Make No Little Plans

Kim BellardEver seen the new TV show 'Pure Genius'?  Probably not; its ratings are dismal.  I've seen it, and, well, it isn't very good.  But what I like is the premise: a young tech billionaire builds a hospital using only the latest technology, and treats patients regardless of cost.

Gotta give the creators props for trying to re-imagine hospitals.  The health care industry could do with some serious attempts at re-imaging, and not just for hospitals.

What made me think about this were two stories about the auto industry, which is desperately trying to remain relevant in a world of Uber, self-driving cars, and our love affair with our various digital devices.

The Wall Street Journal reported how car manufacturers are hiring design and special effects firms who have helped create versions of the future in science fiction movies.  They've doubled their spending on display systems -- to $22b -- and are using some of the science fiction concepts to "create a more compelling user experience."

Meanwhile, The New York Times reported on the Los Angeles Auto Show.  Trying to avoid the fate of buggy manufacturers, auto manufacturers are trying to re-position themselves as being in the "global transportation industry," in the words of Ford's CEO.  More than that; they want to be in the digital device business, "because much of the innovation seems to involve making the car ever more like a giant smartphone on wheels."

At least they are thinking big.  When the health care industry thinks about the future, though, that future tends to look like just more of the same, except bigger, higher tech, and, of course, much more expensive.

Let's change that.  Picture, if you will, a health system -- not health care system -- that looks more like this:

1. Most health problems are averted instead of treated:  Annual exams and periodic screenings now medicalize prevention, sometimes excessively, but we'll think broader and accomplish more.  We'll head off many health problems through better health behaviors (e.g., exercise), and even be able to "fix" broken genes that can/do cause health issues.  
2. We actually know our health status: We may think we monitor our health pretty well, yet two-thirds of us are overweight and over half of us have a chronic condition, so we're not doing such a great job.  That will change.  We're going to have wearables, implantable monitors, and/or other means to give us real-time information about our health (and the health of our microbiome).  We'll even know what to do with it.
3. We bear more responsibility for our health: Not all that happens to our health is under our control, but we will be expected to act responsibly for the parts that are.  If we don't, there will be consequences, such as increased financial obligations for, or even reduced access to, care.   
4. We own our health information: Our health information will be based around us, with inputs from all applicable sources -- our tracking mechanisms, our physicians, etc.  It can be accessed as needed by various parties, but the information belongs to us.  And it will be in consumer-friendly language and visuals, not medical jargon.
5. Your doctor won't be the first person you'll call: Our bodies will have some self-correcting mechanisms to address many situations, but we'll be alerted when we need to seek help.  The first line of help will be AI, which will be able to assess the situation, and either recommend specific actions or triage us to another expert, such as a physician.  And that initial human interaction is likely to be virtual, not in-person, reserving the latter to as-needed.
6. When we do see physicians, we pick on quality/value:  Gone will be the days of choosing physicians, or other providers, based on proximity or even provider network.  We'll know the quality/value of each provider, and we want people to use the best provider for their need.  Moreover, providers who deliver demonstrably better outcomes will get corresponding higher payments. 
7. Financing doesn't drive (necessary) care:  For services that are indisputably proven to be effective, people won't have to worry about payment.  The financing of such services will be a combination of personal financing, peer-to-peer financing, government subsidies, even health insurance, but they get paid.  Determination of which pays how much for what happens on the back end, based on an individual's circumstances.  If individuals seek to get care that has not proven its value, though, they will be expected to pay most or all of it themselves. 
8. Home is where (most of) the care is: Through better ways of monitoring, more supportive services and devices (think robots...), and on-demand providers, most situations that would now call for a stay in a hospital, nursing home, or rehab center will be taken care of at home.  Those institutions will be much smaller, much more specialized, and used only for extraordinary situations and limited durations.  
9. Surgeries and even drugs are exceptions: Our bodies will be helped to do as much of the work as possible -- e.g., stimulating our immune system, adjusting our chemical levels, regrowing broken bones or damaged nerves.  Plus, we'll be using nanobots to fix defects and 3D printing body parts.  When we need surgery, it will be truly minimally invasive, and when we use drugs they will be extremely targeted and for short term use. 
10. Administrative costs are minimal: Much of our current system has administrative costs that are built around payment: armies of medical coders facing off against armies of claims processors, all operating under an ever-more-complicated set of rules.  ICD-10 coding, application of insurance provisions (which become much simpler with clearer definitions of necessary care) -- AI will take over most of these tasks.  We should be thinking of overhead costs more analogous to those for credit card transitions (1-3%), not our current 15-20%.

None of this will be easy.  None of it is impossible either.  If we can't, or simply don't, imagine it, though, none of it will happen; we'll continue to muddle along as we have been.  Daniel Burnham's famous quote, referenced in the title, is: "Make no little plans; they have no power to stir men's blood and probably themselves will not be realized."

I've had enough of little plans for the future of the health care system.  Let's go big.