Medical Tuesday Blog
Dr. Christensen As The Health Innovator Disruption is the cure for what ails health care.
Since the late 1990s Christensen has been influencing change in health care through both his summer leadership program at Harvard Medical School for hospital administrators and regular consulting work for medical giants like Johnson & Johnson and Medtronic. Recently he helped J&J develop a device that would make it easier and cheaper to administer anesthesia. (The Food & Drug Administration rejected it.)
His book The Innovator’s Prescription (2009) was co-written with two doctors, the late Jerome Grossman, who ran Tufts Medical Center for 16 years, and Jason Hwang, a former student of Christensen’s. Hwang contributed enormously to this story.
The authors acknowledge that the fee-for-service reimbursement system, in which providers earn more by treating patients more aggressively, impedes the kind of disruptive innovation that would lead to better care at a lower cost. There are several systems we could adopt that would be better, but there isn’t a road map to get there. The business models of health are frozen in the hospital and the doctor’s office. The path to fixing the system is to disrupt those models. Here are some approaches:
Routinization. A hospital is really three business models under one roof, each of which manages a different type of medical practice. Intuitive medicine is the realm of highly trained specialists handling difficult diagnoses and treatment. Empirical medicine is the costly realm of chronic care and trial-and-error treatment. Precision medicine, the real goal for the system, is a case where diagnosis is known and so is the therapy. Then treatment can be routinized and moved off-site. Disruption will involve pushing more of medicine into the precision category, then automating that care to make it better and cheaper.
Consolidation. The best way to unleash disruption is if more health care providers combine, controlling hospitals, doctors and health insurance. Christensen makes an analogy to RCA in the 1950s. To get people to watch the first color programming on its NBC channel, RCA also had to manufacture color TV sets. A hospital loses money if it tells patients to go to an outside cheaper clinic. But if it owns the health plan and the clinic, disruptive ideas will flourish.
Precision. The kind of targeted therapies now used in cancer treatment, such as the drug Christensen received, will be applied more widely. Diseases will be subtyped more specifically and therapies tailored to work better. This will also save time and money as clinical drug trials become more focused. Specialty clinics will arise to implant devices more cheaply.
Do-it-yourself. Christensen predicts a rise in self-diagnosis and self-care, as tools that used to be stuck in the hospital reach patients and their families.
Government is not the solution to our problems; government is the problem. – Ronald Reagan
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