In health care, it is the lowly consumer who is now calling the shots, driving product and process innovation in areas ranging from electronic medical records [EMR] to retail health clinics. This was the main theme among discussants at the Forbes magazine Healthcare Summit held here in New York on October 10. The central question: in an era of proliferating choices in health care, how and where do all the pieces fit in, and to what end?
The impact of the Affordable Care Act on patients – both the insured and uninsured – served as the focal point in considering this sea change in perspective. Ron Williams, former chairman and CEO of Aetna Inc. and current chairman and CEO of RW2 enterprises, told participants that with the fee for service model receding in favor of more managed care, the health care labor force is likely to change, with more nurse practitioners providing basic care in place of physicians. Williams also said that there has already been significant innovation in health insurance models as traditional providers confront new regulatory headwinds. He pointed to self-insurance, a model where large corporations have created in-house insurance teams in order to avoid costly commercial cover. Robert Robbins, President and Chief Executive Officer of Texas Medical Center, explained that in areas like Houston where a good 30% of the public are uninsured, it is imperative that these new health care model place a much stronger emphasis on prevention and wellness, educating the public to encourage behavioral changes and to foster new social norms (much like the seatbelt and anti-drunk driving ads) that minimize patient contact with expensive acute care services.
Another panel looked at the integration of new health care models such as the retail health clinic and on demand urgent care centers to drive down costs. Richard Rothman, Founder of the Rothman Institute and Professor at Thomas Jefferson University, bemoaned the cumbersome, inaccessible nature of academic health centers – unless they change and adopt a more open approach, their extinction in favor of the new model is a distinct possibility, with a significant impact on the innovations in medical treatment that originate in these institutions. Robert Wah, President-Elect at The American Medical Association, and Global Chief Sciences Officer for the Global Computer Sciences Corporation cited continuity of care as a weakness that needs to be addressed within retail clinics, citing CVS’ Minute Clinic chain as an example. Ultimately, Wah concluded that these new models need to prioritize between providing urgent care for more complex cases and the retail services that champion low level interventions requiring less follow up.
Panelists discussed how the ‘consumer revolution’ will drive major changes in the business of healthcare. Brad Weinberg, Founding Partner at Blueprint Health predicted that employer-based health insurance will soon be a thing of the past— fostered by the Affordable Care Act’s emphasis on moving patients to private insurance exchanges. Health benefits will be viewed by employers much like a 401k; according to Weinberg, that transition will take place more quickly than the conventional wisdom dictates. He predicted with these exchanges, the US will see some 80 new insurance companies, a few of which will do well while many others will not survive. Darren Dworkin, Chief Information Officer, Cedars-Sinai Health System said that decisions in technology for health care systems should concern themselves with two questions: is the technology scalable, and is it something that can grow to be part of the entire organization? He also made the point that patients’ uptake of EMRs, or electronic medical records, is higher when the information is requested by their physician or another trusted provider.
‘How Big Do the Data have to Be?’ contemplated the size and structure of networks of EMRs and the like to be able to wield valuable insights. Stephen Friend, President of Sage Bionetworks stated that data scientists are an increasingly critical component to be able to aggregate data and generate insights. Jon Bush, CEO of athenahealth, suggested that networks need to be able to talk to other networks in order for data to flow smoothly. He suggested that inevitably, while nodes of EMR systems will ultimately consolidate, there would most likely be a series of networks where interchange fees between networks would be likely to facilitate the exchange of electronic health information, essentially creating a sustainable business around health data. Susan Desmond-Hellmann, Chancellor of the University of California, San Francisco suggested that smartphone-dependent monitoring devices with the patient in control will generate a wealth of new data useful for post-marketing studies. Data from the consumer should be made available like a public good, she said. Companies should create agreements whereby patients agree to volunteer their data only if it is shared freely among networks.
Finally, in a discussion drug research, Sean Harper, Executive Vice President for R&D at Amgen, stressed the unequivocal benefit of human versus animal-based evidence, citing that animal-based studies often prove disappointing when a target does not translate to human physiology. This is why more and more research has focused on human genomics in determining the right targets for therapy. However—as Mikael Dolsten, President, Worldwide Research and Development for Pfizer said, “We still have a long way to go to understanding the physiological as well as the pathological element of genomics before we are able to develop drugs based entirely off of it.”