Embracing the future
We need another Flexner report to shake up and restructure healthcare
Our industry has reached its turning point. We’re facing many challenges, but an equal number of opportunities. If administrators and physicians direct their collective focus on weaving together innovations in healthcare delivery, technology and medicine, we can create the healthcare system of the future. And that’s something to be excited about.
The last transformational change in healthcare occurred because of the historic Flexner report. In 1904, the American Medical Association became concerned that training for physicians was substandard and riddled with too much variation. Later, the AMA asked the Carnegie Foundation to survey American medical education, commissioning professional educator Abraham Flexner to study the medical education system and develop recommendations. In 1910, the recommendations were accepted, medical training—and therefore, delivery—was significantly changed, and the modern medicine system was developed.
Arguably, all of the changes seen since that time—medicare and Medicaid, diagnosis-related groups, managed care and even accountable care—have not significantly changed the system developed after the Flexner report was adopted. They have really just changed the financing of healthcare.
More than a century later, transformational change is possible—and needed. We spend $2.6 trillion on healthcare a year as a nation. Still, too few people have access to care they can afford. U.S. fiscal and tax policies have masked this for decades.
It is an undeniable fact that healthcare in this country is broken. It needs to be taken apart and put back together again in a way that will work. The Obama administration is attempting to do that through the Patient Protection and Affordable Care Act, the U.S. Supreme Court is considering the law’s constitutionality, states are moving forward with their own healthcare reforms, and states and the federal government are cutting what they spend on healthcare.
Perhaps it is time for a new Flexner-type report that gives a comprehensive look at the current system as well as recommendations from providers for the system of the future.
Like every other industry has had to do over the past 25 years, healthcare needs to transform fundamentally, and providers need to do it. Providers can fear the changes ahead or they can embrace them and together build a less costly, less fragmented and higher quality healthcare system.
At Scripps, we’re experimenting with some new models of structure and delivery to reduce the non-value-added variation in healthcare delivery and apply modern technology to that delivery model. That’s just what Flexner called for years ago when he recommended that new standards be adopted and that non-value-added variation be removed from medical education and training.
Just over a year ago, we turned Scripps on its side. Through this horizontal restructuring, physicians and administrators have been working to cut costs and improve quality across the system. This effort is a real partnership that goes beyond physician alignment into true engagement. The result has been a performance improvement of $77 million last fiscal year alone, while best practices and successful pilots were implemented system wide.
We’re moving away from being a sickness business to a wellness business, or one that’s in business to keep you well. We’re doing this by knitting together what has been a fragmented delivery system through a focus on streamlined management in the hospital and ambulatory setting, as well as on individualized care, making the most of genomics and innovative technologies. It is the future of managed care—not the purely utilization-management version of 20 years ago, but shared accountability for truly medically managing patients’ care so they receive the right care, at the right place, for the right price.
Not until now did we have the right tools— DNA sequencing, wireless biosensors of virtually every physiologic metric, a digital infrastructure of pervasive connectivity, broad bandwidth, super and cloud computing—to allow us to monitor populations at risk or with chronic illnesses and to deliver individualized medicine.
Providing these tools and the right delivery system will mean patients can be more of a partner in managing their health, improving the quality of care while cutting costs. And individualized medicine is arguably the ultimate example of how to reduce spending while providing the best in care. Case in point: Today, approximately a third of the $350 billion a year spent on prescriptions is a waste. Genomic screenings can help tailor medications to an individual’s needs. That’s a safer and more economical approach, which Scripps has implemented for Plavix and interferon and is exploring for other medications.
The unprecedented level of collaboration between our physicians, scientists and administrators is allowing us to develop these new systems of care and embrace these new technologies and discoveries in the human genome. This is going to significantly change the way we can—and must—deliver care. We see this is the only way we can build a system that will work.
The most exciting time in the history of medicine and healthcare lies before us. It’s our time. And we’ve never been more optimistic about the possibilities ahead.
U.S. healthcare needs to be
taken apart and put back together in a way that will work.