Pressured by rising costs along with an influx of newly insured patients under the Affordable Care Act, and a growing demand to improve quality, efficiency and patient involvement, medicine is facing massive changes and challenges. At the same time, there are also ample new opportunities.
There is no shortage of good ideas to fix the health care system. Hospitals, state initiatives, innovative startups, practitioner techniques, health policy wonks, and patients themselves are all developing new strategies and methods to improve the system. But lassoing those ideas and getting pioneers and visionaries in the same room to share, expand and hash out the logistics has been a problem in the past. Like just about everything else, though, this too is changing.
Some of the Goliaths of modern medicine, as well as numerous Davids, have been getting together in three cities across the country (Boston, Minneapolis and Portland, Oregon) as part of an initiative called the Better Health Tour. It is sponsored by McKesson Corp., a health care service that distributes pharmaceuticals and medical devices, and provides network infrastructure for the health care industry. The initiative has been underway since January, and the aim of the city-by-city brainstorming sessions is to get the conversation going among competitors and collaborators who want to be part of the change. Nothing is off the table, including ideas like accountable care organizations, the use of video and smartphone technology during patient visits, offering appointments at the patient’s convenience, new ways to share medical data – even the ACA itself.
“We touch almost every part of health care, from doctors, pharmaceuticals, nurses, health plans,” says Matt Zubiller, vice president, strategy and business development for McKesson. “We see the problems of each of these customers on a daily basis.”
As hospitals strive to rein in costs and improve quality, they can form partnerships and share expertise with other, often smaller, organizations. But a huge hospital or health care system is like the proverbial ocean liner: turning it around takes time and patience. Smaller startups and innovators can move more quickly, turning on a dime when necessary. Through shared ideas and partnerships, the big players and smaller companies in health care could well end up on the same team.
ZoomCare, one participant on the McKesson tour, is a free-standing medical clinic with 23 neighborhood locations in Oregon, Washington and Idaho. Urgent care, primary care and some specialty care including cardiology, gastroenterology, pediatrics, and physical therapy don’t need to be hospital based, the organization has learned.
“This is one-stop shopping, a whole system of care right in your neighborhood,” says David Sanders, co-founder of ZoomCare. Skype and telephone consultations are also available. Appointments are geared toward the patient needs and schedules, and ZoomCare physicians have admitting privileges to area hospitals. If someone requires a surgeon or oncologist, ZoomCare has partners to whom they refer.
A big difference from traditional medical care is also a part of the equation. Prices are listed on their website, so a patient knows exactly what every visit and procedure will cost beforehand. Posting prices, a step so obvious in just about every other industry, falls into a category within health care known as or a major change in a system that can start at the bottom and relentlessly work its way up through the industry.
Lack of transparency in health care costs – consumers and often providers have no idea what procedures and services cost – is a major and expensive flaw in America’s health delivery system. Everyone has heard horror stories about the $100 aspirin or $1,000 toothbrush charged to a hospital bill. Studies have shown that in New Hampshire, arthroscopic knee surgery in a hospital in 2008 cost an average of $2,406, but the variation was extreme, with hospitals charging as much as $3,600 or as little as $1,200; in 2006 and 2007, an MRI of the spine in Massachusetts cost between $450 and $1,675. Patients rarely know the cost beforehand and are shielded from the true costs since many patients pay very little of their health care bills. Even if they did, some people believe the higher the price, the better the quality, despite a lack of evidence that substantiates that notion.
But ZoomCare is betting that people who pay all or a significant part of their bill, especially for preventive care and conditions that are not life-threatening, will appreciate having information on pricing in advance. About 20 percent of ZoomCare patients pay for their care out of pocket, says Sanders, so of course they want to know what the bill will be. But even insured patients getting care in any setting are picking up more of the tab through deductibles and copays. They, likewise, want to know what things will cost.
“You go to our home page, click ‘price tag,’ and you can see pricing for everything,” says Sanders. “Cost matters to them.”
Money matters, but so does a patient’s ability to carry out a doctor’s instructions. A doctor/patient encounter happens 3.2 million times a day. They talk about what’s wrong, which pill to take, when to take it, what to eat or not eat, and when to come back for a follow-up visit. One study found between 40 percent and 80 percent of information provided by health care practitioners is forgotten immediately, and the more information presented at one visit, the less that is actually retained.
ReelDX is a company that began by providing videos of doctor/patient encounters to help educate medical students. Then, turning on a dime, they saw a broader need: helping patients remember instructions.
“We bring a secure video into the doctor/patient relationship and record the dialogue for the benefit of the patient,” says William Kelly, CEO and co-founder of ReelDX.
The videos, in compliance with patient confidentiality and consent rules and stored within his or her secure medical record, can help remind patients of discharge instructions, treatment options and the care they need to follow at home.
Other aids such as educational materials on a good diet for those suffering from diabetes or exercise routines for cardiac care patients can help individuals get more information, geared to each person’s unique condition. When people get a disturbing diagnosis, like cancer or diabetes, they, too, are likely to forget key parts of their discussion with a physician.
“Universally, patients need additional information from providers,” says Mark Friess, founder of WelVu, a company that helps facilitate patient and doctor communications. “When they don’t get it, they seek it elsewhere.” They may be reluctant to keep calling the physician with questions. To save them from the confusion of sorting through Internet searches that are just as likely to turn up quackery and false hopes as solid medical information, WelVu has come up with a way to further the communication for patients – in their physicians’ own voices.
The WelVu system uses videotaped encounters and patients' visits, and formats them for use on mobile devices, tablets, laptops and desktops. They can include additional information from the physician and supplemental educational information provided by the doctor and aimed specifically at the patient. “It’s a video that’s personalized and customized for them,” says Friess.
Partnerships and collaborations are not limited to entrepreneurial startups. In Massachusetts, Tufts Medical Center has begun an alternative model in pairing with suburban Lowell Medical Center. It’s not the usual hospital takeover; rather, it’s a partnership, with both the bigger and smaller institutions sharing data sharing and greater patient convenience, among several other benefits.
“Our partnership will be the first of its kind in Massachusetts,” says Ellen Zane, vice chair of the Tufts Medical Center board of trustees. “This system is not being formed by one entity taking over another, with the academic medical center as the hub of the universe. What we are creating is a ‘round table,’ if you will.”
Virtual physician visits and specialty consultations are expanding state-of-the-art services to rural areas in Oregon, says Dr. Mark O'Hollaren, vice president of strategic outreach at Oregon Health & Science University. Partnerships, collaborations with doctors, health care workers and patients in far-flung parts of the state are critical to providing good care, he adds.
"It's unbelievably important. We may see a patient [at the OHSU hospital in Portland] for a brief period of time, but we need to understand what happened before, and what they're returning to when they're discharged," O'Hollaren says.
Throughout the country, innovations in telehealth are disruptive in ways that have the potential for improving patient care.
"It can liberate rural communities and underserved areas to provide health care in schools, the workplace, in retail outlets," says Mario Gutierrez, executive director of the Center for Connected Health Policy, a nonprofit working to improve the ability of telehealth to improve care and decrease costs. "Telehealth has the potential to help people become part of a virtual health home."
In many ways, these efforts are bringing the technology of the moment to an industry that has long used state-of-the-art technology in providing treatment, while lagging behind other sectors in billing and record-keeping.
But innovations are more than technology; they also aim to change ingrained attitudes and practices, shifting the focus from provider and institutional convenience to patient convenience. Massive changes in health care delivery are coming down the pike. For every problem, there is no doubt someone, somewhere, with a good idea to help fix it.