Neel Shah, MD, is exploring frontiers of OB-GYN, value-based care, and medical innovation.
This article appears in the January/February 2020 edition of HealthLeaders magazine.
An intellectual giant played a large role in shaping the career of Neel Shah, MD, MPP.
Shah is making his mark in Boston, where he is an obstetrician-gynecologist at Beth Israel Deaconess Medical Center, an assistant professor at Harvard Medical School, director of the Delivery Decision Initiative at Ariadne Labs, and board chair of Costs of Care. He is a self-described health systems scientist—a calling that started when he studied neuroscience at Brown University in Rhode Island.
"My interest in neuroscience came from following a person. When I was in college, there was a professor named Leon Cooper who was my advisor. He won the Nobel Prize in Physics in 1972 for the theory of superconductivity at a relatively young age, then [he] moved on. He decided he was going to study the brain, and he came up with a bunch of theories about the brain that revolutionized the field," Shah says.
"Professor Cooper was an audacious thinker. For every young person, there is someone who believes a better world is possible, and he was that person for me. He was a mentor who taught me to think about systems because the brain is a complex system."
Healthcare reform advocate
Shah cofounded Costs of Care—a nongovernmental organization dedicated to providing better healthcare at lower cost—a decade ago.
"When we started, Costs of Care was focused on transparency. Abraham Verghese has a wonderful quote: 'If you are ordering off a menu with no prices, it's easy to get the filet mignon every time.' We wanted to put prices on the healthcare menu because there were brand-new clinicians clicking on a mouse who were spending tens of thousands of dollars without even knowing it," he says.
"Now, we have moved beyond transparency, which is important, but there are multiple failures at the point of care that are preventing people from accessing affordable, safe, dignified care. We can't tell people what services cost. We often don't tell patients whether a service is worthwhile to begin with. Then, when services are worthwhile and expensive, we are not deploying all of the resources to make sure that patients can comply with our recommendations."
At Ariadne Labs—a joint healthcare innovation center of the Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital, Shah has played a leadership role in the Team Birth Project. The initiative seeks to revolutionize the relationship between pregnant women, their families, and their healthcare teams to boost childbirth outcomes.
"The Team Birth Project is a large-scale experiment across the country that is trying to get clinicians and families on the same page to achieve more appropriate, safer, and more affordable care," he says.
Shah says even though he has always been "a little bit of a generalist," he gravitated toward the field of OB-GYN. He says that as he's spent more time in the field, it's become more personal for him. "I have a family of my own, and one of the things I have realized is that the period when you are growing your family from pregnancy to parenting an infant is a universal period of vulnerability. There are a lot of opportunities to make our systems of support and care better."
Perspectives on healthcare
Following are highlights from a conversation between Shah and HealthLeaders where he shares his perspectives on obstetrics-gynecology, value-based care, medical entrepreneurship, and health systems science.
"In childbirth, the main way we think about quality is the absence of injury. The absence of injury is good, but most women have goals beyond escaping unscathed from the process. Survival is the floor of what they are expecting and what they deserve. If we are going to design a better system, we should be aiming for the ceiling, but we haven't figured out what that looks like."
"Nobody goes to medical school thinking about GDP, but Americans have the least affordable healthcare compared to a half century ago. So, for the longest time of taking care of people, the ethic in U.S. medicine has been thoroughness rather than appropriateness. Thoroughness is a good goal, but appropriateness is a better goal."
"In the quest for thoroughness, 50 years ago there were only a handful of causes of chest pain; now, there are thousands. You literally cannot test for all of them—it's not efficient, it costs people a lot of money, and it can even be harmful to over-test. So, that's why appropriateness is important. We must find out how to deliver healthcare affordably for every American."
"The best models are the ones that put a contingency on payment over and above having simply provided a service. Any of those models are better than testing for something, drawing blood, or poking you with a sharp object, then billing for it irrespective of the outcome. That clearly is a crazy system. There is no other sector of the economy or other industry where that would be OK. There's no other area that tolerates the kind of paternalism or opacity that behavior requires."
"The mission of Ariadne Labs is trying to figure out how we can drive improvements at scale in healthcare. It's kind of the opposite of Costs of Care in some ways. Costs of Care is focused on catalytic, breakthrough innovations. Ariadne Labs is based on the recognition that the dominant cause of suffering in the world is not necessarily lack of knowledge—it's lack of execution. It's about fixing execution failures in a way that works in multiple settings across the world."
"It's 100% entrepreneurship in my mind because there's a vision, a commitment to realize that vision, and there's an ROI that is not necessarily cold, hard cash. It's more about making an impact. It's the same mindset and the same process as entrepreneurship. The things I invent are not widgets or artificial intelligence—the Team Birth Project has a totally analog whiteboard as a key tool. You write with a dry-erase marker, but it is fundamentally changing the way people experience care."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Neel Shah wears several hats: assistant professor, obstetrician-gynecologist, healthcare innovator, and transparency pioneer.
At Ariadne Labs in Boston, Shah has helped lead the Team Birth Project, which seeks to revolutionize the relationship between pregnant women, their families, and their healthcare teams.
"The best models are the ones that put a contingency on payment over and above having simply provided a service," he says of healthcare payment models.