Archives For health care

Re-designing healthcare

September 23, 2009 — 4 Comments

I spent last week at the Mayo Clinic symposium on health care innovation called Transform. It was excellent. A great group of speakers and an audience populated by some of the most important players in health care innovation.

You can check out the videos from many of the speakers at the Mayo Transform site. Unfortunately I can’t link you to the individual talks but I would recommend the following in particular:

Clayton Christensen on the Innovators Prescription. For those that have not read the book this talk makes a rigorous argument for how the business model of healthcare needs to be restated.

Amy Tenderich talks about the Diabetes Challenge. An attempt to get design thinkers engaged in improving the lives of diabetes sufferers.

Victor Montori, a Mayo physician, does a great job of showing how doctors get it wrong when they don’t consider the whole lifestyle of the patient when they prescribe remedies.

Denis Cortese, the current head of the Mayo, describes where the health care system is dysfunctional today and what Mayo plans to focus on to help resolve that.

Elizabeth Teisberg talks about health care policy and in particular the importance of focusing on value not cost reduction.

Frank Moss from the MIT Media Lab gives a great talk and demonstration (with one of his graduate students) on empowering each of us to be responsible for more of our own health care.

Patrick Garaghty, CEO of Minnesota Blue Cross Blue Shield, makes an impressive argument for how it is in the interests of payers to focus on wellness programs. Given the bad press that insurance companies have been getting in the recent debates it was good to see some real leadership coming from them.

As always, Larry Keeley makes an eloquent and urgent case for innovation based on showing how Leonardo got things wrong.

The three ‘i-spotter’ award speakers all gave great short talks on their projects – Jaspal Sandhu, Jeff Belkora and Alexandra Carmichael.

I headed up the last session which was specifically on design thinking. I was followed by three wonderful talks by Karl Ronn of P&G, Christi Dining Zuber from the Kaiser Innovation team and Maggie Breslin from SPARC, the Mayo design and innovation group.

Overall I was very impressed by the level of the dialog about innovation and design thinking, particularly amongst the physicians. I suppose it shouldn’t be surprising that a profession that is focused on making people’s lives better is so enthusiastic about a human centered innovation process.

The image is courtesy of Marc Koska at Safepoint. I included the story of Marc’s innovation, the auto-disable syringe, in my talk.

Mayo Innovation Symposium

August 16, 2009 — 1 Comment

The Mayo Clinic is hosting a symposium on innovations in health care experience and delivery at their Rochester, Minnesota campus in September. I will be speaking on design thinking and health but should that put you off, their are some great speakers on the roster that will be well worth listening to. They include Clayton Christensen, Larry Keeley, Craig Barrett, Linda Avery (23andme), Denis Cortese M.D. (CEO pf Mayo), Karl Ronn (P&G) and Frank Moss (MIT Media Lab).

Check out the website if you are interested in the debate about where health innovation is going. It could be a refreshing change from the circular arguments we are hearing in the press about health reform these days.

Apologies for being off-line but I have been taking a bit of r&r.

The current debate around health care reform is both interesting and depressing. While it is reassuring to see America finally tackle the issue of universal health care access the bigger debate about affordability seems to be going nowhere. Much of the conversation seems to be based around the role of prevention in bringing health care costs down but as Matt Miller pointed out in his Fortune article, prevention does not bring down the cost of health care – if anything it may actually force it up. He argues that a high proportion of health care costs happen in the last few months of life and no amount of prevention can avoid the inevitable.

This may be an extreme argument and few would argue that reducing obesity or smoking and increasing excercise does not have a beneficial effect. However it is correct to assert that prevention alone will not create a sustainable and affordable health care system. And system is the operative word here. Innovations have to occur across the whole system if sustainable change is to happen.

Productivity is just as important as prevention when it comes to creating affordable health. The tendency is for the political argument to jump straight to rationing as the cost control strategy but I believe there is a wealth of opportunity for innovation that creates greater productivity. Some of that will come from technology (although there are precious few examples of that so far) but much can also come from process innovation. Kaiser Permanente found ways to bring the time it takes nurses to change shift down from 40 minutes to 12 by going through a design based exploration led by nurses and other practitioners. Multiplied by every nurse on every shift on every ward in all forty hospitals this added up to a huge amount of extra time available to serve patients. The key here was that the innovations came from the ward floor, not from the executive suite, never mind Washington. Getting design thinking into the hands of health care practitioners may just offer one route to affordable health.

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This is the fourth of a series of pieces originally posted at Fast Company.

In the U.K. in the 1940s, Sir William Beveridge designed what became known as the welfare state. In an ambitious program, the post-war Labor government attempted to put in place a series of services designed to ensure that the population of Britain could reliably receive high-quality public education, health care and other public services. Beveridge envisioned a system in which citizens participated directly in their own well-being. Instead, he helped create what he later described as a “culture of consumption” of public services.

Here in the U.S., a “culture of consumption” is exactly what we have when it comes to health care. The third-party payer system (whether it is private insurance or government) has created passive consumers of health-care services who have little motivation to engage, and bloated, bureaucratic service providers who have little motivation to become more efficient. It is difficult to envision any effective reform of our seemingly doomed system that does not demand much higher levels of engagement from all the participants in the system.

As individuals, we must become more engaged with our health, including living lives that promote health and wellness rather than encourage the onset of chronic disease. As corporations, we must consider the social contract we have that grants us permission to operate and extract profits. As health-care providers and insurers, we cannot continue to demand an ever-increasing percentage of the nation’s wealth without providing widespread and sustainable benefits. Instead of each remaining entrenched in our own view of the system, we must find ways to achieve what presumably is a shared goal of a healthy and productive society.

Fundamental to this collaboration is the creation of platforms that encourage participation. By this I don’t mean goading people into eating healthier food or taking more exercise. These may be beneficial outcomes of other more systemic innovations, but they are not, on their own, going to create the major shifts that we need.

Two platforms that are already under discussion and, in my opinion, offer huge potential for improved collaboration and participation, are e-medical records and health savings accounts (HSAs). With the risk of sounding like a health-care reform lobbyist, here is why I think they are important, but also why I think current ideas about these platforms run the risk of limiting their impact.

Electronic medical records offer the opportunity for each and every member of society to take control of his or her health. Instead of waiting for some symptom to drive us to the doctor, we can integrate information from a host of sources, including ever more pervasive monitoring technologies, to give us a picture of our health. This system could also provide goals, allow us to rate and recommend service providers, let us explore alternative means of achieving health goals, and enable us to create a personal network of health providers where each individual expert can interact with every other to ensure optimum outcomes.

E-medical records can do for health what Facebook is doing for the creation and maintenance of social groups. However, they can only do this if they are designed to serve the needs of every stakeholder, but particularly us as individual citizens. If, instead, they are designed merely to automate existing bureaucratic processes, or to protect the interests of incumbents–including promoting walled gardens of information–then we will miss a huge opportunity to change the way individuals engage with their health.

Open, connected e-medical records designed to support unknown future products and services should be the goal. Imagine an equivalent to the Apple application store where all kinds of health products and services are available and where it is easy for us to build our own unique and personal toolkit for being and staying healthy.

Just as important as the acquisition and management of health services is the question of who pays for them. There is obviously a need for some kind of risk sharing to make health care equally accessible to all. In our current system there is little to motivate individuals to alter their behavior in the interests of better health.

Corporate America has been far more effective at encouraging us to spend money on fashion and beauty or SUV’s than it has been at seducing us to focus on our health. While the introduction of Health Savings Accounts (HSA’s) was a result of attempts to limit rising corporate health-care costs and to give individuals the opportunity to do some of their own risk management, I think they offer an opportunity for the government to significantly change our attitudes towards health.

Existing insurers are understandably reluctant to offer to pay for new services that might have a long-term preventative benefits but are yet unproven, but governments do this kind of this all the time. If the rules around what is a legitimate expenditure for an HSA were open to experiment, I believe that a host of nutrition, fitness and other health-related products and services would emerge to compete with the existing health-care services we have today.

Ultimately, enlightened insurance companies would provide additional benefits to those who took control of their personal health, thus helping to accelerate the shift to health versus health care. Existing incumbents in the health-care industry would get more serious about offering scientifically proven offerings, such as nutrition monitoring, if they could see that there was a significant market for them. Since we, as individuals, would be paying for them with our own dollars those offerings would much more likely be cost efficient.

E-medical records and HSAs are both examples of platforms that encourage participation and that can support an eco-system of innovation that results in untold benefits. Are there other participation-based platforms that might have an impact on health in America?