Healthcare is ripe for disruptive technologies

October 1, 2005

Heal thcare is in desperate need of disruption. Much of our nation's innovation spending is directed at the most complex, challenging and sophisticated problems in healthcare. Much less is being spent on learning how to provide the healthcare that most of us need, most of the time, in a way that is simpler, more convenient and less costly.

Heal thcare is in desperate need of disruption. Much of our nation's innovation spending is directed at the most complex, challenging and sophisticated problems in healthcare. Much less is being spent on learning how to provide the healthcare that most of us need, most of the time, in a way that is simpler, more convenient and less costly.

Many have postulated that our economy cannot sustain spending 20% or more of our Gross Domestic Product on healthcare. Employers have responded by steadily shifting the cost burden to employees thinking that when exposed to the true costs and benefits of any given service, they will be more sensitive to the relationship between price and value, and might curtail marginally useful healthcare.

Until innovators generate new, lower-cost solutions to address diagnosis and treatment of relatively common diseases, we are simply passing the healthcare buck from employer to employee rather than fixing the problem. Costs are rising not just because services and treatments are getting more expensive, but also because innovators are solving ever more complicated challenges for an ever-smaller portion of the population.

Disruptive technologies in healthcare are coming in the form of better and more targeted drugs and rapidly improving testing, diagnostic, and other technologies that allow primary care physicians, nurses, and even self-care practitioners with some level of training to do work once performed only by specialists. Our medical system incurs a significant amount of overhead costs to prepare hospitals and doctors to treat complex illnesses. In reality, most people need a quick look and a prescription. For example, Minute Clinic drop-in sites, in Target and supermarkets, treat 14 primary illnesses from strep throat to warts.

With improving technology, complex work-previously done only at hospitals-now can be accomplished at stand-alone centers, outpatient diagnostic and surgical centers, in-office care, and through in-home and electronic communication. Patients and purchasers are embracing telemedicine and cyber-medicine; the barriers will fall when Medicare drops its insistence that it will only pay for services rendered face-to-face. Enabling less-expensive providers to do things that were previously unimaginable is one of the fundamental engines of economic progress, which will be fought by the established healthcare institutions.

HOW HEALTHCARE WILL BE AFFECTED

We already see clinical practices where the clinician's skill level is matched to the difficulty of the medical problem. Practices employ physician assistants and nurse practitioners to see the routine cases, with primary care physicians moving up-market using advances in diagnostic and therapeutic technologies to perform many of the services they now refer to hospitals and specialists.

The market forces of value-based purchasing of healthcare and pay-for-performance will lead to the creation of new entities to deliver care rather than attempting transformation of existing institutions that were designed for other purposes.

If history is a predictor of the future, new and different means of delivering healthcare will take advantage of the opportunity afforded by disruption.

Joel V. Brill, MD, is chief medical officer of Predictive Health LLC, and serves on MHE's Editorial Advisory Board.

Dennis Robbins, PhD, MPH, is president of Integrated Decisions, Ethics, Alternatives, and Solutions (IDEAS), and serves on MHE's Editorial Advisory Board.