In recent weeks Diana Strubler and Terry Ketchersid have provided expert advice and guidance about MACRA, MIPS, APMs, and a variety of other critical TLAs (three-letter acronyms). In the here and now, incentives and penalties are a way of life, and navigating them successfully is critical to survival. This reality of ever-thinning profit margins and ever-tougher reporting requirements can make practice life seem pretty grim. This week let’s take a break from MACRA and use our imaginations!
Did you read Roald Dahl’s Charlie and the Chocolate Factory or see the 1971 film, “Willy Wonka and the Chocolate Factory”? If so, you may recall the story of poor Charlie Bucket who lived in a tiny dark house with his parents and 4 grandparents. In the book the Buckets have plenty of family love, but very little money. One day Charlie finds a fifty pence coin (the author, Dahl, was British) in the snow, and before turning the money over to his mom he buys 2 Wonka Chocolate bars. In one of the Wonka chocolate bars Charlie finds the last of 5 Golden Tickets to enter the Willy Wonka Chocolate Factory. The next day Charlie and Grandfather Joe join 4 other children for a chocolate factory tour with Willy Wonka. The factory—with its Oompa Loompas, Chocolate River, and candy-creating technology—is a rich, transformative experience for Charlie.
Imagine a “Chocolate” Factory of good health
Today health care is fragmented and costly. Changes like value-based purchasing and digital interoperability are needed, but they are painful, slow steps to a better health care environment. This year, next year, and the year after seem like a litany of avoiding CMS penalties designed to herd everyone in the same direction.
Is there a Willy Wonka Chocolate Factory alternate future? Tom Main and Adrian Slywotzky, as part of the Oliver Wyman Health Innovation Center, articulate a vision for “Health Market 2.0” in “The Marketplace Revolution.” They dub our current environment the “sick-care marketplace” and envision a transformation that integrates science with technology advancements to create a consumer-friendly health environment. “Health Market 2.0” is focused on illness prevention and health maintenance, not sick care.
This new Health Market leverages multi-chain ecosystems. This means that unrelated market systems will converge to deliver consumer-centric health services. For example, technology-supported personal health monitoring devices will be used in a health system that also includes retail pharmacies and multidisciplinary health teams. All aspects of the service will be supported by biomedical intelligent information systems that provide pervasive, user-friendly access to data.
The big switch is that these services may not be delivered in or provided by the traditional health care entities we have today. Brick and mortar hospitals may not be main centers of health service delivery. As an example of disruptive, revolutionary change, the authors, Main and Slywotzky, reference the impact Amazon has had on the traditional retail market. Retail stores still exist, but they are forever changed by online shopping.
In this new Health Market paradigm, chronic care will move from reactive care for acute events to proactive prevention. This change, powered by wearable devices for continuous monitoring, will include high-trust consumer partners who are available 24/7 for advice and support. Care will be consumer-centric and consumer friendly.
What’s the advice for providers today?
- Begin to think about transparency for consumers. The future will be about meeting consumer needs and not so much about meeting payer needs
- Be aware of new devices, especially mobile health monitoring devices
- Pay attention to the new, innovative players in the marketplace like Google, which has patented a glucose-sensing contact lens, and Adherium, which markets the “Smartinhaler” with built-in medication alerts and communication
- Note that telehealth and digital solutions that are convenient and personalized will be attractive to consumers
Technology and science advancements will make personalized and precision medicine a reality. We are seeing big data analytics and artificial intelligence converge with traditional health care in many ways already. For example, IBM Watson Health is a “humanity and technology partnership.” Google is a major investor in 23andMe, the genomics company. Intel, Apple, and Samsung are all playing in the personal monitoring device business.
An interesting example of the power of multi-chain ecosystems changing health care is Surgical Theater. You many have heard about this not from a peer-reviewed journal, but from CNN, CBS This Morning, or EXTRA. Surgical Theater is a Precision Medicine effort that transforms 2D images like CT scans and MRIs into 3D virtual reality. The transformation is made through proprietary Precision VR software. Today neurosurgeons from a number of academic institutions like UCLA, Stanford, and Mayo Clinic are using Surgical Theater virtual reality brain images to plan surgeries and virtually practice surgeries like pilots using a flight simulator. These virtual reality 3D images are viewed by patient and families to discuss treatment plans and expectations. They are also being used to train surgical residents.
The Golden Ticket
Today, physician practices are in the Charlie Bucket-like dark and uncertain house of evolving health care, but the health environment and ecosystem may be changing in ways, like Willy Wonka’s Chocolate Factory, that are hard to imagine. Rapid advancements in scientific knowledge around genomics and stem cell research will change diagnosis and treatment opportunities. Computing power, machine learning, and personal health devices will revolutionize data-driven precision care delivery. The physician role will continue to evolve as one of the most highly skilled members of the care delivery team, but physicians in brick-and-mortar buildings may not be central to the new Health Market. Hopefully all of us as health care consumers will find the Golden Ticket of the best possible personalized health care.
Dugan Maddux, MD, FACP, is the Vice President for CKD Initiatives for FMC-NA. Before her foray into the business side of medicine, Dr. Maddux spent 18 years practicing nephrology in Danville, Virginia. During this time, she and her husband, Dr. Frank Maddux, developed a nephrology-focused Electronic Health Record. She and Frank also developed Voice Expeditions, which features the Nephrology Oral History project, a collection of interviews of the early dialysis pioneers.