What if Medicare became the fast-moving pioneer of implementing new practices, care models, technologies, and business models for healthcare? What would the world be like if health plans and providers were encouraged to be continuously innovative in coming up with better and better ways to care for patients? How do we incentivize continuous innovation in healthcare delivery while at the same time discovering and using best practices in medicine?
In his recent Op Ed in Politico, our CEO Paul Otellini wrote: “We should not believe that we can produce one right answer for how to do health care for the next 100 years.” This one line is worth a lot more thought. In the recent D.C. debate about delaying reform (I blogged about this on July 22nd), I have heard in the public comments from Congressional members and even used the phrase myself: “Let’s get it right.” But I don’t think we should fall prey to the notion, as Otellini points out, that we’re going to suddenly and magically figure out how healthcare should be done for the next 100 years, or even the next 10. “Getting it right” probably means realizing there is no one utopian right answer—that we need many models and kinds of care in the 21st century.
The pace of technological innovation and cultural change—especially in an increasingly global and connected society—will move quickly. And while it is probably imprudent to have healthcare change at the same pace, we can’t hamstring the progress of healthcare with policies and procedures that fail to anticipate and incorporate new technologies, trends, and cultural movements. Iterative, continuous innovation has worked well in other industries to improve quality, reduce costs, distribute expertise, and enhance safety. So too, it needs to be designed into our health reform policies.
I can imagine what some of the cries of critique for this innovation notion would be: “Healthcare is different than every other industry because it is life-and-death!” “We can’t train doctors to use a new procedure every other month when some new technology comes along!” Or “We need careful, evidence-based studies before just throwing some new practice out there to the wolves.” Of course healthcare is not the same as selling a new breakfast cereal, requires some consistency and standards in training and care protocols, and should have scientific evidence for adopting new innovations. But that doesn’t let us off the innovation hook.
There has to be ways we can accelerate the knowledge turns and training in healthcare. Waiting 10 to 20 years (which is not uncommon) to catch up with basic internet technologies to deliver care or to incorporate new proven procedures is unacceptable. Surely we can find empirical methods to prove out new best practices that don’t require the time and energy of a full “randomized control trial” for every new idea. It is a false dichotomy to have to choose between either “innovation” or “empiricism.”
Today, I fear that clinical “best practices” have become so calcified and codified—and with the specter of malpractice hovering in the background—that we’re stifling the creative, improvisatory, innovative, and common-sense improvements that doctors and nurses must be trusted to make as they balance the art and science of medicine on a daily basis. We’ve got a healthcare system that is too slow and too regulated to facilitate innovation in the large (major new technologies or care models) or innovation in the small (common-sense, small changes that clinicians make in the moment). We need to unclog both of these innovation pipelines.
So, let me suggest three things that might improve our reform agenda:
1) Embrace Otellini’s Innovation Challenge: Let’s set Otellini’s challenge on continuous innovation as an upfront principle that we’re striving for in healthcare reform. Let’s look for policies that encourage and accelerate the adoption of improved procedures, technologies, and care models, which also means evaluating how we train and retrain care providers. And let’s develop a Comparative Effectiveness research infrastructure that, while empirical and evidence-based, is also fast and scalable as it translates science into new healthcare practices.
2) Examine the CMS Innovation Center: Let’s hear more about what the Congressional bills and staffers have in mind when they mention a “CMS Innovation Center.” This could be a good idea or a terrible idea depending on the motives and implementation plan. Such a Center could be designed as a safe, scientific place for innovation to thrive, where new ideas are invented, piloted, and then implemented quickly across Medicare and Medicaid populations. Or it could be designed as a place to “park” innovation—to contain new ideas so that they never spread to the whole system. Obviously, I vote for the former: an innovation accelerator in CMS that can translate new research into widespread practice.
3) Expertise in Innovation on IMAC: Let’s ask innovation experts—people like Clayton Christensen or Andy Grove—to serve on IMAC, the Independent Medicare Advisory Council that President Obama has been talking about (see Peter Orszag’s blog to learn more about IMAC). They describe this as an “independent, non-partisan body of doctors and other health experts.” But don’t stop with only doctors and health experts…open IMAC up to innovators and entrepreneurs who know how to implement and accelerate new ideas for the improvement of healthcare and society.
To many healthcare providers, researchers, and patients, my opening questions are almost laughable. Medicare, Medicaid, and CMS are hardly seen as the enablers and early adopters of innovation. In fact, CMS is more often seen as a “slow follower” if not the primary barrier to innovation…for the entire medical marketplace since private payors often follow the pace, payments, and protocols established by CMS. Nonetheless, I suspect two things are true: 1) that it is far too easy to make Medicare our scapegoat while missing some of the innovative things that they are doing right; and 2) that we’re failing to be innovative ourselves if we can’t imagine ways in which Medicare—and other healthcare institutions—can transform themselves into continuous innovators.