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Healthcare Tsunami
Tom Peters/06.20.01
HealthCare2001
Consumerism X Demographics X IS/Internet X Info Consolidators X
Genetics & Devices Revolution = YIKES!
Golden Age of Patient-centric, Genetics-driven Healthcare Looms! Current status: $1.3T. 70M uninsured. 90K killed and 2M injured p.a. in hospitals. 85% treatments
unproven. Cure depends on locale in which treated. 50% prescriptions not
work. 2X docs. 2X hospitals. IS primitive. Accountability & measurement nil. And everybody’s mad and feels powerless:
docs, patients, nurses, insurers, employers, hospital administrators
and staff.
1. Consumerism (Patient-centric Healthcare)
“The Web enables total transparency. People with
access to relevant information are beginning to challenge any type of
authority. The stupid, loyal and humble customer, employee, patient
or citizen is dead.”
Kjell Nordstrom and Jonas Ridderstrale, Funky Business
Anne Busquet/ American Express
Not: “Age of the Internet”
Is: “Age of Customer Control”
Amen!
“The Age of the
Never Satisfied Customer”
Regis McKenna
“A seismic shift is underway in healthcare. The Internet is
delivering vast knowledge and new choices to consumers – raising their
expectations and, in many cases, handing them the controls.
[Healthcare] consumers are driving radical, fundamental change.”
Deloitte Research, “Winning the Loyalty of the eHealth Consumer”
“We expect consumers to move into a position of dominance in the early
years of the new century.”
Dean Coddington, Elizabeth Fischer, Keith Moore & Richard Clarke, Beyond Managed Care
Today’s Healthcare “Consumer”:
“skeptical and demanding”
Source: Ian Morrison, Healthcare in the New Millennium
“Medical care has traditionally followed a ‘professional’ model, based on two assumptions: that patients are unable to become
sufficiently informed about their own care to allow them a pivotal role, and that medical judgments
are based on science.”
Joseph Blumstein, Vanderbilt Law School
“He shook me up. He put his hand on my shoulder, and simply said,
‘Old friend, you have got to take charge of your own
medical care.’ ”Hamilton Jordan, No Such Thing as a Bad Day (on a conversation with a doctor pal, following
Jordan’s cancer diagnosis)
“If healthcare organizations don’t wake up, smell the coffee – and get online with real services, transactions, and
more for these e-consumers to do – the newly empowered e-consumers will
become even more disgruntled with the hornet’s nest of paperwork that plagues
the system.”Douglas Goldstein, e-Healthcare
“It may be the most far-reaching evolution of them all: the metamorphosis of passive patient into consumer – and well-informed,
assertive consumer at that. The defining axiom of traditional medicine – ‘doctor’s
orders’ is being turned on its head. These days it’s the patients who are armed, the
doctors who must get wired to keep nimble.” “E-health is the new house call.”
Richard Firstman, “Heal Thyself,” On Magazine (04.01)
“What’s needed are comprehensive strategies that leverage the latest
technology and provide the services that eHealth consumers are demanding,
including convenience and customized services such as online physician
interaction or online management of health benefits and customized disease
management programs.”
Deloitte Research, “Winning the Loyalty of the eHealth Consumer”
“Consumerism”: HMO backlash (e.g., plans with more choice). Alternative Medicine, Wellness & Prevention bias. Info availability (disease, health,
docs, support groups, outcomes). Boomers (“I’m in charge!” Discretionary $$$$ to spend:
cosmetic surgery, vision improvement, fertility,
etc.). Self-care (chronic disease). High expectations (genetics, etc.) …
Consumer Imperatives
ChoiceControl (Self-care, Self-management)
Shared Medical Decision-makingCustomer Service
InformationBranding
Source: Institute for the Future
“E-consumers …
want knowledge
are already connected
want convenience
want it to be all about themwant control.”
Douglas Goldstein, e-Healthcare
“Savior for the Sick”
vs.
“Partner for Good Health”
Source: NPR/VPR 08.15.00
“No one currently ‘owns’ the eHealth Consumer. It’s an
open playing field.”Deloitte Research, “Winning the Loyalty
of the eHealth Consumer”
“We find that eHealth consumers are willing to pay
– and even switch health plans – for the services they
most want.”Deloitte Research, “Winning the Loyalty
of the eHealth Consumer”
“The ‘curative model’ narrowly focuses on the goal of cure. …
From many quarters comes evidence that the view of health
should be expanded to encompass mental, social and
spiritual well-being.” Institute for the Future
“In many ways, the nursing profession is the most qualified to respond to current changes in the health system. Nurses’ training focuses more on the
behavioral and preventive aspects of health care than does that of
physicians.” Institute for the Future
“A 7-year follow-up of women diagnosed with breast cancer
showed that those who confided in at least one person in the 3
months after surgery had a 7-year
survival rate of 72.4%, as compared to 56.3% for those who
didn’t have a confidant.”Institute for the Future
Internet User, F41
$63,000 HHI64% work FT54% moms
6 hours/week onlineSource: NetSmart Research
“Self-medication is the wave of the future, whether the [pharmaceutical] industry
likes it or not.”
Wall Street Journal (5-23)
DTC > Professionals
ClaritinPravachol
ZybanEvista
PropeciaPrilosecPrimera
Source: JAMA
Make time for your most important
asset. Your health.
Ad for Mayo Clinic Executive Health Program/Jacksonville, Orlando Airport
“Online Medical Records Seen Empowering
Patients”
Source: Headline, Boston Globe, 07.31.2000, re 1K docs and 700K
patients @ CareGroup
Determinants of Health
Access to care: 10%Genetics: 20%
Environment: 20%
Health Behaviors: 50%Source: Institute for the Future
Message: Patients aren’t.
Consumers [will] rule.
2. Demographics: The BOOMERS Reach 55!
“NOT ACTING THEIR AGE: As Baby Boomers
Zoom into Retirement, Will America Ever Be the
Same?”USN&WR Cover/06.01
50+
$7T wealth (70%)/$2T annual income50% all discretionary spending
79% own homes/40M credit card users41% new cars/48% luxury
$610B healthcare spending/74% prescription drugs
5% of advertising targetsKen Dychtwald, Age Power: How the 21st
Century Will Be Ruled by the New Old
Boomer World
“From jogging to plastic surgery, from vegetarian diets
to Viagra, they are fighting to preserve their youth and
defy the effects of gravity.”M.W.C. Howgill, “Healthcare Consumerism, the
Information Revolution and Branding”
“Pick up any copy of Glamour or Men’s Health, and you’ll see pages of advertisements encouraging readers
to enlarge their breasts, retard baldness, correct their vision,
improve their smile, or relieve stress through herbs, massage therapy,
acupuncture – you name it.”Coddington, Fischer, Moore & Clarke,
Beyond Managed Care
Message Boomer: (1) “There are
l-o-t-s of us.” (2) “We have
the $$$$$$. (3) “We’re/I’m in charge!” (4) “We’ll take no
guff from from anyone.”
(5) “We know the emperor has no clothes.”
3. The IS/Web REVOLUTION
Info Revolution
Consumerism (research, consultation, B2C, etc.)
Clinical Info Systems (guidelines and outcome measurement, etc.)
100% Web-based (internal) SystemsElectronic Medical Records
Patient-physician email-consultationTelehealth-Remote Monitoring
(biosensors, home testing, etc.)
Telemedicine (consultation, invasive treatment, “global medical village,” etc.)
“We’re in the Internet age, and the average
patient can’t email their doctor.”
Donald Berwick, Harvard Med School
Henry Lowe, U. of Pitt. School of
Medicine: “Broadband, Internet-based,
‘multimedia’ electronic medical
records”
“Doctors Without Borders”
World Clinic/Dr. Daniel Carlin: e-mail consultation & treatment for ex-pats, global execs, etc. Developing world: “They have the primary care doctors,
but no infrastructure to train specialists. We become the
specialists.” More: “Telemedicine Kiosks in Central America.” Etc.
*On Magazine 04.01
Telemedicine: E.g. …
HANC* [Home Assisted
Nursing Care]
*BP, ECG, pulse, temp
Telemedicine …
Reduces days/1000 patients and physician visits for the chronically ill
Decreases costs of managing chronic disease
Expands service areas for providers
Reduces travel costs to and from medical ed seminars
Douglas Goldstein, e-Healthcare
Detroit Med Center: $100M IS Makeover
Experiment: Surgical residents equipped with Palm IIIxe. Med Director: “It’s not unusual to have
a team of 5 or 6 residents responsible for the patients of 25 doctors. For each resident, that
could mean seeing 40 patients spread across 10 floors and 5 buildings.” Records work was
manual; but “Now you export the list of patients to your Palm, with the room number for each
patient and with lab results from the last
72 hours.”
“Without being disrespectful, I consider the U.S. healthcare
delivery system the largest cottage industry in the world. There are
virtually no performance measurements and no
standards. Trying to measure performance … is the next revolution in healthcare.”
Richard Huber, former CEO, Aetna
“A healthcare delivery system characterized by idiosyncratic
and often ill-informed judgments must be restructured
according to evidence-based medical practice.”Demanding Medical Excellence: Doctors and
Accountability in the Information Age, Michael Millenson
“As unsettling as the prevalence of inappropriate care is the enormous amount of
what can only be called ignorant care. A surprising 85% of everyday medical
treatments have never been scientifically validated. … For instance, when family
practitioners in Washington were queried about treating a simple urinary tract infection, 82
physicians came up with an extraordinary 137 strategies.”
Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson
“With little fanfare, a gathering revolution is transforming the everyday
practice of medicine. Owing more to laptops than lab coats, this
is an information revolution, one that is beginning to yield answers to the
most basic questions that haunt those who are sick: Who shall live and
who shall die?”Demanding Medical Excellence: Doctors and Accountability
in the Information Age, Michael Millenson
“Quality of care is the problem, not managed care.”
Institute of Medicine (from Michael Millenson, Demanding Medical Excellence)
RAND(1998): 50%, appropriate preventive care. 60%,
recommended treatment, per medical studies, for chronic
conditions. 20%, chronic care treatment that is wrong.
30% acute care treatment that is wrong.
CDC 1998: 90,000 killed and 2,000,000 injured
from nosocomial [hospital-caused] drug
errors & infections
Various studies: 1 in 3, 1 in 5, 1 in 7, 1 in 20 patients “harmed by
treatment”
Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson
“Established state-of-the-art cancer care – about
which there is no longer any debate – is
erratically applied.”Source: Institute of Medicine’s National Cancer Policy Board
“In health care,
geography is destiny.”
Dartmouth Medical School 1996 report, from Demanding Medical Excellence: Doctors and
Accountability in the Information Age, Michael Millenson
“Practice variation is not caused by ‘bad’ or ‘ignorant’ doctors. Rather, it is a natural
consequence of a system that systematically tracks neither its processes nor its outcomes,
preferring to presume that good facilities, good intentions and good training lead automatically
to good results. Providers remain more comfortable with the habits of a guild, where
each craftsman trusts his fellows, than with the demands of the information age.”
Michael Millenson, Demanding Medical Excellence
“In a disturbing 1991 study, 110 nurses of varying experience levels took a written test of their ability to calculate medication doses. Eight
out of 10 made calculation mistakes at least 10% of the time,
while four out of 10 made mistakes 30 % of the time.”
Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson
“With meticulous detail, historical accuracy, and an uncommon
understanding of the clinical field, Millenson documents our struggle
to reach accountability.”
Journal of the American Medical Association, on Demanding Medical
Excellence: Doctors and Accountability in the Information Age, Michael Millenson
“Patient by patient, problem by problem – drug reactions, hospital
caused infections – Salt Lake City’s LDS Hospital has attacked treatment-
caused injuries and deaths. One of the secrets of LDS’s success is a custom-
built clinical computer system that may serve as a national model for how
to save patient lives.”Demanding Medical Excellence: Doctors and Accountability
in the Information Age, Michael Millenson
Message: (1) Effective &
encompassing use of IT is the healthcare revolution. (2) Get on
all-the-way on board or get discarded. (3) The situation as
it stands is pathetic.
4. The “Consolidators”: Fat or Thin?
WebMD (or heirs
and assigns)
“Virtual health care webs force providers to focus on their areas of excellence and to
invest in areas where they can generate a sustainable
competitive advantage.”
Healthcare.com:Rx for Reform, David Friend, Watson Wyatt Worldwide
“The future of hospitals is murky. A combination of technological advances,
managed care, and changes in Medicare reimbursement policy
means that the underlying demand for inpatient services
will continue to fall.”Institute for the Future
“America has twice as many hospitals and physicians as
it needs.”Med Inc., Sandy Lutz, Woodrin Grossman
& John Bigalke
Message: Somebody is
gonna get this right!
5. Genetics & Devices
Genetics & Devices
Pharmacogenomics (“mini”busters, rational drug design, personalized medicine,
gene therapy, vaccines--20% to 50% prescriptions not work)
Neural Stem Cells
Minimally invasive surgeryAdvanced imaging
Pharmacogenomics: End of Blockbusters by End-of-Decade (Reuters/5-22)
Barrie James, Pharma Strategy Consulting: “We’re moving from a blunderbuss approach to laser-
guided munitions, and it marks a sea change for the industry. The implications for existing
business models are devastating.” Allen Roses, SVP Genetic Research, GlaxoSmithKline:
“minibuster.” Rob Arnold, Euro head of life sciences, PWC: “Once you start dealing with minority
treatments, small biotechs who are more nimble and don’t need $500-million-a-year drugs to make
money could be at a real advantage.”
“Recognizing that a single misspelled gene means the difference between being
poisoned and being cured was the first victory for the new
science of pharmacogenetics.”
Newsweek (06.25.01)
“Pharmacogenomics could
fundamentally change the nature of drug discovery and marketing,
rendering obsolete the pharmaceutical industry’s practice of spending vast amounts of time and
money to craft a single medicine with mass-market appeal.”
The Industry Standard (05.28.01)
“BIG DRUG MAKERS TRY TO POSTPONE
CUSTOM REGIMENS. Most drugs don’t work well for about half ther patients for whom they
are prescribed, and experts believe genetic differences are part of the reason. The
technology for genetic testing is now in use,. But the technique threatens to be so disruptive to the
business of big drug companies—it could limit the market for some of their blockbuster
products—that many of them are resisting its widespread use.”
The Wall Street Journal (06.18.2001)
“Imagine the day that your surgeon performs your heart bypass sitting at a computer thousands of miles from the
operating table. That day may come sooner than you think.”
Newsweek (06.25.01)
“There is no question in my mind that the future of heart
surgery is in robotics.”
Dr. Robert Michler, OSU Med Center, upon the FDA’s approval of robotic partial-
bypass surgery
Message pharacogenomics:
(1) There is a drug revolution
coming. Pretty damn fast. (2) My
bet: Most Big Pharma will get run over!
Message Summary: (1) An unparalleled time for
imagination and bold action. (2) A time of unprecedented
opportunities. (3) A time
of unprecedented risk.