Healthcare urgently needs a Copernican Revolution

This article was originally published here

The year 1543 A.D. will forever be celebrated as a sentinel time in the annals of science.  In that year, Nicolaus Copernicus, a Polish mathematician and astronomer, published his model of the universe and theorized that it was the sun, not the earth that was at its center—a remarkable, if not heretical, revelation for the time.  To his contemporaries, this represented an unconditional inversion of common perception; but one that which offered a new and simplified framework and sparked the scientific revolution.  In our view, the health care industry is now currently embarking on a similarly a radical “Copernican Revolution.”   Fueled by advances in digital technology and associated cultural changes, we are in the midst of experiencing a paradigm shift from a predominantly provider-centered to a customer-centered model. Yet, despite the strong evidence of this shift and technology’s power to transform business models in other industries, many healthcare leaders are having difficulty coping with this change.  Some in fact are doing all they can to hold onto the past.   But little can be done, after all, to halt this on-coming tsunami.  Today’s digital platforms and networks will indisputably herald the success of this much-needed revolution.

In January 2016, Community Catalyst, a national consumer health advocacy organization, launched the Center for Consumer Engagement in Health Innovation.   At the conclusion of the program, Amy Berman, senior program officer for The John A. Hartford Foundation, summarized the Center’s policy priorities with these incisive comments:

We live in a pre-Copernican model where all of the planets float around the healthcare system; the patient is just one of them. What we need is a shift…an entirely new frame, and this will shift everything when we do it…we need the patient at the center. We need to put the sun where it belongs.

However, we have a very long road to travel before we truly achieve patient-centered healthcare, where individuals become the authorized keepers of their health using digital platforms and networks, just as customers are empowered in other industries using Uber, Airbnb, Amazon, Facebook and LinkedIn.

We only have to look inward to see that this is true.  As busy Orthopedic Surgeons specializing in Total Joint Replacement surgery, two of the authors frequently evaluate 40 – 50 patients in a day.  Here is the typical experience of these valued customers with our healthcare system today.  They phone our office and navigate our multilayered phone system for an appointment “on premise”, a physical space remote from their home. They wait weeks or even months for the visit and are obliged to take time away from their work or other important activities to be conveniently fit into our 8 a.m. – 5 p.m. schedules.  If a last minute surgical emergency or other scheduling conflict arises, it is not unusual for the long awaited appointment to be pushed out another few weeks. Once the customer arrives at the office, they wait until being called up to the window by a receptionist with the dreaded, “can I have your insurance card and can you please fill out these forms.”  The forms request pedantic information such as “what is your chief complaint” and redundant data that the office already has at hand—name, date of birth, primary care physician and so on. The patients then wait in the waiting room, wait in the examination room, wait for x-rays, and wait for the doctor, often multiple times.  If they have had previous imaging studies, but they are not available or accessible, the same studies are usually repeated.  If prior medical records are not available or accessible the patient is asked to pick them up at another physicians office and deliver them to ours.  And after all this hassle, the preponderance of these patients present with common orthopedic conditions and eventually receive routine treatment such as physical therapy and non-steroidal medications.  A much smaller number actually will require our surgical expertise.  This tells the all too common story of the “current state” of healthcare delivery.

Now we humbly ask: is this patient-centered health care?  Is it the patient or the healthcare provider that is the sun?  Is there any other service industry on the planet that would offer their customers such a dreadful experience and have any chance of survival?  If so, we can be assured that they are just as ripe for disruption as healthcare.

But there’s more.  For decades, the modus operandi and predominant payment methodology in healthcare has been fee-for-service, a system in which providers receive compensation for offering services regardless of their outcomes.  So, the more you do—tests, visits, labs, scans—the more you earn, even if the additional activity adds no value.  This is widely recognized as the root cause for today’s highly fragmented, inefficient, wasteful, and siloed healthcare system and it is the patients who suffer the consequences.

Here’s just one example of how this commonly plays out for patients.  In our Joint Replacement practice, two of the authors have patients, complaining of hip pain, who arrived in our offices having already gone through a gauntlet of medical interventions.  They have had major lower spine surgical procedures to no avail, followed by a series of spinal injections without improvement, followed by an inguinal hernia repair and yet still had severe unremitting activity-related pain.  Only then was it determined that their primary condition, all along, was a severely arthritic hip and replacement was indicated.

Most of us have stories like this in our health history—where we bounced around through various unrelated practitioners and treatments, at great cost, effort, and stress—before finally determining the true cause of our ailment. In 2009 one of the authors developed severe burning pain and dysesthesias in both feet.  After seeing his primary care physician, he was referred to a neurosurgeon. Testing was performed and it was concluded that he had “stenosis or a ruptured disc”.  Surgery was performed but the pain persisted so a second spinal procedure was undertaken three weeks later, once again without improvement in the severe pain.  For the next 18 months, more testing was performed and the author received extensive physical therapy, various medications, and steroid injections.  The pain continued.  Finally, a neurologist confided that the diagnosis had been incorrect and recommended a consultation with a hematologist/oncologist.  More testing including a bone marrow biopsy was carried out and the diagnosis of a variant of multiple myeloma was made.  That too proved to be incorrect.  Further blood and immunological analysis finally concluded that the diagnosis was Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), an acquired immune-mediated inflammatory disorder of the peripheral nervous system.  Two and one half years after the onset of symptoms, weekly chemotherapy treatments with Rituxan and IVIG have produced remarkable clinical palliation and remission of the disease.

The toll on these patients?  Unnecessary pain and suffering and an incredible amount of lost time trying to navigate the system to find the right doctors, obtain and share their health information, and achieve the right diagnoses.  The toll on the system for patients such as these?  Millions of dollars of wasted resources.  But this inevitably happens when the healthcare universe is physician-centered.  Each provider is doing his or her best, but is limited by knowledge, connections, and perspective.  Collaboration between multiple systems and providers, often essential, is difficult and ineffective.

The system must change.  Achieving the goal of patient-centered healthcare requires two major shifts.  First, healthcare must re-design its core processes from provider-centric to customer-centric.  Second, and related, healthcare must utilize the myriad technologies that are available today in order to provide that patient-centered care without dramatically scaling up the resources required.

Utilizing technology for patient care doesn’t only mean providing care via teleconference, but embracing the wide variety of technologies that can improve a patient’s healthcare experience—including making appointments, tracking expenses, managing records, finding support, and receiving treatments.  Access, cost, convenience, and outcome can all be improved via technology.

The Institute of Medicine defines patient-centered care as: “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.”  Considering this definition and the current experience of most patients, it is clear we have a long way to go.

However, patient-centered care has become a broadly and over-used term at risk of becoming cliché.  We posit that when, not if, the health care industry truly shifts its mindset (and hence their actions!) to a bona fide customer-oriented approach using digital platforms, dramatic improvements in health care value will ensue—and costs will come down.  In his keynote remarks at the Center for Consumer Engagement in Health Innovation’s commencement, Dr. Donald Berwick said “we have enormous evidence, overwhelming scientific evidence, that when people can control their own care, the care gets better, and generally—by the way—the costs fall dramatically.”

Now the healthcare world might argue that it is different, and somehow uniquely immune to the havoc wreaked by digital connectivity and network disruption in other industries.  We disagree.   Consider the following examples where once powerful industries believed that their legacy business models were immune from digital disruption:

  • Airbnb is among the most valuable hoteliers, but owns no hotels
  • Uber is more valuable than Ford and GM, yet has no cars
  • Facebook is the world’s largest publisher with 1.7 billion editors
  • Amazon’s market cap has grown beyond Walmart’s

The good news is that some leaders already understand what a healthcare revolution will look like.  Dr. John Noseworthy, President and CEO of the Mayo Clinic, recently said, “It took Mayo Clinic 136 years to serve 20m patients per year… We will innovate to serve 200m patients per year by 2020, without building new hospitals”.   How is this possible?  Only by accessing digital technologies—including everything from teleconferencing, virtual healthcare to machine learning—can the Mayo Clinic scale its patient care at this rate.

With the writing on the wall, it’s time for those in the health care industry to follow the Mayo Clinic’s lead and ask:  What is our digital transformation strategy?  Healthcare is the largest private-sector industry—accounting for 13% of the total United States workforce and 18% of the Gross Domestic Product, and if it doesn’t transform itself soon, Silicon Valley is waiting to enter the market and bring a new, more customer-friendly experience.

In fact, there is evidence that the transformation has already begun and that digital platforms are starting to re-engineer healthcare delivery.  New online networks, such as Patientslikeme, allow communities of patients to learn from each other about their conditions and potential treatments.  New platforms, such as MotherKnows, allow patients to better access, manage, and even share their personal health records.  New systems, such as Heal, Pager, and Talkspace, allow patients to access a network of doctors over phone and video chat for remote diagnosis and care.  New technologies, such as machine learning, are changing the way diagnoses are made—IBM’s Watson now can provide evidence-based treatment recommendations for oncologists!  Slowly, healthcare is changing—from end to end.

Consequently, It is now essential that leaders in the health care universe step forward and invert their thinking and their actions to put patients at the center.  Doing this will require investing in digital platforms rather than physical platforms in order to serve patients as the center of the system.

Those of us in the healthcare industry who want to be a part of this transformation will need to do three things:

  1. Change our thoughts:  what we currently believe about health care determines the system we create;
  2. Recruit new digitally savvy leaders and board members: an essential step in all transforming industries; and
  3. Change our actions: put customers at the center and given them the information they need;

Our future is in our hands.  We must come to grips with the notion that we in healthcare are not uniquely disruption-proof and that we must invert our traditional views of the provider-customer relationship.  Other industries that have held out hope that they were immune to innovation are now losing value at an alarming rate to Silicon Valley start-ups.   We still have time to put patients where they belong—at the center, but our time is running out.  Apple, Google and Microsoft have already entered the health care industry, collectively funneling billions of venture capital dollars into this space.  We are, therefore, proverbial sitting prey.  Nigel Fenwick, principal analyst at Forrester, has said “by 2020, businesses that learn to master digital will become the predator, while those that make minor changes or don’t do anything at all will become digital prey.” For decades, we’ve been insulated from forces that have unmistakably and formidably re-shaped other business sectors. Not this time. The power of the digital network is like a tsunami. Prevailing obstacles will be overcome by this wave of network power. It’s time to move, or be pushed aside.

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