There is no shortage of coverage about the failings of healthcare in the US. Despite the largest per capita investment in the world, our population health statistics demonstrate that we are not earning the value on investment we should. Many system-level visions for change lack connection to the day-to-day realities in the field. This makes them enticing to hear about but can lead to cynicism by industry insiders who see the practical gaps between concept and reality.
One vision that resonates as being both radical and far-reaching while still connecting to the real business of healthcare is one put forth by Robert Wachter in the last chapter of his book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age (McGraw Hill, 2015). This vision relies upon technology that exists, financial structures that are being piloted, facilities whose functions are already being reimagined. Some aspects of his look into the future include:
Significantly fewer hospitals, which are focused on major surgeries, procedures, or ICU-level care; highlights include:
Private rooms with high resolution video for consultation with providers, specialists, other types of care givers, and family members
An electronic personal health record shared by clinicians and patients
Advanced computerized decision support for providers fueled by big data and possibly artificial intelligence
Chronic and routine care will be accessed through tele-visits with community-based providers or at home:
Intelligent and convenient remote monitoring will help patients with chronic care intervene before problems become more severe
Tools that enable home-based care such as for monitoring vitals, basic diagnostic tests (e.g., looking for an ear infection)
Personalized medicine will increasingly find more successful and less disruptive treatment courses
Providers will include a medley of roles (physicians, nurses, pharmacists, physical therapists, dieticians, administrators, mental health workers, case managers, to name a few), with the role of the physician changing to one that is more specialized.
Patients will have a greater role, whether through managing a personal health record, participating in treatment decision-making, or managing health through tools and data.
Payment systems will include incentives for quality, safety, and cost, with outcomes focused on patient goals versus distant universal criteria. Patients will also have financial skin in the game.
Government’s role will be “setting up rules and standards to facilitate interoperability, ensuring security, creating an honest and level playing field for vendors, convening stakeholders, funding research, and monitoring safety. Reaching the ideal future state will depend on government assuming its proper role: the meaningful – and limited – use of its vast powers.” (page 266)
At Spring Street Exchange we’ve been talking with healthcare leaders about their visions for the future and look forward to sharing more takes on where we could (and would like to be) headed. What about this vision resonates with you?