The U.S. healthcare industry is in the process of major transformation and during a health innovation conference at the Massachusetts Institute of Technology (MIT) on Oct. 21, faculty, researchers, clinicians and practitioners addressed the challenges confronting the industry and the tools being brought to bear to address those challenges.
MIT’s Sloan School of Management’s Initiative for Health Systems Innovation (HSI) sponsored the “Technology, Analytics and Systems” conference at the Cambridge, Mass.-based campus with a specific focus on three major challenges—the management of chronic illness, the role of telemedicine and intra-system payment and reward plans for providers.
To kick off the day-long conference, Jay Levine, retired principal of ECG Management Consultants, drew parallels between the ongoing transformation in healthcare to transitions in other industries in which there were dramatic federal realignment of regulations, such as the banking and airlines industries. “There was dramatic disruption in those industries, characterized by new entrants into the industry, low cost entrants, and consolidation among players to attain scale and market. This transition is now happening and it’s ripe for the innovation and application of technology and analytics and other tools that are bringing to bear in the healthcare industry,” Levine said.
MIT Sloan Professor Retsef Levi, Ph.D., co-chair of the conference and the HSI, said, “The health system is under significant pressure to change, to transform itself, and to articulate what this transformation is about, the current health system is designed to provide discrete, reactive care for sick patients, in specified locations, and it’s physician-focused with providers paid based on the volume of activities performed.”
He continued, “What it needs to transform to is very different. The idea of health is going to be broader, more comprehensive—what do patients eat, do they smoke, where do they live? It’s going to require us to think deeply about what we do for every patient, and how we think about the welfare of the population. It’s going to be team-based, patient-centric, and data-driven personalized care. And providers will be paid based on risk managed, health outcomes and efficiency.”
Retsef also said market incentives and payment schemes will not be enough to drive the transformation. “There is a lot of evidence in the last 50 years that tweaking market incentives is not enough,” he said, noting the development of accountable care organizations (ACOs). “There is growing concern that just merely changing the incentives is not sufficient as some organizations are seriously struggling and it’s an ambitious task.”
“We really need to fundamentally rethink how health systems are structured and what organizational capabilities they should have in terms of analytics, technology, workforce, processes and resource allocation. We need to think deeply about behavioral and cultural considerations—the humans that are patients and the humans that are providing the care. And, of course, we need to continue to leverage advancements in clinical innovation and how use that to create effective systems with better outcomes at sustainable cost.”
Retsef also said MIT’s Sloan School of Management’s HSI program is working to bridge different stakeholders across disciplines to address these healthcare challenges. “Most health systems, even the pioneering systems, struggle with the stream of ideas and technologies and how to take these ideas and technologies and do something that is sustainable economically. There is very little infrastructure to allow these systems to think and experiment rigorously to learn what works. We can be facilitators with data-driven experimentation and system cost-benefits analysis,” he said.
The Role of Telemedicine
During a panel discussion, healthcare industry leaders and an economist discussed the current and future state of telemedicine and the challenges to more widespread use of telemedicine technologies.
On the panel were Kevin Galpin, M.D., acting chief consultant of Veterans Health Administration (VHA) Telehealth Services; Michael Hodgkins, M.D., vice president, chief medical information officer at the American Medical Association (AMA); Mary Modahl, chief marketing officer and senior vice president, American Well Corporation and Joseph Doyle, Erwin H. Schell professor of management and a professor of applied economics, MIT Sloan School of Management.
Looking at the current state of telehealth and what it encompasses, Galpin, whose agency, the VHA, has been progressive in this space with two million telehealth visits in 2014, said, “We break it down into three things. There’s accessibility to the system, so a patient has an appointment over at this location and how do I make it easier for the patient to get access to care, whether that’s bringing something from a main medical center to a local clinic, or even to their home. Second, there’s the capability to increase capacity, so in underserved areas, in rural areas where it’s hard to recruit, we go to areas that I can recruit and deliver services through digital technology. And then quality and looking at areas where we want to improve outcomes. In our ICUs, we added telemedicine as an additional layer of providers and systems on top of what we already have and we get better outcomes. Those three things can blur and great programs will improve all three, but you can focus on one and you can have different goals for different programs.”
Modahl with telehealth vendor American Well, said, from a technology point of view, telemedicine is moving rapidly forward. “You hear about technology such as remote monitoring, two-way video visits and those technologies, and we have individual silos of innovations, but when they come together, the applications become truly exciting.”