arnold Milstein now. He is positive. « We have gone through forty years of learning to understand how our industry can work better. I do not consider these bad investments as failures if we learn from these mistakes for the future. « 

Managing meaningful data to meet the patients’ needs

A key to success in the healthcare system of tomorrow is to learn how to effectively manage health data.

« With the development of new technologies, the goal is to reduce health facilities through the digital », explained Scott Weingarten, Senior Vice President and Chief Clinical Transformation Officer, Cedars-Sinai Health System.

« We have to deal with a large volume of information:

• 50% of this information come from care evidence-based;
• we have resources produced by approximately 20 000 biomedical journals;
• an article on health is published on average every 26 seconds;
• the volume of medical information has doubled in the last three to five years.

Today, electronic health records are used by:

• 96% of hospitals;
• 85% of physicians’ offices.

Clinical decisions are determined by the analysis of its data.

How can this mass of information be analyzed? What is the best diagnosis? This is the kind of question that must be asked by the caregivers today. »

Lee Hood, Senior Vice President and Chief Science Officer, Providence St. Joseph Health, emphasizes the importance of the cloud and how it can improve the wellness of patients.

« Through data analysis, we can better understand the transition from wellness to disease. The idea with the big data management is to work on preventive medicine, to understand how the combination of genetics and environment can influence a person’s health. »

From this observation comes out a priority: « to find how to educate patients, physicians and other healthcare players to take advantage of this massive influx of data to improve the provision of care for both the rich and the poor people ».

The expert is positive about the future of health care in the United States: « I sincerely believe that we can find a system in which the health care delivery system will be better and will have reasonable cost. »

« It is possible to simplify the health care system for all by adopting a pro-active attitude allowing everyone to positively affect his health, summarized Amy Compton-Philips, Executive Vice President and Chief Clinical Officer, Providence St. Joseph Health. We have to imitate the models that work in other areas rather than wasting time and money to innovate. We have to change the culture of the healthcare industry to be able to change the sector. »