Em­brac­ing the fu­ture

We need an­other Flexner re­port to shake up and re­struc­ture health­care

Modern Healthcare - - OPINIONS COMMENTARY - Chris Van Gorder and Dr. Eric Topol Chris Van Gorder is pres­i­dent and CEO of Scripps Health, San Diego. Dr. Eric Topol is Scripps’ chief aca­demic of­fi­cer and au­thor of The Creative Destruc­tion of Medicine.

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.

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