Innovation Follow Up: The Citizen's Action Report

Earlier this year I showcased the work of the Citizen's Health Task Force and their attempts to solicit ideas on ways to innovate in health care.

After 28,000 submissions (gotta love the power of the Internet), the Task Force quietly released their report today.

While there are more than 39 pages of recommendations, here's a quit snapshot copied directly from their site (Citizens Health Care Task Force, 2006):

1. Establish Public Policy that All Americans Have Affordable Health Care.
Americans should have a health care system in which everyone participates,
regardless of their financial resources or health status, with benefits that are
sufficiently comprehensive to provide access to appropriate, high-quality care
without endangering individual or family financial security.
• This public policy should be established immediately and implemented by 2012.

2. Guarantee Financial Protection Against Very High Health Care Costs.
No one in America should be impoverished by health care costs. A national public or
private program must be established to ensure:
• Participation by all Americans
• Protection against very high out-of-pocket medical costs for everyone
• Financial assistance to pay for this coverage to families and individuals based on
ability to pay

3. Foster Innovative Integrated Community Health Networks
• The federal government will provide leadership and financing for a national initiative
to develop and expand integrated public/private community networks of health care
providers. This recommendation should be accomplished through the following
actions:
• Focus first on people and localities where improved access to high quality care is
most needed. These networks would offer local residents – including, but not limited
to, low-income and uninsured individuals and people living in rural and underserved
areas – a source of coordinated health care.
• Identify governmental agencies at the national, state and local levels to coordinate
private and public funding sources currently dedicated to helping provide care to the
underserved by supplying the necessary information and leadership.
• Establish a public/private group or not-for-profit entity at the national level responsible
for advising the federal government on the community health care network’s
performance, funding streams, best practices and research.
• Expand and modify the Federally Qualified Health Center concept to accommodate
other community-based health centers and practices serving vulnerable populations
with special emphasis on families and prevention.

4. Define Core Benefits and Services for All Americans
Establish a non-partisan public/private group to define America’s core benefits and services and
update them on an ongoing basis
• Members will be appointed through a process defined in law that includes citizens
who represent a broad spectrum of the population, including, but not limited to,
patients, providers and payers.
• The group will be staffed by experts.
• Identification of core benefits and services will be made through an independent, fair,
transparent, and scientific process.
Within economic constraints and guided by evidence-based science and expert consensus
regarding the medical effectiveness of treatments, the group will define the core benefits and
services based on the following principles:
• Core health services will cover the continuum of care throughout the individual’s
lifespan.
• Health care encompasses wellness, preventive services, primary care, acute care,
prescription drugs, patient education, and the treatment and management of health
problems provided across a full range of inpatient and outpatient settings.
• Health is defined to include physical, mental, and dental health.
• Over time, this entity would appropriately take into consideration advances in clinical
science

5. Promote Efforts to Improve Quality of Care and Efficiency
The federal government will expand and accelerate its use of public programs for advancing
strategies that improve quality and efficiency across the health care system.
Using federally funded health care programs, the federal government will promote:
• Integrated health care systems built around evidence-based best practices
• Health information technologies and electronic health record systems
• Elimination of fraud and waste in administration and clinical practices
• Widespread availability of consumer-friendly information about health care services,
including transparency on prices, cost-sharing, quality, efficiency, and benefits
• Increased focus on health education, disease prevention and health promotion,
patient-provider communication, and patient-centered care
• Biomedical research aimed at improved quality and efficiency

6. End-of-life care should be fundamentally restructured so that people of all ages have increased access to these services in the environment they choose.
End-of-life care should be fundamentally restructured so that people of all ages have increased
access to these services in the environment they choose.
• Public and private payers should integrate evidence-based science, expert
consensus, linguistically appropriate and culturally sensitive end-of-life care models
so that health services and community-based care can better handle the clinical
realities and actual needs of patients of any age and their families.
• Public and private programs should develop and support training for health care
professionals that emphasizes proactive, individualized care planning and clear
communication between providers, patients and their families.
• At the community level, funding should be made available for support services,
including non-medical services, to assist individuals and families in accessing the kind
of care they want for the last days of their lives.

Good Stuff! And a significant step forward thanks to our fellow citizens...

Innovation: Curious About Who's Most Likely To Change Health Care? Watch the VC Firms…

Revolution Health

I’ve mentioned these folks before, but Steve Case (yes, the same Steve Case that started AOL) is looking to develop companies that support “sustainable living and wellness lifestyles” – clearly something our mainstream health system has struggled to do. For a quick glance, check out some of their recent investments:

Exclusive Resorts
Flexcar
Miraval

Bill Ericscon and Mohr Davidow Ventures

MDV is looking for a new device that can identify new types of hospital-borne infections in just a few hours. Places they have already invested in:

ParAllele
Pharmix

And if you’re interested in who’s looking to invest in remote monitoring implantable devices, look no further than Corey Mulloy and Highland Capital Partners. Recent investments have included:

AccentCare
Archemix
YogaWorks

Too bad mainstream providers have the longest sales cycle on the planet and are slow to adopt such innovations in the marketplace.

Innovation: Providing Capital To Those Who Have None

With the growing regulations around joint ventures in diagnostic imaging (read: hospitals not currently allowed to joint venture diagnostics with physicians) and other technologies - there has been a rise in companies willing to facilitate “under-arrangements” with both hospital and physicians.

Here’s how it works:

1) A technology financing company, such as Accelitech (a newly formed company that has regrouped some of the top leadership from Neurosource) forms a “leasing company” that goes out and buys the technology of choice (in the case of Accelitech, steriotactic radiosurgery technology – such as the CyberKnife – has been a popular choice).
2) Hospitals and physicians are then allowed to buy into the “leasing company” at 10-15% each.
3) The leasing company than works out a deal with the hospital to lease the machine on a “per use” or “per click” basis.

Why do it:
1) The hospital can get the latest and greatest technology without putting up $4-5 million in capital.
2) Physicians get an opportunity to gain access to new technology and can financially participate in the long-term returns of the leasing arrangement
3) The purchase is off-balance sheet – not adversely affecting bond ratings.

For sure there will be increased scrutiny of these deals as time goes on, but certainly worth looking at if your capital starved and want to stay competitive in your marketplace.

Also…my apologies for the extended absence. I’ve experienced a perfect storm the last couple of weeks and unfortunately had to forego some of my regular blogging time.

Innovation: Tapping the truly experienced

Earlier this week Civic Ventures announced the winners of its Purpose Prize - five awards of $100,000 each to people over 60 who are taking on society’s biggest challenges.

Now before you think this is just another random award for people running after school programs for neighborhood kids (not that we don't need more after school program's for neighborhood kids) - take a look at some of the winners (courtesy of Civic Ventures Website):

Conchy Bretos
After a varied career in housing, marketing, health, and women’s issues, Conchy Bretos ran for a seat on the Dade County Commission in 1993 and lost. She was then appointed to the job of Florida Secretary for Aging and Adult Services, a position that allowed her to see firsthand the thousands of low-income elders and disabled adults who were not getting the service they needed to stay in their homes. As a result, many ended up in nursing homes prematurely, because they could not afford in-home care or assisted living facilities. Bretos became the driving force behind the nation’s first public housing project – the Helen Sawyer building in Miami – to bring assisted living services to older adults who just need a little help to stay in their homes. Today she runs a consulting company that has helped 40 public housing projects in a dozen states bring assisted living services to their residents.

Charles Dey
At 64, after a career in education and a record of starting programs to ensure equal educational opportunities, Charles Dey was looking for his next career. His long-time friend Alan Reich, who founded the National Organization on Disability years earlier when an accident left him a quadriplegic, told Dey to “do for young people with disabilities in the 90s what you did for minorities in the 60s.” So Dey created Start on Success, a National Organization on Disability program to provide paid internships and to assign workplace mentors to predominantly minority high school students with physical, mental, and emotional disabilities. To date, more than 1,500 disabled high school students have had internships at universities, hospitals, and small businesses in five cities. So far 85% of them have gone on to full-time jobs or further education. Without the benefit of any job training program, only about 30% of inner-city, minority students with disabilities have comparable success.

Frank Brady
A serious heart condition forced Frank Brady, a jet-setting international businessman, to retire 10 years ago. Recalling an earlier health crisis – he survived spinal meningitis as an infant thanks to experimental treatment with a new miracle drug called penicillin – Brady created Medical Missions for Children in 1999. The organization helps seriously ill children who lack access to quality medical care, and educates the medical professionals who care for them. Medical Missions for Children uses interactive video technology to allow pediatric specialists to remotely diagnose patients and recommend treatment, and internet and broadcast technology to collect and distribute cutting-edge information to thousands of medical professionals across the country.

After reading about the above three winners, I couldn't help but reframe the traditional view helath care providers take of their volunteers and retired community members. Why not ask some key members of our retired community who have worked in various industries and ask them to fix some of our deepest problems in health care? Issues might be:

• Developing a retail strategy for a health system
• Defining areas in which price transparency could be a competitive advantage
• Building a customer service strategy for physicians in our ORs
• Cost efficient ways of delivering preventative care to the uninsured

As more baby-boomers retire, live longer, use more health services, and look for a way to give back - accessing their help and expertise should become a strategic initiative itself.

Innovation: Rise and Fall of the Device

News came out today that the coated stent launched in 2000...may create a significant increase risk for thrombosis, or blood clots.

While more than 6 million drug eluting stents have been implanted around the world, this recent report is unlikely to change physician or patient behaviour. Much like pharmaceuticals later to have caused serious side effects after FDA approval, Boston Scientific and others will launch a significant marketing campaign that acknowledges the risks while selling its continuing benefits to the market. The FDA may, or may not, launch an investigation - the likely outcome to be a requirement to note the increase chance for side effects.

In the end, a basic philosophical question remains: which desire is greater amongst patients - the ability to have the latest and greatest (and a higher chance of success) or the assurance that our care is 100% safe? How one answers the question creates cascading affects on cost, quality, innovation, and other significant policy attributes.

But stepping too far into innovation threatens the very trust we have in the health care system while increasing costs in an effort to bring more technology to the market.

In the end, a balance must be achieved between adequacy, equality, and efficiency...metrics for which we have not yet decided upon.