A recent Sacramento Bee article Medical debate looks at comparing therapies states the over “$700 billion is spent annually on “unproven medicine and procedures, a significant factor in the escalating cost of health care.” The reporter does not quote a source for this figure so I am left with wondering what constitutes “unproven” care. By my rough estimation – that would amount to over ¼ of all healthcare cost, in 2009 (see Trends in Health Care Costs and Spending).
Let’s go back to the Innovator’s Prescription, as I mentioned in the previous blog, Mr Christensen certainly indicates his concerns about current business models used in medicine. “Solution-Shop” model is the primary system by which medicine currently operates. Under this model, care is provided in an intuitive and/or experience based manner. Heuristics or “rules of thumb” is the predominating feature in this manner of care, leading often to trial-and-error case management. It is under this assumption, one certainly could content that much of “intuitive” medical approaches are “unproven” – basically we are guessing or purposing a treatment is going to work. The author and news reporter both makes a valid point that moving to “precision” or predictive medicine will be not only valuable but necessary in order to control healthcare costs.
In the Triad of reform through disruptive innovation – it is the technological enablers which act as a catalysis for change. Processes must become simplified, more accessible and cost reduced in order to be made available to great population of “users”. According to the author the direction of changes are seen as occurring through imaging and molecular diagnostics.
Evidence in veterinary medicine certainly supports the imaging enablers as influential in improving patient care. Parallel radiographic systems (such as CCD) have resulted in simple, easy to use and less expensive digital systems that rival the more expensive “standard technology” flat panel and computed radiographic systems. The result is digital radiographic systems have entered mainstream use and have improved the diagnostic capabilities for the small veterinary practices. Ultrasound is also an excellent example of advantages realized through greater affordability and ease of use. These systems have lead to improvements in diagnosis and therefore a more precise approach to care. My one caveat is that these systems have not lead to point of transfer care away from the doctor and I would contend the need and support of advance training as well as consultation with specialists (ie Radiologist).
Computational bioinformatics as well as studies in genomics will be continuing growth areas in healthcare. Genetic screening has tremendous implication in advancing predictive medicine. Along with genomics, molecular biology and computer modeling will improve safety and efficacy of medications. The implications and advantages in these fields with regards to influence on veterinary care is anticipated to be realized but not predicted to be as rapidly implemented – just not the funding or return on investment that can be achieved compared to human healthcare.
Along with the technologic enablers already mentioned systems such as Clinical Decision Support Systems and Personalized Health Records, our patients (clients) will become better informed and better educated in managing their own medical care. I believe that enablers will result in advancing predictive medicine and safer personalized care. Patients are already seeking information through the internet. For these goals to be fully realized, healthcare needs to play an active role throughout to support and assist patients in the right direction.
The ultimate goal of disruptive innovations – is to move medicine away from its traditional roots of a doctor dependent system to become more personalized, patient-centric. There is supporting opinion that the future of healthcare will/is transitioning to the Information Age of Healthcare. “Individual Self-care” will be the leading driver in the model of information age healthcare. In order to facilitate this transition healthcare must become more predictive and commoditized.
Yes, I am not a big fan of thinking that medicine can be compare to building the Model-T and understand that we “old guard healthcare professionals” have reason to pause and wonder “what does all this mean.” That said the ability to make medicine more precise has profound implications. Will it reduce the cost of care by removing “unproven” care – No not completely, but it will result in our decision having greater impact and ultimately improve quality of life.
A colleague of mine has a crystal ball prop that he occasionally refers to in illustrating to clients the challenges of determining outcomes. If systems can help us put away the crystal ball – I am all for them!
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Disruptive innovation is great but there are still outliers like a fine Swiss watch. Your $35 chronograph watch with an LCD display has more functions, keeps better time, and is easier to service than a Rolex, but people are still willing put out over $2K for heavy watch with a mechanical movement. So who has the better business model? Rolex with a low volume and high margin or Timex with high volume and low margins? Replace Rolex with Unisys and Timex with Dell and the answer is not always clear. Unisys could not sell PCs since that could cut into their mainframe business. That allowed Dell an opportunity to sell a high volume to the masses. Now, however, Dell's product are low margin commodities. Without some added value besides price, Dell is in a competitive death spiral.
ReplyDeleteSo, how does a stodgy company like Rolex continue to be able to command a premium for its watches while other companies like Swatch, Timex, and Garmin keep on coming out with more advanced but inexpensive products? I don't have the answer.
I think a good way to leverage your informatics is to get owners to prepay for care and access for their pets. If you are able to answer their questions and prescribe treatment without them having to drag their pet in, the added value will be worth it to them. However, informatics without changing your healthcare delivery options will be at best cost neutral.
A vet clinic is already probably very efficient. I do not think that empowering vet techs to do 90% of the healthcare delivery is the answer. A better option would be to centralize all of the pet's care to include grooming, immunizations, diet, and healthcare with flags for problems specific to that pet or breed. Reminders can be mailed, called, or e-mailed out automatically by the informatics system. "how is the exposure keratitis on your shih-tzu's eyes?"
Outstanding observations and comments! The watch analogy is perfect in describing disruptive innovations.
ReplyDeleteMany/most larger (veterinary) practices still depend on the "standard innovations" - I personally am a "Rolex" seeker, not always good for cash flow but I am learning to temper my enthusiasm for technology or at least be a better judge of application and impact of patient care.
Determining impact for cost saving through "disruptives" will be very difficult to gauge. Will the cost savings be a pass-through to the client/patient? Likely not, because there is still an investment required to purchase. What we can anticipate is savings through enhance diagnostic capabilities leading to more efficient (less hypothetical management)along with greater independence for the client/patient to manage their own care. Additionally, education will lead to more active participating in preserving health (smarter lifestyle choices). Reminder tools are starting to surface and will enhance delivery of care.
Nice observation about business models. I do see "Boutique" medicine as a untapped service in the veterinary market and this has tremendous opportunities to leverage informatics. If I was looking to general practice, this is a model that I would strongly explore.