Revolutionizing Healthcare Through Industry: 2015

As a 1995 MIT Sloan grad, and co-founder of the Healthcare Club with Trevor Moody when we were graduate students there, it was wonderful to participate in the first official MIT Healthcare conference since forming the Healthcare Program at Sloan, which was held in New York City (probably because the 100" of snow that fell in Boston this year hasn't melted yet and people can't get around very easily!) the school brought together to showcase some of the academic work MIT Sloan is doing in the field and a number of distinguished speakers. The Healthcare Program at Sloan includes the addition of 5 or more courses to the Sloan MBA for a certificate. The agenda for the conference is below, with some of my key takeaways in blue.

Seated at our table was a representative from Minute Clinic in New Jersey, who was interested in the transformation of Healthcare as it pertains to retail clinics, and a transformation I have been particularly interested in following as it started in MN as QuickMed ~2000 before being acquired by CVS, and academics Richard Bohmer & Clayton Christenson have written HBS case studies about Minute Clinic and it's clear disruptive impact on Healthcare which I have used while teaching the Medtech course at UST. An added bonus for me was seeing some very successful graduate school friends who were in the audience as well, Debbie Bein Baron, who is now in BD at Pfizer, and Bryan Gilpin who has been working for Boston Scientific internationally and in Massachussets over the past 8 years.

The main feeling I had coming away from the meeting is that the work presented at the conference focused on organizational change from within hospitals and providers, vs. the innovation & themes I have been exposed to in our marketplace and other settings strike me as much more in tune with the dramatic change required to make our healthcare systems and market function like the industry it needs to from more top-down marketplace reform in INCENTIVES and INDUSTRIAL PROCESS. The drivers I find most interesting in the dynamics of change are CONSUMER CHOICE and PROVIDER PAYMENT. Could we find a way to focus in more clearly on those areas as key drivers of innovation?

Minnesota Innovations in Medtech & Managed Care:

QuickMed/MinuteClinic - retail care
Zipnosis / Virtuwell - online care
Definity Health - re-introduction of high-deductible health insurance, with corresponding legislative work to introduce Health Savings Accounts
Optum, the services arm of United Health Group, comprised of Rx (pharmacy benefit management) Insight (data for fraud detection turned Big Data for effective healthcare intervention research), and Health (proactive health management based on industrial platforms that can evolve.),
Fairview system experience as evidenced by Diabetes management with computerized care pathway recommendations, implementation of Zipnosis in the network, and proactive use of Patient-based electronic medical records.

Others I recognize as contributing core thought leadership in Healthcare Innovation, which I would have liked to have seen more development of in MIT's work, include:

Regina Herzlinger (HBS! ~first healthcare and first woman academic) and her fabulous thinking on Consumer Driven Healthcare and the implications of evolving the industry around healthcare that consumers both want and can afford
iTriage - I asked the closing keynote speaker, former CEO of Aetna, Ron Williams, to comment on this remarkable company that Aetna bought out of Denver, CO, started by two physicians, that can enable consumers to self-diagnose & triage their care and if connected to an insurance plan, know the cost involved to them for different option. He indicated it was "an app" that is useful to patients, but didn't elaborate further on the impact it could have on insurer's relationships with their members and patients' ability to interface effectively with providers.
Atul Gawande's "Cheesecake Factory" concept - Why Can't Healthcare be Like the Cheesecake Factory? (August 2012 New Yorker article on Hospital Chains.) To me, this is the central question for true healthcare innovation aimed at both patient satisfaction and meeting the industrial goals of access, quality, and cost reduction.
West Health and CMS Pilot projects - How can Technology Reduce the Cost of Healthcare? That question should be right up MIT Sloan's alley... the student presentations on product/technology ideas for investment were rather traditional, not what I would have expected from Sloan now.
CarePathways by Richard Bohmer, HBS - where are we at with de-mystifying medicine and making it more process-directed and less of an art? How much more room is there? How far would we get in reducing the ~30% waste in Healthcare Expenditures through process improvements?

These are the types of questions I would have liked the MIT academics to have posed as central objectives of the healthcare center in addition to the interesting work that was presented.

New York: Healthcare Conference

MIT SLOAN IMPACT: ACCELERATING INNOVATION IN THE HEALTH INDUSTRY
Friday, March 13, 2015 ($50 registration)
Location: 10 on the Park | 60 Columbus Circle, 10th Floor, New York, NY 10019
http://mitsloan.mit.edu/alumni/events/2015-nyc-healthcare/#tabs-2
Accelerating Innovation in the Health Industry:MIT Sloan brings together MIT faculty and alumni industry leaders to present research and discuss the state of the art processes, organizational transitions, and technological innovation within the health industry and academia as it relates to transformational care delivery and health management.

12:00 p.m.

Registration

12:30 p.m.

Welcome Remarks & Luncheon
David Schmittlein, John C Head III Dean, MIT Sloan School of Management

12:45 p.m.

The MIT Initiative for Health Systems Innovation
Joseph Doyle, Erwin H. Schell Professor of Management and Professor of Applied Economics
Retsef Levi, J. Spencer Standish (1945) Professor of Management and Professor of Operations Management
Janet Wilkinson, Senior Lecturer; Director of the Initiative for Health Systems Innovation 70 students currently in the Healthcare Club at Sloan. Speakers, Career connections.

1:00 p.m.

Managing Organizational Changes in Health Care Systems
Kate Kellogg, PhD '05, Associate Professor of Organization Studies

Learn lessons regarding the implementation of medical reform on-the-ground, inside healthcare organizations. This research investigates the very critical stage that both policymakers and academics all too often neglect, namely the period after a policy has been adopted. Explore the case of implementation in Primary Care settings of a reform called Patient Centered Medical Home to highlight the cross-professional challenges that can occur within organizations after policy has been made. Discuss the role of subordinate professionals in facilitating reform implementation. Dr. Kellogg described how she empowered Medical Assistants, the lowest level employee in the HC system, to influence Physician change to follow / comply with Health Reform regulations / objectives such as opioid contracts with patients so they don't share the drugs with those who don't have the prescription or processes for screening for Diabetes. Like an Ops Re-Engineering initiative in Mfg - allows Dr.'s to work at the top level, and puts structural power in place at MA level. A great example of effective organizational change.

1:30 p.m.

Healthcare Analytics in Action
Joseph Doyle, Erwin H. Schell Professor of Management and Professor of Applied Economics

Learn how BIG data can be used to measure value in healthcare. In particular, the use of randomized trials, along with natural experiments that focus on the effective random assignment of treatment to patients, can provide credible estimates of the effects of healthcare delivery reforms on costs and patient health. These methods also provide a framework to measure hospital and physician quality—an increasingly important task as payment reforms aim to “pay for quality.”

Mentioned CMS Innovation Institute.

Big data: Cell phone apps for detection & prediction.

Camden - "hot spot" maps by Dr. Jeff Brenner - thought leader on bending the cost curve.

Interesting story of correlation between the AMBULANCE COMPANY that is called and which hospital the patients are brought to; some bring patients to expensive hospitals that impacts care & $ no matter where the patient lives.

2:00 p.m. MIT Innovator in Healthcare Pitch
Ben Merewitz, MBA '15, Co-founder and CEO of Agile Devices - technology for faster access to blood vessels to save lives (45 sec BSC vs. 23 sec Agile) Brian Hess CTO (or of Curative Ortho?)

2:05 p.m.

Break

2:35 p.m.

MIT Innovator in Healthcare Pitch
Samantha Simmons, MBA '15, Founder of Curative Orthopaedics, Inc.

2:40 p.m.

Cost and Quality in Healthcare - Network objectives max productivity, throughput, utilization, welfare.
Retsef Levi, J. Spencer Standish (1945) Professor of Management and Professor of Operations Management

The current policy discussions around healthcare focus on: health charges rather than the true cost of delivering healthcare; efforts to reduce avoidable medical errors; and measures of quality. The discussion will cover several collaborative research projects that engage Sloan faculty and students with clinicians and staff at Beth Israel Deaconess Medical Center, Boston. These projects are developing systematic approaches to analyze and measure cost and safety that provide decision support tools to inform and guide systematic improvement in network and process design and resource deployment.

Cost / Access / Quality Triangle:

Reduce Cost = Reduce CHARGES (30% waste due to overuse, underuse, underperformance, misuse)
Access: HEALTHCARE REFORM
Quality: Checklist

Checklist introduced by Peter Pronovost - reminded me of Jack Homer's "Aggregate Harm" - checklist prevented errors from absentmindedness, "noise," incompetence.

3:10 p.m.

Keynote Address
Peter Slavin, M.D., President of Massachusetts General Hospital

"Don't get mad, get data!" Has enjoyed collaboration with MIT academics in social science and operations research to improve MGH's services with OR scheduling, primary care redesign, and hospital bed capacity utilization.

4:00 p.m.

Break

4:15 p.m.

MIT Innovator in Healthcare Pitch
John Lewandowski, PhD Candidate, Founder and CEO, Disease Diagnostic Group. Malaria.

4:20 p.m.

Labor-Management Partnerships under the ACA: Lessons from Kaiser Permanente
Tom Kochan, George Maverick Bunker Professor of Management; Professor of Work and Employment Research and Engineering Systems; Co-Director of the MIT Sloan Institute for Work and Employment Research

Kaiser Permanente and the Coalition of Kaiser Permanente Unions have built the largest, most successful, and sustained labor management partnership in American history. We have studied the partnership for the past fifteen years. We will use this research to illustrate how the healthcare workforce can contribute to innovation, quality of service, and employee satisfaction and development in healthcare.

Unit-based teams. Didn't follow McKinsey's advice to split up Kaiser's unique model. Has been successful through years of work on the organizational system.

4:50 p.m.

An Analytics Approach for Designing Clinical Trials for Cancer
Dimitris Bertsimas, SM '87, PhD '88, Boeing Leaders for Global Operations Professor of Management; Professor of Operations Research; Co-Director of the Operations Research Center

We propose an analytics approach for the analysis and design of clinical trials for cancer. We build a comprehensive database from clinical trials and use it to develop statistical models from earlier trials that predict the survival and toxicity of the combination of the drugs used, when the drugs used have been seen in earlier trials, but in different combinations. Using these statistical models, we develop optimization models that select novel treatment regimens. We apply our approach to gastric cancer with very encouraging results. Ultimately, our approach offers promise for improving life expectancy and quality of life for cancer patients at low cost.

BIG DATA. Father died of cancer. Excellent example of how we can improve care decisions with smarter use of the data that exists. Recall Atul Gawande's point that physicians could never keep up with each individual journal article in order to make better clinical decisions....

5:20 p.m.

Keynote Address
Ron Williams, SF '84, Former Chairman and CEO of Aetna, Inc. (until 2011)

www.ronwilliams.net; RonWilliams@RW-2.com RW2 Enterprise, Equity and Consultation. On MIT Corp. Serves on BoD of JNJ.

Gave overview of U.S. HC cost vs. outcomes (the familiar story!) Ron's analysis is that:

Price of care in U.S. drives most of the cost.
U.S. physicians earn more: student debt, PCP $186k, Ortho $442k
Without financial constraints, "preferences rule"
iTriage aimed at providing an "Amazon-like" experience
What about Payer / Pharma relationship? "We have needed to find a way to pay for innovation in pharma. Great deal of risk. Going forward into future will need to figure out how to pay for performance. Look for things that have important benefits." Karin thinks - how can we use the MARKET to determine the rates of return on high risk?
On Healthcare Reform - "Politics trump policy"
On Price - "Transparency is helpful in any economic situation."