Brad Stuart featured interview in Forbes
U. S. Healthcare Innovation Demands A Paradigm Shift
New opinions are always suspected, and usually opposed, without any other reason but because they are not already common. - John Locke
We are just over two weeks into 2014, and the dominant conversation about healthcare in the U. S. is the Affordable Healthcare Act. Rather, there is not so much a conversation about the legislation, as there are two distinct points of view blathering on about competing ideological value sets. If this “debate” is representative of how we are going to approach innovation in healthcare, we are in deep trouble as a society. Fortunately, in the realm of health care innovation, there are people in the world, doing real work, developing new ways of delivering care, and committing time, energy and creativity to making healthcare better.
Dr. Brad Stuart is one of those practitioners on the cutting edge of reform. Dr. Stuart has more than thirty five years of experience in internal medicine, palliative care and hospice, and is a nationally recognized innovator in healthcare. He has devoted a lifetime of work to improving clinical and economic outcomes in medicine, by focusing on “dignity, choice and responsibility.” He is co-founder and CEO of ACIStrategies. I talked with Dr. Stuart at length about the state of healthcare in the U. S. and what he sees as the greatest challenges and best opportunities. In this installment, Dr. Stuart is addressing the need to change how we talk about healthcare.
Henry: It seems to me that the core science of medicine has progressed tremendously over the years. Yet, for some reason, we seem unable to manage the delivery and payment systems with any real degree of competence. Why is that?
Dr. Stuart: In an interesting way, we are victims of our own success in healthcare. American medicine took a big leap forward after World War II. Innovations like antibiotics, modern surgical techniques and imaging technology helped us tackle problems that had stymied humans for thousands of years. Trauma, infections, complications of childbirth and other acute problems came under control in just one or two generations. And what happened was that we conquered acute illness, but while we weren’t looking chronic illness took its place.
Henry: So, would you say that it’s sort of like science outran its own headlights?
Dr. Stuart: Well, not exactly. It’s more the law of unintended consequences. I think about it like this: Our paradigm in post-World War II was all about how to treat the serious, acute illnesses right in front of us. And that focus — that paradigm — served us very well. In medicine we saw the world through the lens of acute illness and the result was substantial, high-impact innovation in acute illness management. But what our paradigm didn’t allow for was the resulting growth in chronic, advanced illnesses. Chronic heart disease is a great example. Between 1950 and 2000, the rate of sudden death from coronary disease was cut in half. But coronary disease doesn’t go away just because a patient has bypass surgery. All the survivors still have hardening of the arteries, and it progresses. So today heart failure, or fluid overload due to a heart muscle weakened by chronic coronary disease, is an epidemic. It’s the leading cause of hospitalization and readmissions in America today. So, while we solved many of the acute problems in heart disease, we unwittingly created a legacy of chronic disease that is not going to be solved the same way we solved acute problems.
Henry: So, is solving these kinds of problems about ideas, or about science, or about delivery or what?
Dr. Stuart: Well, of course it’s about all of those things and more. But I tend to think the science will take care of itself over time, and there’s certainly no lack of new ideas and pragmatic solutions to healthcare challenges. The real barrier seems to me to be a management or organizational problem: How can we replicate and scale innovative models that have already addressed — or at least begun to address — various healthcare problems. There are any number of good, working models out there right now that, if scaled up and taken into account in our national healthcare planning, could have a huge impact. And we are badly in need of the changes and improvements we could realize from many of these models.
Henry: So, what is the barrier. The average healthcare consumer is likely going to say “Great, if something out there is working well, why don’t we just implement it across the board.” What keeps us from taking sound working models and deploying those on a larger scale.
Dr. Stuart: I don’t think there’s an easy, or simple answer to that question, because healthcare is such a mammoth, complex topic. But one thing that I see as central to our inability to scale is wide-spread fragmentation in healthcare delivery. Think about it like this: Suppose you want to buy a car. Suppose that in buying that car you have to shop for an engine, a drive train, a body and tires, all separately, from separate vendors, with separate billing systems. Then, when you have purchased all the parts, it’s up to you to assemble those parts and make your own car. And pay each of the vendors separately. And you end up with something that might, or might not work, and you will pay full price whether it works or not! The average consumer simply wouldn’t do this. But that’s almost precisely what we do in health care. We have multiple specialist providers, different delivery systems, different payment systems and a very complex challenge: you! But the “product” you want to buy — the physical well being of a whole person — simply does not get considered in our healthcare system. In a very real sense, you might say that we have a supply chain problem, rather than a science, or payment, or medical problem.
Henry: At times, this seems like an almost intractable problem — re-engineering an entire system that is as complicated as healthcare. Based on your many years in the trenches, are you optimistic that we will solve this?
Dr. Stuart: Yes, I am! American healthcare is undergoing a revolutionary paradigm shift, and it’s one that is long overdue. This shift is as much about how we see the patient and the patient experience as it is about medicine. We are moving rapidly into a revolution at the interface of human relationships and technology, and this is especially true in medicine. In my view, this is a move away from differentiation, analysis, and specialization and toward community, synthesis and integration. Now, that sounds like a lot of big words, but I think the meaning is in a sense rather simple: What it means is changing the way we think about medicine from “What can I as a physician do to you?” to “What do you as a patient want to realize as your health outcome?”
Henry: As a consumer, of course, that sounds great. But how in the world are we going to set about transforming an established system of delivery that is based on the provider, to one that is based on the patient? That seems to me to be a tall order.
Dr. Stuart: Of course it is. I think there are three things that are critical to this change: One is the “accountable care” model, a second is “quality,” and a third is a thoughtful advanced care model. Each of those three innovations is critical to both improving healthcare delivery and to controlling costs.
Henry: And each of those is going to require a bit of discussion, which we’ll do next week, starting with “accountable care.”
By Henry Doss, Contributor – Forbes
Henry Doss is a student, musician, venture capitalist and volunteer in higher education. His firm, T2VC, builds startups and the ecosystems that grow them. His university is UNC Charlotte.
For the original article in the Forbes online blog, please click the link here: http://onforb.es/1hs5cVn
