Good morning. As the Chief Medical Officer of the health care business of Philips, it is an honor to discuss the ‘State of our Union’s’ health care system. Currently, our health care system is fairly strong, but could be stronger. Given the global challenges presented to our social and economic well-being, there is much work ahead of us as clinicians, consumers, product and service suppliers, health policymakers, and public opinion leaders. Today, I would like to offer a “diagnostic view” regarding fundamental issues we face both as a nation and as a global community, mention new perspectives on the role of technology and innovation, and suggest broad principles that should guide health care reform discussions. First and foremost, our health care system must reaffirm its commitment to the patients and care givers in our communities. As Americans, we are uncertain if we will receive the health care we need when we need it. We face unprecedented medical demand as our society ages faster than our ability to diagnose and treat illness. Hospitals struggle financially. Physicians are asked to care for more patients while mired in a medical information explosion. In thinking about health care as a system, if we only examine the pressures faced by business, government, and providers, we miss the forest for the trees. We must remind ourselves that our health care system exists to meet our personal needs and the needs of our families and friends. Everyone in this room – and by extension, each of our loved ones and neighbors – relies on our health care system to bring them peace of mind, and our current system must deliver. To illustrate, in October of 2008 (1), the Kaiser Family Foundation asked more than 1,200 adults: “What kinds of things are you worried about?” These folks were surveyed in the midst of our financial crisis when millions of Americans were watching the values of their homes and investments plummet, when people were agonizing as their coworkers lost their jobs, and when ongoing threats to our national security dotted the presidential debates. Americans answered that they were more worried about their health care than about losing their jobs, losing money in the stock market, or being the victim of a terrorist attack. Many cited concerns about the cost of health care, about losing coverage, and about the quality of health care. So what might be a remedy? Each of us is looking for an affordable, beneficent health care system that treats each of us according to whom we are and what we want. We are looking for health care that understands and anticipates our needs – that reminds us about our immunization status, identifies the lump when it’s small enough to treat, and doesn’t insist that we take a full day off from work when we have a simple sore throat.
We want to make certain our health care system delivers on its promise: high-quality health care, delivered efficiently, by care providers who have the right tools and information that help us make the best decision for ourselves.
How do we deliver this remedy? If we are to reform our health care system we must embrace the promise of “meaningful innovation”. That is, those game changing actions that create new paradigms and productively alter the way we live, and as a clinician, I would add in “compassionate way”. Technology and simple innovation will not suffice. We must create a market and policy climate that rewards innovation that reforms the relationship between the patient and the clinician and fosters a health care peace of mind. “Meaningful innovation” in health care should be? 1. First, chronic illnesses pose our greatest health care challenge. In 2005, 133 million Americans had at least one chronic illness, with minority and low-income populations disproportionately impacted (2). In most cases, we understand how to treat an individual patient, but delivering that care systematically and effectively to millions of patients is a real challenge. Many strategies that address the challenges of caring for these patients focus on linking physicians under a common, care-management umbrella, through the use of information technology (3). To date, results are mixed, given the lack of infrastructure that supports individual care providers, and the absence of a reimbursement system for these multidisciplinary, physician-based services (4). In the recent past, hospitals which have focused on treating discrete, acute episodes of illness, disease, or injury are developing hospital-based programs to manage chronic illness (5). Reforming the role of the hospital into a continuous provider of care to a community makes sense and has the potential to reduce overall spending and improve quality.
2. A second example of meaningful innovation can be found in many of our nation’s intensive care units, where patients are often frail and quite ill. We’ve all seen the marvels of modern ICU medicine, and the technical advances are breathtaking. We’re all familiar with the endless streams of clinical data scrolling across monitors, and the incessant beeping of alarms and warnings. Technology brought us the monitoring equipment, but in the end, we rely on dedicated teams of nurses and doctors to understand the information and make the right medical decisions. Here again, innovation is at work. What if we design computer-based systems to monitor a patient’s ICU data and present a crisp summary to clinicians? As for true disruption, what if these systems assess in advance when a patient might take a turn for the worse or might need an adjustment in their medication? Building risk-assessment models to help doctors anticipate a patient’s deterioration can “change the game” in the ICU. Rather than scrambling when a patient goes into distress, these alerting systems provide the medical team with meaningful information for preventive intervention. By enabling more timely diagnosis and treatment, we reduce cost and improve quality. More importantly, these innovative patient monitoring systems can assure for ourselves, our families, and our clinicians that when we are patients we will receive high quality care at our most vulnerable moments.
3. Finally, we’re all familiar with the “biotechnology revolution”. Increasingly, biologic-based medicines are being developed that can treat chronic illnesses. On a parallel track, our ability to determine a patient’s individual genetic makeup and proclivity to disease is advancing rapidly. However, given the cost of these medicines and the variation in individual genetics, there is significant benefit in knowing which patients are more suited for a particular treatment based on their genetic make-up and the biological action of the medication.
This next wave of innovation links patient-specific diagnostics with patient-specific treatments. In effect, combining two, inter-related innovations that can transform the health care playing field. Instead of a one-size-fits-all “miracle” drug, we have miracle drugs that are customized to our unique genetic structure and the specific biology of the disease. As a result, patients will respond to treatment faster, with fewer side effects, and we’ll do a better job at matching the right drug therapy with the right patient. Now, what if we link patient-specific diagnosis and treatment with targeted drug delivery? You may have read about capsules you swallow that contain miniature cameras for use as diagnostic tools. What if you incorporated a disease-specific medication at a patient-specific dose and delivered the drug therapy to a targeted disease site? In a sense, you would have an intelligent pill, such as the Philips Research iPill, that could be swallowed, thereby delivering medication via the intestinal tract to the site of local disease, such as the intestinal inflammation associated with Crohn’s disease. These are three examples of “meaningful innovation”: compassionate (people-focused), sensible (simple), and, yet disruptive (and useful) - improving the quality of health care, reducing overall costs, while aligning technology around the needs of the patient and the clinician. As I stated at the outset, our health care system seems strong, but falls short of our high expectations. As this new Administration tackles the challenge of health care reform, a few suggestions: Second, our health care system must move away from paying doctors and hospitals for services and interventions, and instead move towards a payment system that reflects the overall manner in which patient care is delivered. By shifting payment towards those services needed to get a patient healthy, we make sure that care providers have the incentive to work together, use diagnostic and treatment tools in a cost-effective fashion, and focus on the one measure of quality that matters most: Did the patient get better? (6)
Third, we need to expand the number and variety of providers. Advances in our ability to equip clinicians with real-time information and guidelines, coupled with our deepening understanding of disease and illness, should enable us to better deploy the skills of physician assistants, nurse practitioners, community health workers and other highly-skilled care providers. Physicians and nurses must always be at the center of our delivery system, and reform must assure they have the authority and ability to leverage their extensive training and experience through ancillary support. (7)
Fourth, we should recognize that innovation emanates from a robust biomedical research and development infrastructure. Continued support for basic biomedical research is vital to meet these demands, and the public and private sector have an obligation to resist the temptation to cut R&D investment.
Finally, reform should provide specific incentives for the right kinds of innovation - innovation that constructively disrupts the old ways of doing things, innovation that creates new opportunities for patients to care for themselves, and innovation that enables clinicians to deliver the right care at the right time in the right setting using the right information.
I am very optimistic about our collective ability to strengthen our course – to help simplify medical care and support the profession, using a full set of 21st century diagnostic, treatment, and management tools. As we embark on this journey of reform, we are challenged to reaffirm our commitment to patients; to restore individual peace of mind through meaningful innovation that is both compassionate and people-focused; to encourage the development and adoption of disruptive innovation that is both sensible and useful; and to align our public policies with these goals. Speaking for Philips and as a physician, on this dawn of the 111th Congress and the Obama administration and of the most important policy debate in our nation’s history, we wish our clinicians and lawmakers well and we reaffirm our commitment to reforming our health care system in an innovation-rich, patient-focused manner.
1. Kaiser Family Foundation (October, 2008). “Kaiser Health Security Watch.” Retrieved January 15, 2009, from http://www.kff.org/healthpollreport/CurrentEdition/security/index.cfm.
2. Centers for Disease Control and Prevention. Retrieved January 15, 2009, from http://www.cdc.gov/NCCdphp/overview.htm.
3. Siu, AL, Spragens, LH, Inouye, SK, Morrison, RS, Leff, B. (January/February 2009). The ironic business case for chronic care in the acute care setting. Health Affairs, 28,no.1(2009):113-125 doi: 10.1377/hlthaff.28.1.113.
4. Decker SL, et al. The use of medical care for chronic conditions. Health Affairs.28. no.1(2009):26-35:10.1377/hlthaff.28.1.26.
5. Bott DM, et al. Disease management for chronically ill beneficiaries in traditional Medicare. Health Affairs.28. no.1(2009):86-98:10.1377/hlthaff.28.1.86.
6. Hartzband P and Groopman J. Money and the changing culture of medicine. NEJM 2009;360(2):101-103
7. Bodenheimer T, et al. Confronting the burden of chronic disease: can the US health care workforce do the job? Health Affairs.28. no.1(2009):64-74:10.1377/hlthaff.28.1.64.
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