Like many, I apply a majority of my time, skill, and creativity to positively advance our healthcare system. With the hope that by the time I become afflicted with a disease, I'll enter the system with greater confidence. In my ten year journey, I’ve followed many paths and cleared some of my own. While proud of the lives I've been able to positively impact, I remain largely dissatisfied with what I’ve been able to change. I write this letter to myself in order to organize my thoughts, and revise a plan to bring greater change over the next decade. I only hope others find it, or parts of this, worth aligning with and in doing so sharing their thoughts toward a unified mission.
To set the stage, I admit having a simpler view of our health system. It has two parts that are currently, and unfortunately divided. Care management (medical) and management of care (business). Medical care staff set out to achieve preventative, curative, and palliative objectives effectively. While the business arm seeks to apply financial, logistical, and operational policies to achieve efficiency. One forcing the other to do more with less. Grasping to maintain profits, expenses get pushed along until they're placed upon the patient. In many ways, it's similar to how taxes pass onto the consumer. Quality of care seems impossible in the current state.
But, who defines quality?
As a patient I think it should be the patients themselves who define quality. As a businessman, however, I know that in actuality it's defined by disparate entities with outdated lead measures and conflicting objectives. Each entity facing their own struggles. If you don't work in healthcare, I outline a few below:
Medical societies are often five to ten years behind, and slow to update standards.
Hospital institutions have ineffective means for disseminating knowledge and upholding standard improvement initiatives.
Research is encumbered by institutional restrictions that prohibit, stymie, or do not support collaboration.
Industry organizations are desperate to recoup operating costs which surge patient and insurance billings. Insurance companies focus more on financial risk aversion rather than patient disease aversion. It goes on and on.
So how can our healthcare system, and the healthcare providers within it, aim more of their efforts at providing value to the customer and reduce the non-value added work? Without achieving that paradigm shift, it seems to m e that precision medicine will not prevail.
Healthcare absent of collaboration - and I mean collaboration like never seen before with complete disregard to the ways of the past - will not allow for precision medicine to flourish. The system inherently can't allow it because balancing both care management and management of care forces it to take broad-based approaches. Minimal individualization leads to unnecessary expense and to litigious vulnerability. Sure, broad-based medicine is effective for vaccinations, immunizations and the like, but it's wasteful when dealing with the individual. I want to lead the transition by which our healthcare industry can catch up to other industries that have placed the customer (patient) experience first. Industries as old as manufacturing (e.g. Toyota) to as new as internet-based (e.g. Amazon Web Services) retail companies who do it so successfully.
The first problem I can tackle is in eliminating waste. This is how I can make the system better, and maintain hope that others will help bring down the remaining barriers.
Identifying Customer’s Waste:
It’s important to make the necessary distinction between cost and waste. Waste is easily identifiable but due to habits and disparate organizational interests, it’s hard to eliminate. In the management of waste, its reduction increases capital. While I can categorize these as pharmacological, operational, or procedural, the following are specific areas I can impact:
Defects - lack of overall quality, inadequate surgeries, readmissions, misdiagnosis, etc.
Excessive production - over screening, over medicating, unnecessary surgeries, lengthy inpatient stays, etc.
Wait Times – material processing, patient scheduling, repeat tests, patient data sharing/transfer delays, etc.
As patients, we’ve experienced some to all of those wastes and it’s why we put off going to the doctor. As past, present, or future caretakers we pray they get remedied.
Typical examples of waste in Oncology are adverse reactions to inappropriate medications, unnecessary PET and CT scans, improperly used high-cost drugs/procedures, excessive use of chemotherapies, reliance on empirical treatment protocols, or prolonged maintenance or palliative methods to satisfy the hopes of family members (a cost that should be an acceptable form of “waste”). By eliminating some of this waste, we could empower the oncology arm of healthcare to streamline the organizational routes of appropriate detection and proper intervention for individual patients.
Genetics and Genomics Role in Reducing Waste:
At its very roots, genetic information provides DNA-level-immune performance information. It should guide healthcare teams to optimize surveillance of high-risk patients for early cancer detection. Genomic data then describes the outcome of gene signaling deviations indicating how cancer has prevailed against DNA-level-immune response. Both should, and must, be used to develop individualized care plans that eliminate waste in that consumer’s care. However, a singular point of data is virtually useless; only data in aggregate is useful. We must unify efforts across multiple systems which represent large and diverse patient populations to delineate patterns and waste. It's not enough to partner, collaborate, we also need an unbiased and medically appropriate platform. That brings me to the next topic.
Healthcare’s Awaited Aggregator:
Think of a centralized agent which reduces the resources and time required to generate data, without bias to what may or may not be useful. I think of Google who provides the same no-cost answer to a student as it does to a businessman seeking information for financial gain. I believe such an aggregator is needed within healthcare.
Who is best positioned to be that centralized aggregator? In order to be an aggregator, organizations will need to evolve beyond a product company in favor of a service company. The product companies, like molecular testing labs or specific device companies, will face increasing price competition as it all moves toward commodity stock. Otherwise, new companies will form, infrastructurally different, with greater connectivity to the patient that are more nimble to respond to their value-needs.
If data is the key to unlocking cures for cancer, then data-service providers will be essential to cracking the combination. Becoming and/the aggregator positions an organization to be an integral, and indispensable part of the healthcare system. Crafting collaborations that benefit the partners more than itself is a powerful position to be in. A position of being a platform. Where the value of the system built on top of the platform exceeds the value of the platform itself. Simply and precisely because the platform has immense worth, purpose, to the patient whom all products built upon serve.
Now I believe is the time for organizations to take a different financial approach, forsake Wallstreet, and be patient in their return to become the patient-defines-value aggregator of healthcare. For the patient’s sake!
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