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Healthcare TsunamiTom Peters/09.12.2004
HealthCare2004
Consumerism X Demographics X IS/Internet X
Quality X Information Consolidators X Genetics &
Devices Revolution = YIKES!
Golden Age of Patient-centric, Genetics-driven Healthcare Looms!
Current status: $1.3T. 30M-70M uninsured. 90K killed and 2M injured p.a. in hospitals. 85%
treatments unproven. Cure depends on locale in which treated. 50% prescriptions do not work.
2X docs. 2X hospitals. IS primitive. Accountability & measurement nil.
And everybody’s mad and feels powerless: docs, patients, nurses, insurers, employers,
pharma & device cos, hospital administrators and staff.
1. Consumerism (Patient-centric Healthcare Arrives)
Anne Busquet/ American Express
Not: “Age of the Internet”
Is: “Age of Customer Control”
Amen!
“The Age of the
Never Satisfied Customer”
Regis McKenna
“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
“Parents, doctors, stockbrokers, even military leaders are starting to lose the authority they once had. There are all
these roles premised on access to
privileged information. … What we are witnessing is a collapse of that
advantage, prestige and authority.”
Michael Lewis, next
“Teens and young adults are flocking to the Web for health-related information as much as
they are downloading music and playing games online and more
often than shopping online, according to a national survey
from the Kaiser Family Foundation.” —Reuters
“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, Health Care 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
“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
“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
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, 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 60 in ’05!
“NOT ACTING THEIR AGE: As Baby Boomers
Zoom into Retirement, Will America Ever Be the
Same?”USN&WR Cover
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
“Some grocery stores have better
technology than our hospitals and
clinics.” —Tommy Thompson, HHS
Secretary
Source: Special Report on technology in healthcare, U.S. News & World Report (07.04)
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
Want email consultation: 90% patients, 15% docs.
Evidence: Patients do not pester docs. Time is saved. No one has sued (shows “care & connection”—
the absence of which is the major cause of suits).
Source: New York Times
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.
Source: On Magazine
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.”
“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
The VHA gets it! E.g.: Laptop at bedside calls up patient e-records from one of 1,300 hospitals. Bar-coded wristband confirms meds. National Center for Patient Safety in Ann Arbor. Docs and researchers
discuss optimal treatment regimens—research center in Durham NC. Doc measures & guidelines; e.g.,
pneumonia vaccinations from 50% to 84%. Blame-free system, modeled after airlines. “What’s needed in the U.S. is nothing short of a medical revolution and
the VHA has gone further than most any other organization to revamp its culture and systems.”—
Rand/Source:WSJ 12.10.2001
“Our entire facility is digital. No paper, no film, no medical records. Nothing. And it’s all integrated—from the lab to X-ray to records to physician order entry. Patients don’t have to wait for anything. The information from the physician’s office is
in registration and vice versa. The referring physician is immediately sent an email telling him his patient has shown up. … It’s wireless in-house. We have 800 notebook computers that are wireless. Physicians can walk around with a computer that’s
pre-programmed. If the physician wants, we’ll go out and wire their house so they can sit on the couch and connect to the
network. They can review a chart from 100 miles away.” —David Veillette, CEO, Indiana Heart Hospital (HealthLeaders/12.2002)
4. “Quality”: COULD IT TRULY BE
THIS AWFUL?
“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
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
HealthGrades/Denver: 195,000 hospital deaths per year in the U.S., 2000-2002 =
390 full jumbos/747s in the drink per year. Comments: “This should give you pause when you go to the hospital.” —Dr. Kenneth Kizer, National Quality
Forum. “There is little evidence that patient safety has improved in the
last five years.” —Dr. Samantha Collier
Source: Boston Globe/07.27.04
1,000,000 “serious
medication errors per year” … “illegible handwriting, misplaced decimal points, and missed drug
interactions and allergies.”
Source: Wall Street Journal / Institute of Medicine
Answer: (1) Physician order-entry system, (2)
stick to treatment guidelines for high-risk
patients, (3) adequate ICU staffing.
The perils/costs of folk wisdom:
Pills vs. IV/ $100 per use.
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
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.
YE GADS! New England Journal of Medicine/ Harvard Medical Practice Study: 4% error rate (1 of 4 negligence). “Subsequent investigations around the
country have confirmed the ubiquity of error.” “In one small study of how clinicians perform when patients
have a sudden cardiac arrest, 27 of 30 clinicians made an error in using the defibrillator.” Mistakes in
administering drugs (1995 study) “average once every hospital admission.” “Lucian Leape, medicine’s
leading expert on error, points out that many other industries—whether the task is manufacturing
semiconductors or serving customers at the Ritz Carlton—simply wouldn’t countenance error rates like
those in hospitals.”—Complications, Atul Gawande
“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.”
Source: Dartmouth Medical School 1996 report
Geography Is Destiny
E.g.: Ft. Myers 4X Manhattan—back surgery. Newark 2X New Haven—
prostatectomy. Rapid City SD 34X Elyria OH—breast-conserving surgery. VT, ME, IA: 3X differences in hysterectomy by age 70; 8X tonsillectomy; 4X prostatectomy
(10X Baton Rouge vs. Binghampton). Breast cancer screening: 4X NE, FL, MI
vs. SE, SW. (Source: various)
PARADOX: Many, many formal case reviews …
failure to systematically/ systemically/ statistically
look at and act onevidence.C.f., Complications, Atul Gawande
Deep Blue Redux*: 2,240 EKGs … 1,120 heart attacks.
Hans Ohlin (50 yr old chief of coronary care, Univ of
Lund/SW) : 620. Lars Edenbrandt’s
software: 738.
*Only this time it matters!
“Most physicians believe that diagnosis can’t be reduced to a set of generalizations—to a ‘cookbook.’ … How often does my intuition lead me astray? The radical implication of the
Swedish study is that the individualized, intuitive approach that lies at the center of modern medicine is flawed—it causes more mistakes
than it prevents.” —Atul Gawande, Complications
Probable parole violations: Simple model (age, # of previous offenses, type of crime)
beats M.D. shrinks.
100 studies: Statistical formulas > Human
judgment. “In virtually all cases, statistical thinking
equaled or surpassed human judgment.”—Atul Gawande,
Complications
Geography Is Destiny
“Often all one must do to acquire a disease is to enter a country where a disease is recognized—leaving the
country will either cure the malady or turn it into something else. … Blood pressure
considered treatably high in the United States might be considered normal in England; and the low blood
pressure treated with 85 drugs as well as hydrotherapy and spa treatments in Germany would entitle its sufferer to lower life insurance rates in the
United States.” – Lynn Payer, Medicine & Culture
“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, Michael Millenson
It’s (measurable, systemic) outcomes,
stupid!
Leapfrog Group/med errors: “Not since Jackson Hole Group guru
Paul Ellwood, Jr., M.D., coined the term ‘HMO’ in 1970 has one idea so
fully captured the imagination of the healthcare industry.”—
HealthLeaders
Leapfrog Group:
CPOE/Computerized Physician Order Entry*ICU staffing by trained intensivists**EHR/Evidence-based Hospital Referral***
*Duh I: Welcome to the computer age.**Duh II: How about using experts?***Duh III: If you do stuff a lotta times, you tend to get/be better. Source: HealthLeaders
Empire Blue Cross and Blue
Shield: 4% quarterly bonus for hospitals that meet Leapfrog’s CPOE and
ICU-staffing standards.
Source: HealthLeaders
The Benefits of … FOCUSED EXCELLENCE
Shouldice/Hernia Repair: 30-45 min, 1% recurrence.
Avg: 90 min, 10%-15% recurrence.
Source: Complications, Atul Gawande
Computerized Physician Order
Entry/CPOE: 5% of U.S.
hospitals
source: HealthLeaders/06.02
“When a plane crashes, they ask, ‘What
happened?’ In medicine they ask: ‘Whose fault was it?’ ”—James Bagian, M.D. &
former astronaut, now working with the VHA.
Winning By Acknowledging Failures
Wernher Von Braun, the Redstone missile engineer who “confessed” &
the bottle of champagne. Award to the sailor on the Carl Vinson—for reporting
the lost tool. Amy Edmondson & the successful nursing units with the
highest reported adverse drug events.Source: Karl Weick & Kathleen Sutcliffe, Managing the Unexpected
5. 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!
6. Genetics, Devices, the Future of Big
Pharma
“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
Genetic data: 2X every 6 months.
Source: Financial Times
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 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
E.g., Genentech’s Herceptin, useful in 25% of advanced breast cancer cases.
Would probably have been uneconomic if subjected to 9X
patients in phase III clinical trials.
Source: FT
Pharmacogenomics: End of Blockbusters by End-of-Decade (Reuters)
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.”
“BIG DRUG MAKERS TRY TO POSTPONE
CUSTOM REGIMENS. Most drugs don’t work well for about half the 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)
Forbes100 from 1917 to 1987: 39 members of the Class of ’17 were alive in ’87; 18 are in ’87 F100; the 18 F100
“survivors” underperformed the
market by 20%; just 2 (2%), GE & Kodak, outperformed the market from
1917 to 1987.
Source: Dick Foster & Sarah Kaplan, Creative Destruction: Why Companies That Are Built to Last Underperform the Market
Biotechs: Amgen, Genentech, Biogen, Genzyme, Celltech,
ImClone Systems. Bioinformatics: Accelrys, Cognia, Double Twist,
IBM Lifesciences, NetGenics, SAS Institute.
“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
“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!
The Future of Reps:
Whoops
“Consultative selling requires dialogue … and
the time for that dialogue. Unfortunately, this seldom
happens in today’s hurry-up complex world of
pharmaceutical selling.”—newspost/spbt
Study of 500 Reps: 65% “had face-to-face conversation with the
physician for less than 30 seconds per visit. In fact, more than half of the 65% admitted that
the average time is less than 15 seconds.”Source: newspost
“Research reveals no evidence of overall superior selling behavior related to
experience beyond five years. Quite the
opposite …”—newspost/spbt
Pediatric cardiologist & practice head: “I don’t see them, period. I study, write papers, use the Web, attend a minimum of 4 or 5 major conferences a year. My staff may
see them, but I in general find their views uselessly prejudiced. Call it, I’m afraid to say, ‘hucksterism.’ ”
Urologist: “A few of them—a very few—are excellent. The good ones
are self-deprecating. If their product is not all that great, they’ll admit it. Mostly, it’s a waste of my
time. I let the staff handle it.”
Family Practice Office (3 Docs, Midsize town) Administrator
TP: “How often does Dr. X see Reps?”PA: “He doesn’t.” [Emphatic.]
TP: “That was sharp in tone! Why?”PA: “We used set aside a two-hour block, once a month. But a lot of the Reps missed appointments. That, however, was the least of it. The biggest problems were the Reps who kept pushing the same thing, visit after visit. They had absolutely nothing new to say.”TP: “So how does Doc X keep up?”PA: “The Internet.” [T.O.V. = “What else?”]
Internist (Silicon Valley): “The Web is generally better. I spent a year of painstaking study, and now I have a system that keeps me informed in a ‘push’ fashion. I began as a skeptic, harassed by a few of my
techie patients, and I’ve become a ‘believer’ and proselytizer.”
Oncologist: “They are, or can be, helpful to the two-thirds of docs, to
be frank, who don’t study much. I’ve got one or two I’ll call, but otherwise I’m ‘not available.’ ”
Pharmaceutical exec: “Truthfully, we hire attractive women as much as we can get away with. That plus
pens are huge influencers—it’s what our focus groups tell us.” (The
“attractive young women” theme was a constant refrain. “I find it laughable, to a point,” a female M.D.
told me. “What I fear is that it works.”)
ER doc/exec: “It’s pathetic. The docs are half assed in their learning styles.
Most don’t even pretend they are keeping up. Reps? She who has the best pens wins. Health care is out of control—and laughingly unscientific. Whatever your nightmare stories are, trust me, the reality is much worse.”
Plastic surgeon & practice head: “My practice has changed 100% in the last 10 years. Sadly,
that’s not true for three-quarters of my colleagues. Information technology is a big part
of it. It’s extremely user-unfriendly. It took me and my partners and office staff a year to
customize our approach—and as we did so the role of the reps became less and less important.
I won’t even let our staff schedule time with them. It’s inefficient, and most of them are
humorously biased—and insult us by imagining it’s not transparent.”
Big Pharma (Summary):
(1) Discovery … too complex, wrong scientific emphasis. (2) Distribution … reps’ role
under heavy fire. (3) “Solution” = More consolidation = Stupid. (D + D = G???) (4) Short your stock.
7. Conclusion.
Golden Age of Patient-centric, Genetics-driven Healthcare Looms!
Current status: $1.3T. 30M-70M uninsured. 90K killed and 2M injured p.a. in hospitals. 85%
treatments unproven. Cure depends on locale in which treated. 50% prescriptions do not work.
2X docs. 2X hospitals. IS primitive. Accountability & measurement nil.
And everybody’s mad and feels powerless: docs, patients, nurses, insurers, employers,
pharma & device cos, hospital administrators and staff.
Message Summary: (1) An unparalleled time for
imagination and bold action. (2) A time of unprecedented
opportunities. (3) A time
of unprecedented risk.
HealthCare21
HealthCare21: 21 Ideas for Century211. Hospitals kill people. (And many of those they don’t kill, they wound.) (And they deny it.) (ERRORS RULE!) And: Hustling ambulances kill pedestrians—and don’t save patients.2. Doctors are spoiled brats—who don’t like measurements. Or any form of “interference.” Docs are also cover-up artists. The REAL Hippocratic Oath: “DON’T RAT ON A FELLOW DOC”. 3. Most prescription drugs don’t work—for a PARTICULAR patient. Current drugs = Blunderbusses.4. Think … WELLNESS. Think … PREVENTION.5. THERE IS LITTLE “SCIENCE” IN “MEDICINE.” (See state to state variations … country to country variations … the general lack of agreed-upon treatments.)6. You could save thousands of lives (think Schindler)—if you just outlawed handwritten prescriptions.7. “Detailers” will disappear … when GenX docs arrive.
HealthCare21 (Cont.)8. IS/IT in hospitals is sub-primitive (despite enormous expenditures).9. Systemic IS/IT is worse—links between docs, insurers, providers, patients.10. ELECTRONIC MEDICAL RECORDS …TO UNIFORM STANDARDS. (NOW.) (PLEASE.) 11. THE WEB WILL LIBERATE. (Info = Power.) (BELIEVE IT.) 12. 80M BOOMERS RULE. ($$$$$. Desire for c-o-m-p-l-e-t-e CONTROL. NOW. “LEADERSHIP” OF AGING PROCESS.)13. “Drug Discovery” processes at Big Pharma are … hopelessly over-complicated. (???: Bye Bye … Big Pharma.)14. 90% of the “healthcare fix”: HARVEST THE LOW-HANGING FRUIT. “They” are … NOT … the Enemy. “I have seen the enemy … and it am me.” Damn it.
HealthCare21 (Cont.)15. The number of U.S. un-insured is the nation’s #1 disgrace. That said, insured “consumers” are spoiled brats. They/we/me act as if healthcare were a free good … and believe that an incipient hangnail calls for at least a CAT scan … or two. ANSWER: MAKE US FEEL THE PAIN.16. Genetic engineering & biotech change … EVERYTHING. (Within 15 years.)17. New Medical Devices change … EVERYTHING. (Within 15 years.)18. IS/IT changes … EVERYTHING. (Within 10 years.)19. New Docs change … EVERYTHING. (Within 10 years.)20. New Patients change … EVERYTHING. (Within 5 years.)
* *
HealthCare21 (Cont.)
21. ALL THIS = ENORMOUS OPPORTUNITY. The
Opportunity of Several Lifetimes. (For the Bold & Brave.) H’Care WILL be … TOTALLY … re-invented in the next two decades. (And, hey, it is our largest “industry.”)
HealthCare2
Healthcare’s 1-2 Punch
1. Hospital “quality control,” at least in the U.S.A., is a bad, bad joke. Depending on whose stats you believe, hospitals kill 100,000 or so of us a year—and wound many times that number. Finally, “they” are “getting around to” dealing with the issue. Well, thanks. And what is it we’ve been buying for our Trillion or so bucks a year? The fix is eminently do-able … which makes the condition even more intolerable. (“Disgrace” is far too kind a label for the “condition.” Who’s to blame? Just about everybody, starting with the docs who consider oversight from anyone other than fellow clan members to be unacceptable.)
2. The “system”—training, docs, insurance incentives, “culture,” “patients” themselves—is hopelessly-mindlessly-insanely (as I see it) skewed toward fixing things (e.g. Me) that are broken—not preventing the problem in the first place and providing the Maintenance Tools necessary for a healthy lifestyle. Sure, bio-medicine will soon allow us to understand and deal with individual genetic pre-dispositions. (And hooray!) But take it from this 61-year old, decades of physical and psychological self-abuse can literally be reversed in relatively short order by an encompassing approach to life that can only be described as a “Passion for Wellness (and Well-being).” Patients—like me—are catching on in record numbers; but “the system” is highly resistant. (Again, the doctors are among the biggest sinners—no surprise, following years of acculturation as the “man-with-the-white-coat-who-will-now-miraculously-dispense-fix it-pills-for-you-the-unwashed.” (Come to think of it, maybe I’ll start wearing a White Coat to my doctor’s office—after all, I am the Professional-in-Charge when it comes to my Body & Soul. Right?)