A new ecosystem for health Please tell us what innovation means in health care. Innovation is discovering and implementing solutions to improve health, and the care processes necessary to accomplish this. Health does not mean the absence of disease; instead, it means that a person can live their lives fully and unencumbered. Fundamentally, this means keeping people healthy so that they can meet the needs of those who rely on them, whether their role is that of a father, mother, son, or grandmother.
Douglas L. Wood, MD, FACP, FACC Center for Innovation at Mayo Clinic Dr. Wood is medical director of the Center for Innovation and a practicing cardiologist at Mayo Clinic. He previously served as vice-chair of the Department of Medicine, and chair of the Division of Health Care Policy and Research at Mayo. He served on the Governor’s Health Care Reform Task Force and has been a leader in health reform in Minnesota. He has served on the Minnesota Citizens Forum on Health Care Costs and currently serves on advisory committees for medical home payment and provider peer grouping for the Minnesota Department of Health. He received the Distinguished Service Award from the American College of Cardiology, the Burgess Meredith Award from the American Medical Association, the Citation of Merit from the University of Missouri School of Medicine, and the Distinguished Service Award from the MMA.
What are some of the challenges that innovation in health care faces? The problem with innovation in health care is not due to a lack of advances in genetics, drugs, and devices, but in the lack of innovation in the delivery system itself. Successful innovation is signiﬁcantly impeded by payment systems that focus on the number of visits, tests, and procedures. Our current emphasis on measuring processes of care and narrow clinical outcomes has created a multi-billion dollar measurement industry that has lost sight of the need to improve health. How is innovation in health care related to more than just technology? Sometimes the solution is to use less technology and less “medicalization” of care, and to increase the human capacity to achieve health. We are all quite fascinated by wearable gadgets and apps for our phones, but the thing to keep in mind is that technology must make people’s lives better, more enjoyable, and easier. What does a “new ecosystem” for health care mean? We should actually use the term “ecosystem for health,” which means all the elements needed for people to achieve health. Health care is really just a small part of what it takes to be healthy. When talking about an ecosystem, we have to consider our communities, our home environment, and then think about how to structure education, social services, sustainable economic structures, transportation, security, and safety, among other things. As for the health care system, it means thinking about health at home, at work, or at school and then integrating in aspects of public health, mental health, access to care, integration of care, affordability, insurance, technology, and infrastructure, which affects people and health care providers. How will this new ecosystem happen? The new ecosystem starts with a vision of what health should be, including all the determinants of health. An analysis of the gaps in our current system will identify the areas in which innovation is needed to make this new vision work. It should start with a deep understanding of what people
MINNESOTA PHYSICIAN MARCH 2016
need, followed by a way to bring about accessible and affordable services within a system that is capable of rapid, adaptive change. In my view, this new ecosystem for health will be initiated and implemented by individuals and organizations outside of established medical institutions in response to real and personal challenges. These changes will have to gain traction and connect with communities and markets. The resulting products and services could create a new network of resources or alter existing networks. Of course, success will depend on access, affordability, outcomes, and trust. Established medical institutions—such as Mayo Clinic—will need to remain relevant and identify their place and role within the new ecosystem. With these forces at play, the new ecosystem for health will thrive because it will be based on people’s actual needs. How will the delivery of health care change? We need to help people make better choices about their health and as a result, must move care to where people live and work. Every year, I see more individuals, entrepreneurs, and health care providers, challenge assumptions, take risks, and make signiﬁcant changes for the future of health. These isolated, independent actions that focus on improving the well-being of family members, neighbors, and loved ones, are among the most positive signs I’ve seen for the future of health care. These brave souls march forward out of frustration with America’s health care system, because it is tied to an outdated, traditional medical model. The existing structure is too entrenched, and we ﬁnd our country, for the most part, still burdened with skyrocketing pharmaceutical prices, shackled to reimbursement systems based on sickness care, and wrestling with rising insurance costs, despite the Affordable Care Act (ACA). There is no question that we need a new model to achieve changes in health. Some of the most promising momentum I’ve experienced for the future of health and health care has come from a relatively small annual gathering of innovators and disruptors called the Transform conference, hosted by the Mayo Clinic Center for Innovation. Transform is a catalyst for engaging people to boldly create a sustainable future for health. In 2015, more than 700 attendees from 34 states and 15 countries with backgrounds as providers, administrators, researchers, designers, technologists, entrepreneurs, policy experts, and payers from more than 200 organizations participated in the three-day event. What are your thoughts about the Affordable Care Act? Right now there is not much in the ACA that creates affordability for people. It has helped to signiﬁcantly reduce the number of Americans without access to insurance. But, if insurance is