Disruptive Innovation and Reform of Our Healthcare System

In a number of previous notes, I have suggested that our healthcare system is broken and needs radical reform. In one of them, I pointed out some of the absurdities of hospital pricing (see: Why the Prices Charged by Hospital for Inpatient Care Are Irrelevant). I have also discussed in previous notes the idea of disruptive innovation that was originated by Clayton Christensen and colleagues. Dr. Jason Hwang, a co-author with Christensen of "The Innovator's Prescription: A Disruptive Solution for Health Care" will be lecturing about this same topic at the upcoming Lab InfoTech Summit on March 16, 2009, at the Venetian Hotel in Las Vegas.

Many people are in agreement that we badly need a new healthcare business model and disruptive innovation can provide a lens through which we can better understand the changes that will be necessary. A recent article in the New York Times discusses this specific idea (see: Disruptive Innovation, Applied to Health Care). Boldface emphasis is mine:

Two main causes of the system’s ills are century-old business models, for the general hospital and the physician’s practice, both of which are based on treating illness, not promoting wellness. Hospitals and doctors are paid by insurers and the government for the health care equivalent of piecework: hospitals profit from full beds and doctors profit from repeat visits. There is no financial incentive to keep patients healthy....Advances in technology and medical research are making it possible to envision an entirely new health care system that provides more individualized care without necessarily increasing costs, some health care experts say....As researchers develop ways to define diagnoses more precisely, more effective treatments can be prescribed.... Ultimately, those therapies can be administered by nurse practitioners or others trained to handle routine ailments. The expensive “intuitive medicine” practiced by doctors trained to wade through a thicket of mysterious symptoms in search of an accurate diagnosis can then focus on those cases that truly require their services....Disruptive innovators in health care aim to shape a new system that provides a continuum of care focused on each individual patient’s needs, instead of focusing on crises.[Clayton] Christensen and his co-authors argue that by putting the financial interests of hospitals and doctors at the center, the current system gives routine illnesses with proven therapies the same intensive and costly specialized care that more complicated cases require.

Almost every sentence in this excerpt is juicy and food for thought. I hardly know where to start in order to react. To pick only one of the ideas, I particularly like the following: Disruptive innovators in health care aim to shape a new system that provides a continuum of care focused on each individual patient’s needs, instead of focusing on crises. I have discussed the need for a continuum of care in previous notes (see, for example: Predisposition to Disease and Pre-Disease on the Health Continuum). You may want to review the diagram presented with this note that illustrates the ideas of predisposition to disease, pre-disease and clinically overt or manifest disease.

I am in favor, as noted in the excerpt above, of having nurse practitioners initially see most patients and treat routine ailments using well-defined diagnostic and treatment algorithms. In addition, I believe that greater use should be made of the superb medical diagnostic options that are now available and getting more sophisticated by the day. These would include clinical lab testing, including molecular diagnostics, with some selected medical imaging initially. This will enable the diagnosis of pre-disease, which is to say disease in its earliest stages, and a broader orientation toward preventive medicine. The more complicated patients will be referred to physicians by the nurse practitioners for more complicated diagnostic procedures and ultimately treatment. As noted above, such a broad approach will help to avert much of the crisis-oriented care of today.

Comments

[Mark Pool, M.D.]

An innovation such as this would require (I would argue already now requires) a radical change in medical school curricula and residency training. I don't believe that there are sufficient experienced physicians with (adequately compensated) time to re-orient curricula. Suffice to say, there are massive challenges to American medical education that must occur yesterday.