Healthcare We Want Is Coming

“When the facts change, I change my mind. What do you do, sir?” ― John Maynard Keynes

The healthcare facts are changing. They are changing in a way that should enable us to be very optimistic. While the national debate has been dominated by rising costs and extending health care coverage under the Affordable Care Act (Obama Care), the changing facts with the most profound impact have been overshadowed.  Virtually unnoticed are three transformational catalysts that will fundamentally change our entire healthcare system. They show promise in delivering the healthcare what we want – patient-centric care.

Science

In just over the last decade, what’s big in science is what’s very small.  Science has made big strides at the cell level, within molecules and with the quantum mechanics of the atom. This has helped to launch of whole new fields of “omics” (genomic, proteomics and microbiome). Whole genome sequencing, data science and massive computational algorithms are now used to identify potential cancer cures. The cures are based on understanding our unique human genes, cancer cells and reactions to tailored therapies in petri dishes. Our unique healthy cells can now be created by inserting the nuclei of embryotic stem cells into our skin cells. Medical research and scientific studies are doubling our knowledge of the human body every two years.  Scientific research based on the 5,000 person Framingham Heart Study will soon get new insights from the 1M person University of California at San Francisco Health eHeart Study. With medical information going digital, big data analytics will begin to identify new correlations that will change medicine many times during our lifetimes.

These rapid science advances will make personalized medicine possible. This patient-centric approach that will tailor your treatment based on your conditions, research and the 3 billion base pairs of your unique human genome.

Technology

Mobile health devices that monitor physiological, activity and behavioral metrics will begin offering new insights that are not possible with annual physicals. These devices show promise in identifying patterns that could soon forecast heart attacks or other adverse conditions like warning lights in cars. BRCA1 or BRCA2 gene mutations, linked to breast cancer, can be identified by doing little more than sending a saliva sample along with $99 to a company. We now have ingestible pills with RFID tracking and are developing nanoscale devices to monitor and deliver treatment at the molecular level.  Medical records are becoming digital and are now sent in nanoseconds rather than days. These digital medical records will be used by big data analytics to identify the source and spread of pathogens, the effectiveness of treatments and the best warning signs that lead up to acute conditions.

In 2014, hospitals and physicians will be required to share your medical information to you electronically enabling the possibility for care to be delivered remotely. While physician office visits will always be available and sometimes necessary (like going to a bank), the convenient option of remote care we soon be available for those who choose it (like the ATM). Technology will help to make health care more patient-centric by being more efficient, effective and convenient.

Reimbursement

In a non-market economy like healthcare, reimbursement (Medicare) is the customer with over 90% of the payments to health care providers flowing through third party reimbursement. The customer (Medicare) started on October 1, 2012 to demand performance by withholding reimbursement on behalf of patients. This is just the beginning of a major transformation of reimbursement that will reward performance rather than volume of services. The current reimbursement system was developed as a result of the Balanced Budget Act of 1997.  It was before Google was a company (’98), smart phones (Blackberry ’98), text messaging between carriers (1999), online payments (PayPal 2000) and digital video calls (Skype 2003).

New performance reimbursement programs (PRPs) are being piloted and are expected to be rolled out over the next couple of years. They will need to leverage the latest science and technology to be effective. The PRPs being developed focus on value, episodes of care and managing the health of a population. The PRPs are intended to reward quality, patient satisfaction and low cost.  While true patient-centric care is about patient outcomes, the new PRPs do implicitly reward outcomes. PRPs will incent providers to lower overall cost that can come from making people better. With everything being measured electronically, the new PRPs will also improve outcomes by producing performance metrics that will enable patients to select providers based on outcomes.

The science and technology healthcare facts are changing. That is why Ronald DePinho, President of MD Anderson Cancer Center, believes they will result in discovering the cure for cancer. The customer (reimbursement) facts are changing. Reimbursement will demand performance and offer incentives to help people get better (a way to reduce cost is improve health).  The healthcare facts are changing and the patient-centric care we want is coming soon.

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