Spotlight on Health Care Disruptors and Innovators

Despite its rising level of health care spending, the United States lags behind other countries in many outcomes and quality measures. Much of the U.S. health care costs includes major administrative functions and infrastructure that bring little or no value to the system, some contend.

During a presentation at the AMCP Annual Meeting, Jorge Font, MPH, senior vice president of Precision for Value, LLC, in Sugar Land, Texas, and Elizabeth Oyekan, PharmD, FCSHP, CPHQ, senior director of quality and population health solutions at Precision for Value, LLC, in Centennial, Colorado, discussed innovative and disruptive companies and services that will likely change the health care landscape in the coming decade.

Value-based care has become a key focus in health care, and while preliminary outcomes for disease-specific conditions have shown good results, questions remain as to the overall impact. Thus, more progress is needed, particularly in areas where spending remains high.

The speakers noted that there are different archetypes for health care disruption and innovation:

• Care delivery disruptors
• Technology and big data enablers
• Personalized care enhancers
• Cost trends and access facilitators
• Legislative and performance drivers

They then gave examples for each of these categories: The CVS/Aetna merger is a care delivery disruptor that may reduce cost of care through scale and site of care and integrate data. An example of the technology and big data enablers is health care blockchain, which helps manage clinical trials data and electronic medical records, while maintaining regulatory compliance. Data cannot be changed without leaving a mark, and the complex coded data is highly secure. United Healthcare, Quest, Humana, and Multiplan are participating in pilot to keep provider directories accurate, while IBM Canada, Kalibrate, and Boehringer Ingelheim are using a blockchain app to complete medical histories in hospitals. The Amazon, J.P. Morgan Chase & Co., and Berkshire Hathaway Inc., Health Transformation Alliance is an example of access facilitators.

These corporations are seeking to create a health system that reduces costs and increases supply chain efficiency, transparency, and consumerism by incorporating innovative technology, operating in a not-for-profit structure, and creating consumer-focused solutions to encourage competition and transparency. Use of biomarkers in cancer is an example of personalized care enhancers. A more personalized approach to cancer diagnosis and care can reduce unnecessary therapies, toxicities, adverse events, as well as maximize response to and durability of treatment.

Finally, an example of legislative and performance drivers is Medicaid’s use of social determinants of health, including genetics, behavior, and social and environmental factors. This includes addressing housing and community development, job creation, exercise, and education, as well as identifying public health patterns. The Centers for Medicare & Medicaid Services is working with communities to expand their geographic reach, access, and success to provide more cost-effective care.

The speakers concluded by discussing strategies for keeping up with disruptors and innovators: Establish a culture and process for rapid implementation of new endeavors; focus on quality, access, and affordability; pursue partnerships; invest in data analytics and health information technology; and focus on improving access and convenience.

Necessity drives innovation, and there is currently a profound need to improve the efficiency, quality, and cost of the health care system, the speakers concluded.