HealthLeaders talked to numerous innovation experts during this past year. Here are some of the more remarkable perspectives we heard.
It is said that no thought is original, but as the innovations editor for HealthLeaders, I think I may have heard a few novel ideas this year.
I have the privilege of speaking with a diverse group of leaders about how their organizations approach innovation. We shared their insights with you throughout 2019. Now, as the year winds down, we offer a collection of some of the more remarkable perspectives that emerged during our conversations.
1. Don't Place Physicians' Needs First
In most other industries, the customer's demands come first. In healthcare, the cultural milieu is quite different; the focal point has traditionally centered on physicians, says Joseph C. Kvedar, MD, vice president of Connected Health at Partners HealthCare in Boston.
"We need to have a long, hard look at why we think healthcare is different," says Kvedar, who is also a professor of dermatology at Harvard Medical School. Physicians have a distorted perception of their role in healthcare, he says.
"It's complicated because of this relationship that we have with insurance [companies], the patient, and the staff" he says. "Everyone tends to layer praise on the doctor because … a doctor drives all the revenue; we're like the rainmaker."
Physicians also "have the magic pen," says Kvedar. Patients can't get a prescription without consulting their doctor, "So everyone's nice to us."
Yet patients often have to wait for months to get an appointment and perhaps for hours once they arrive, creating discord. "I have countless stories of patients who have been angry to the staff, they're mean to the nurse, and then they're sweet as pie to me," he says. "It happens all the time."
As a result, physicians "get lulled into the sense that we're incredibly important," says Kvedar. "We've got to wake up to the fact that other service delivery models don't tolerate that, and we can do better on behalf of our patients."
The concept of connected healthcare helps shifts the focus to patients by factoring in their needs and convenience.
2. Show Clinical Personnel the Money
Making the leap from the lab into the clinical arena is essential to the innovation process, and physicians play a key role in testing and scaling innovations, says George Hamilton, MBA, one of three managing directors and partners of Intermountain Ventures, an investment company that handles innovation investments for Salt Lake City–based Intermountain Healthcare.
To stimulate physician involvement, pay them, Hamilton says.
Intermountain Ventures has 30 Intermountain physicians across a variety of specialties who have agreed to participate in the evaluation and implementation process.
"The most important component of the pilot work we do is having a clinical champion," Hamilton says. "We need someone inside the clinical organization to be excited enough about the opportunity to pound the table for it and represent it."
"One of the key failure points for a venture is when there isn't anyone inside the clinical shop that's excited enough about it to push it forward" he adds. "If someone isn't excited about the venture opportunity, it will just die on the vine. We draw from our pool, and if we can't enlist a clinical champion, we don't do the deal."
If a physician's services are enlisted, he or she is compensated through subsidies built into the venture firm's financial structure, Hamilton explains.
"We had to figure out the right way to make that happen in a way that's fully compliant" he says. "They won't be part of the capitalization of the new company; we don't offer equity in exchange for their services … but we'll certainly pay for their time."
Eyal Zimlichman, MD, MSc, who serves as deputy director, chief medical officer, and chief innovation officer at Sheba Medical Center in Tel HaShomer, Israel, shares a different approach. About 20 years ago, Sheba opened an office to commercialize its research. The initiative has been successful, generating substantial income for the government-run hospital, says Zimlichman, who formerly served as lead researcher at the Partners HealthCare clinical affairs department in Boston.
Sheba offers financial incentives for those who develop ideas. When physicians' innovations are commercialized, they receive 35% of the income that Sheba earns. Many have become millionaires, says Zimlichman, creating a strong incentive to innovate.
3. Consider a Membership Model to Expand Innovation Resources
With limited funds and lean operations, some health systems have developed creative approaches to maximize the power of innovation.
The Wake Forest Center for Healthcare Innovation in Winston-Salem, North Carolina, which is funded by Wake Forest Baptist Health and Wake Forest School of Medicine, invites anyone affiliated with the Wake Forest system to become a voluntary member of its innovation team.
The 60 members have full-time jobs elsewhere in the Wake Forest system but contribute to the center's activities. Most are involved in bringing a particular innovation to life, says Eric Kirkendall, MD, the center's deputy director, but they are required to participate in structured and unstructured activities alike to advance other members' initiatives.
Membership is open to anyone in the Wake Forest system, not just faculty members. By including hospital nursing leaders and managers, for example, who can test innovations in the clinical environment and train others how to use a new device or process, Kirkendall says the center enhances the opportunities for innovations to make the leap from the lab into the patient care setting.
"All we ask is that members become meaningful contributors to our group collective," says Kirkendall.
4. Unrecognized Players May Become Competitive Threats
As healthcare leaders cast their collective gaze on Google, Amazon, Apple, Walmart, and CVS Health, wondering whether and how these companies will disrupt the industry, bear in mind that unknown players could pose a competitive threat just the same.
As she looks to the horizon, Indu Subaiya, MD, MBA, sees a development that should pique the curiosity of health system executives. Subaiya, a co-founder and former CEO of Health 2.0, now serves as president and co-founder of Catalyst @ Health 2.0.
There's a new type of technology platform where companies are "inverting the stack," says Subaiya. Rather than selling a solution to a health system, such as an artificial intelligence or remote care product, she explains, these companies hire their own clinical professionals to offer complete, end-to-end care delivery packages.
Initially these may not appear to be a competitive threat because they focus on a specific issue, like elderly care or diabetes virtual care management, she says.
"But when you start packaging those platforms with mechanisms for reimbursement, which many of them are now doing … once you're in their member network, you're basically being completely taken care of in that very high-touch, clinically oriented way," says Subaiya. "So they almost then become a provider too."
As an example, she cites Devoted Health which raised $300 million in Series B funding last fall and was approved by the Centers for Medicare & Medicaid Services to offer Medicare Advantage plans to seniors, which it couples with personal health guides.
"Underneath Devoted Health's stack is basically a layer of technology and services that's highly tech-enabled and data-enabled," says Subaiya. Other companies she says to keep an eye on, she says, include Omada Health, Lark Health, and Virta Health.
5. Build Bridges to Community Resources
"Historically, the community health world and the medical world have been disparate and different," says Rich Roth, senior vice president and chief strategic innovation officer for CommonSpirit Health. "To succeed in taking care of the community, we have to link these resources."
As healthcare organizations innovate, particularly with initiatives related to social determinants of health, they should consider tapping into the "incredible resources" already available in the community, he says. These include organizations focused on food security, homelessness, and culturally relevant disease management, as well as Federally Qualified Health Centers.
"One of the biggest themes that we'll probably see moving forward is how do you best link the social and community world with the medical world to care for patients who are at their most vulnerable," says Roth.
6. Insurance and Improved Payment Models Are Foundational
Innovators need to examine critically the American approach to insurance and healthcare financing models, particularly for primary care, says Asaf Bitton, MD, MPH, executive director of Ariadne Labs, who is also a Harvard University professor and a primary care physician affiliated with Brigham and Women's Hospital.
"I think that there's a moral and human case for everyone having access to healthcare, but I also think that there's an economic and a financial imperative," says Bitton. "It makes economic sense to have everyone covered, both because of uncompensated care that the rest of the covered people end up shouldering the bill for, but also because health insurance and lack of health insurance traps people in jobs and limits movement across economic systems. It's something that every other developed country in the world has figured out how to do, and I think that we can do so as well."
Payment models need to evolve, he says.
"One of our fundamental challenges in the U.S. is that we have a delivery system that's designed around the idiosyncrasies of a payment model that just happened to come into being, as opposed to having a payment model designed to support the delivery of a healthcare system [constructed] around the user's needs," he says.
The solution should closely factor in the role primary care providers play, he adds.
"We know from great evidence that healthcare systems built on a foundation of primary care deliver better care at lower costs," says Bitton. "Without that financial coverage and without health financing mechanisms that actually reward them, primary care sort of dies on the vine."
Value-based payments should double expenditures toward primary care, he says, as opposed to paying hospitals to do more.
Mandy Roth is the innovations editor at HealthLeaders.
Don't place physicians' needs first, but compensate them for their involvement.
Consider a membership model, and build bridges to community resources.
Unrecognized players may become competitive threats.
Insurance and improved payment models are foundational innovation issues.