Some 500 data analytics gurus representing the health care ecosystem including hospitals, physician practices, life science companies, academia and consulting came together on the lush campus of SAS in Cary, North Carolina, this week to discuss how Big Data could solve health care’s Triple Aim, as coined by keynote speaker Dr. Donald Berwick: improve the care experience, improve health outcomes, and reduce costs.
Before Dr. Berwick, appointed as President Obama’s first head of the Centers for Medicare & Medicaid Services, Clayton Christensen of the Harvard Business School, godfather of the theory of disruptive innovation in business, spokee about his journey from the slide rule to mainframe computers, personal computers, laptops and today, smartphones; this is a journey from centralization to decentralization. He used that construct as a context for what the health care industry needs to undergo, from centralized centers of high-technology and knowledge (think: academic medical centers) to decentralized care where people live, work, play and pray: ultimately, into the home and patient’s hands (the Health Populi Holy Grail).
Christensen joked about a future scenario when confronted by St. Peter at the Gates deciding Clay’s eternal fate. He would ask the gatekeeper 3 questions, one of which would be, “Why did you only give us access to data about the past? How are we to sort out the future?” The answer, Christensen said, lies in the power of data analytics, giving a shout out to SAS’s core business.
He then described the history of synthetic fiber development at DuPont, which began in its first phase as a trial-and-error process, then moved through empirical testing and finally, precision development. This, too, is what Christensen sees as the evolution of life sciences, moving through evidence-based medicine (the second phase) toward personalized medicine, based on risk assessment that matches highest probability therapies for success with the individual person. Ultimately, the way health care is delivered in the U.S. today isn’t the right business model for dealing with chronic care, which consumes 80% of the nation’s health care dollars.
“Personhood” was a theme taken up in the second keynote by Dr. Berwick, who has been a long-time proponent of patient-centered health care. After a fascinating, quite candid behind-the-scenes discussion about his time inside the Beltway at CMS, he sobered the audience with a discussion of the Realpolitik of Health Reform and health care deficit driver.
Berwick then talked about the opportunity to drive waste out of the U.S. health system in several respects, from clinical waste where too much or too little care is given to each individual, to fraud and abuse where data analytics have shown great success in targeting maleficent health providers. His research has found that at least $1 in $3 of health spending could be conserved were the waste wrung out of processes.
Berwick’s five principles for re-making the U.S. health system are:
1. To put the patient/person first
2. To protect the disadvantaged (giving a nod to Hubert Humphrey’s approach)
3. To get to scale (pilots won’t do, with Berwick suggesting that health reform scale be done in regions and states)
4. Act locally
5. Return the money, to expand access and re-invest in health care that works.
Berwick concluded by providing several examples of health care providers that focus on the person at the center of delivery in team-based care models. Most notably is the AFHCAN model, part of the Alaska Native Tribal Health Consortium. AFHCAN is a telehealth provider that has innovated a cart and software suite that is mobile, to meet the needs of Alaskans who live far from health providers. This decentralized, distributed approach is the kind of innovation that Christensen envisions, moving expertise and technology away from “the center.” Outcomes improve, patient satisfaction drives upward, and costs fall. That’s meeting the Triple Aim.
Health Populi’s Hot Points: Ironically, this excellent conference left out a key voice in the conversation the entire day: that of the patient. While Berwick’s passion for putting the patient at the center was most welcome and highly relevant, the inclusion of a consumer health advocacy voice, whether a Consumers Union, a National Partnership for Women and Families, or similar, would have been a constructive lens and filter on the day’s discussions and health industry tracks of providers, life sciences, and health plans
It’s clear that Big Data will and must play a growing role in managing risk, finance, and uncertainty in health care. Protecting patient care, privacy and access mustn’t get lost as this innovation proliferates the health ecosystem.