Innovating Health Care Innovation
The fundamental question about health care innovation is “Why is it taking us so long to get there?” It’s a trick question. The tools we use to deliver health care—pharmaceuticals, medical devices, surgical techniques, imaging, genomic analysis, and other diagnostic tests—have undergone remarkable advances since the two of us went to medical school. Both of us are general internists, which means we treat conditions like diabetes, hypertension, hyperlipidemia, chronic lung disease, coronary artery disease, and obesity. There isn’t a single condition among those that we treat the same way now as when we went to medical school, and in nearly every case our treatment is far better than what we had before--the exception is obesity—not much progress there, except for weight-loss surgery. If innovation is defined as the implementation of new practices that add value, then health care should be seen as one of the most innovative industries around.
But it isn’t. The fact that everywhere we see calls for innovation in health care suggests that the kind of innovation we see in health care falls short of the kind of innovation we seek in health care. Isn’t it enough that many childhood leukemias are now curable, that aortic valves can be replaced without surgery, and that some centers do hip replacements as an outpatient procedure? Those things are great, but people also want lower cost, broader access, and better service.
The pressing need for innovation in health care today is for innovation in service delivery. It’s about making it easier to know what you need; easier to understand the cost to you and the choices you have; easier to schedule an appointment; easier to avoid hospitals and if you absolutely have to go there to find your way around them; and easier to understand your bill. It’s about not waiting, about understanding the choices you face, about feeling informed and comfortable and listened to and in control and valued. This is the consumerist view of health care innovation and, in some way, it is a tribute to the tremendous advances in cancer biology and other basic sciences that we are now focusing on this. We need to invest in the science that will put an end to ovarian cancer, to pancreatic cancer, to Alzheimer’s disease, to aging. We are so far from where we need to be. In the meantime, we need to make high value health care for conditions we can treat easily available to all of us. That is the real promise of health care innovation and that is why it makes sense to ask why it has taken us so long to get there.
In this paper in Health Affairs, we’ve reviewed the varied approaches to health care innovation taken by many of the leading US academic health systems. Some like Clay Christenson have argued that major innovations have to come from outside an industry, and he points to changes like urgent care centers. While this may be true to some extent and there is a great deal of exciting work from outside entities and the start-up world, many academic systems are making major investments in innovation and we think many of these will bear fruit, so we elected to focus primarily on these in this piece. It’s good that we found the approaches are varied because health care innovation of this kind is a new field and the right approach is far from certain. In that sense, variation is good. But if there is one essential key to success it is making internal innovation a strategic priority.
Academic health systems are enormous incubators of innovation in the form of externally supported generalizable research in biomedical sciences. In many other industries, internally resourced research and development (R&D) investment is seen as a marker of how long a firm plans to stay in business. By that standard most health care organizations are short-sighted, because they haven’t invested their own resources into making their services better. But a few organizations have led the way. We’ve reviewed the strategies at the Cleveland Clinic, the Geisinger Health System, the Mayo Clinic, the University of Pittsburgh, and the University of Pennsylvania. They include some of the innovation leaders, and have an array of strategies. Of the centers we discuss, the Cleveland Clinic is the most externally focused and the University of Pennsylvania the most internally focused. Each targets better clinical value but with different strategic approaches.
- In a trademarked process called INVENT, the Cleveland Clinic invites inventors to submit their innovations to a team of market analysts and medical product experts guide selected inventors toward commercialization.
- Geisinger Health System turned its innovation group into a for-profit entity called ProvenCare, selling its care improvement tools to other organizations. Acute care, chronic care, and primary care tools are driven by the principle that standardization drives safety and quality.
- The University of Pittsburgh’s Center for Medical Innovation aims to identify small companies offering services beneficial to their own enterprise, investing in or co-developing them. One such company, dbMotion, helped the University of Pittsburgh Medical Center’s meet its need to share data within its large network. dbMotion was eventually sold for $235 million.
- Mayo Clinic’s Center for Innovation uses a design-based approach, producing decision aids for diabetes, statin use, osteoporosis, depression, and acute myocardial infarction to facilitate conversations between physicians and their patients on medical decisions.
- The University of Pennsylvania focuses on redesigning service delivery within its existing business lines. Innovation projects are solicited internally, and winning teams are tutored in design, often abandoning their initial solutions for different ones that are empirically tested. The center also develops information technology platforms that facilitate the development of dozens of customizable mobile and desktop clinical apps to manage individual patients or populations of patients.
None of these approaches is easy. The view that we can take the transformative ideas behind Amazon, Starbucks, Airbnb, or Uber and apply them to health care misses an important point; health care is a capital intensive, high stakes, highly regulated industry where power is shared among payers, consumers, managers, and those with licensed and credentialed expertise. While that may seem like a recipe for stagnation, health care has something else, which is that it attracts people who have passion. The same passion that drives transformative change in the basic science of improving treatment is now being applied to improving the service pathways that deliver that improvement.