Medical Tuesday Blog

Health Care Innovation

Jul 7

Written by: Del Meyer
07/07/2018 7:36 AM 

The Health Innovation We Need

By Dave A. Chokshi, MD, MSc

The word innovation is omnipresent in health and health care, describing new uses of technology and data, entrepreneurial ventures, and public sector efforts. Given the many challenges in the US health sector—including decreasing life expectancy, increasing costs, declining rates of health coverage, and potentially widening health disparities—new approaches are undoubtedly needed. But innovation is often tantamount to small-scale pilot projects or to digital tools mismatched with clinical realities, as seen with the electronic health record and clinician burnout.

How do we get from flashes of health innovation to a steadier flame?

Perhaps we should frame it less as innovation and more as imagination. The late theoretical physicist Richard Feynman, PhD, described imagination and the scientific process thus: “The great difficulty is in trying to imagine something that you have never seen, that is consistent in every detail with what has already been seen, and that is different from what has been thought of; furthermore, it must be definite and not a vague proposition.” 

Pursuing novel solutions to the most difficult problems in health—across the domains of care delivery, public health, and government—requires a similar type of imagination.

Care Delivery Transformation

Reimagining how health care is delivered begins with a metamorphosis for primary care. Although primary care is literally the “first point of care” for many patients, it is grappling with competition from convenient care models such as urgent care centers for acute conditions and from new corporate entities (typified by the merger between CVS and Aetna) for chronic conditions. CVS provides thousands of access points that patients may already frequent, while the insurer Aetna changes the incentives such that keeping patients healthy may be a more lucrative proposition. In both cases—for acute and chronic conditions—telehealth could provide a “virtual front door.” Amid these shifting sands, primary care may need to cede some first-contact services for healthier patients while renewing a commitment to the longitudinal relationships at the heart of comprehensive care for more complex patients. . .

Public Health Priorities

Karen DeSalvo, MD, MSc, and other architects of the Public Health 3.0 model have urged thinking beyond innovation in clinical settings. In this framework, community prevention complements clinical prevention (eg, immunizations and colonoscopies) and treatment by addressing the social, economic, and environmental factors that predispose patients to illness. For instance, Kaiser Permanente recently announced an investment of up to $200 million, joining with mayors and business executives around the country to address housing stability and homelessness, citing their impact on health. . . .

Role of Government

The Department of Veterans Affairs (VA) could be at the vanguard of addressing the social determinants of health. Although the VA system is generally known for delivering health care services, the broader department administers education and vocational rehabilitation benefits, pensions, legal services, home loans, life insurance, and disability compensation. The VA has already made significant strides in reducing homelessness among veterans from 2010 to 2016. A whole-person approach to meeting medical and social needs at scale could serve as an exemplar for other populations.  . . .

Of course, government alone cannot turn flashes of innovation into flame. Rising to our health challenges will require reimagined partnerships between the public and private sectors, between patients and clinicians, and between practitioners in health and many other fields that help produce health.

JAMA. 2018; 320(5):427-429. doi: 10.1001/jama.2018.954

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