When the FDA issued its first approval for a gene therapy for an inherited disease nearly a year ago—a cure for a type of blindness—it was heralded as breakthrough, a moment decades in the making. With dozens of other genetically engineered therapies moving through clinical trials, the long-promised era of personalized, gene-based medicine seemed to be at hand.
But there was a catch: the one-time treatment, Luxturna from Spark Therapeutics, costs $850,000.
In a recent Goldman Sachs research report about the promise of gene therapies, analysts asked a question that gets to the heart of a growing dilemma for the healthcare sector: “Is curing patients a sustainable business model?” As this first wave of genetic treatments hits the market, industry leaders face a stark choice. These therapies could save or change lives, but they come at unprecedented cost. Indeed, Novartis recently said that its life-saving gene therapy
In health care today, the conversation around transparency centers on the consumer. The consumer is empowered to ask for treatment options and costs, potential treatment risks, realistic outcomes, and much more. Health care providers must respond with as much information as possible to ensure appropriate care is delivered, quality and safety are top of mind, and patients and their care team can make thoughtful care decisions.
I believe it is impossible to have complete transparency with patients without first developing a strong culture of internal transparency — among all team members, at all levels, on all issues — throughout the health care organization itself.
When team members are open and honest with each other, without fear, it leads to mutual trust, collaboration, and sharing of best practices across disciplines. Patients are the ultimate beneficiaries.
Physician discontent over deteriorating working conditions and growing risks to patient care has risen to alarming levels in European hospitals. To understand physicians’ evolving reality, Bain’s biennial Europe Front Line of Health Care Survey tracks European practitioners’ attitudes, priorities and decision-making power. The findings are based on input from 1,156 physicians across nine specialties and 154 hospital procurement administrators in Germany, France, the UK, and Italy. Our research shows that a majority of doctors wouldn’t recommend their hospital to family or friends as a place to work or receive care. Citing staffing shortages, budget cuts, aging equipment and inadequate facilities, physicians warn they are unprepared to cope with looming healthcare challenges. Provider organizations have attempted structural changes over the past few years to fix specific problems, but, on the whole, their efforts have fallen short.
When an entire system needs renewal, it’s hard to know where to
The debate on how to reduce costs and improve quality in the world’s most expensive health care system continues. While policy initiatives such as accountable care organizations (ACOs) and bundled payments put hospitals at the center for reorganizing care delivery …
The potential for improving the quality of healthcare has never been greater. Advances in data analytics give us the ability to look at large populations and precisely segment their needs and new technologies such as tele-medicine give us the capabilities to deliver customized experiences at scale.
But the most powerful drivers of change are not necessarily technological; radical improvements increasingly also come from applying new innovation methodologies like design thinking that focus on developing a deep understanding of patient experiences and invite patients and partners into co-creation processes.
These methodologies free us from cognitive blinders. Healthcare professionals often see the patient experience through the lens of their own expertise. They come with a theory about what needs changing, which they assume will improve the system. That can be helpful,
Most people at one time or another have struggled to navigate the complexities of the U.S. health care system. Many have received unpleasant surprises, such as a medical bill they expected to be covered by their health insurance or an unexpectedly expensive bill for a simple service. This type of confusion results in a lot of administrative work, including avoidable calls to customer service centers or time spent helping people find lower-cost options for services. It is costing employers and health plans billions of dollars each year.
Recognizing this exorbitant cost, Accenture developed a literacy index to evaluate how well consumers can obtain, understand, and navigate information and services. We used this index to assess how health care literacy affected the performance of nine consumer experience touchpoints. We then calculated the correlating impact to administrative costs. From this, we identified strategies in which health plans could
Productivity in the United States’ health care industry is declining — and has been ever since World War II. As the cost of treating patients continues to rise, life expectancy in America is beginning to fall. But there is mounting evidence that artificial intelligence (AI) can reverse the downward spiral in productivity by automating the system’s labyrinth of labor-intensive, inefficient administrative tasks, many of which have little to do with treating patients.
Administrative and operational inefficiencies account for nearly one third of the U.S. health care system’s $3 trillion in annual costs. Labor is the industry’s single largest operating expense, with six out of every 10 people who work in health care never interacting with patients. Even those who do can spend as little as 27% of their time working directly with patients. The rest is spent in front of computers, performing administrative tasks.
When it comes to health care costs, America’s employers are at a crossroads. Competing for scarce labor in a tight market, they will have trouble continuing to shift medical bills onto employees as they have for several decades.
That means that to control costs going forward, employers may have to confront the true underlying causes of rising health care expenditures: high prices and health care inefficiencies. To address these challenges, they will have to band together in purchasing coalitions that give them the local market power to force health systems to reform.
Employers are the largest single provider and purchaser of health insurance in the United States, covering over 150 million workers and their dependents and purchasing 34% of all health care dispensed in the country. As a potential force for change, only the U.S. government can rival America’s business community.
Many factors make an organization prone to sexual harassment: a hierarchical structure, a male-dominated environment, and a climate that tolerates transgressions — particularly when they are committed by those with power. Medicine has all three of these elements. And academic medicine, compared to other scientific fields, has the highest incidence of gender and sexual harassment. Thirty to seventy percent of female physicians and as many as half of female medical students report being sexually harassed.
As we wrote in a recent New England Journal of Medicine article, “Imagine a medical-school dean addressing the incoming class with this demoralizing prediction: ‘Look at the woman to your left and then at the woman to your right. On average, one of them will be sexually harassed during the next 4 years, before she has even begun her career as a physician’.”
The efforts of many healthcare organizations and medical
We recently conducted an in-depth study at Lumere to gain insight into physicians’ perceptions of clinical variation and the factors influencing their choices of drugs and devices. Based on a survey of 276 physicians, our study results show that it’s necessary to consistently and frequently share cost data and clinical evidence with physicians, regardless of whether they’re affiliated with or directly employed by a hospital. This empowers physicians to support the quality and cost goals inherent in a health system’s value-based care model. Below, we offer three recommendations for health systems looking to do this.
Assess how data is shared with physicians. The reality is that in most health systems, data sharing occurs in irregular intervals and inconsistent formats. Ninety-one percent of respondents to our survey reported that increasing physician access to cost
Most modern health care improvements seem to involve expensive technology and an uncomfortable amount of change management. But clinical and nonclinical staff at the Rotterdam Eye Hospital have improved patient care and raised staff morale at a very modest cost: 10 minutes a day and a special deck of cards.
Members of the hospital’s design thinking team were inspired by something they saw when they boarded a KLM Airline flight: During a pre-flight huddle of the cabin crew, team members introduced each other and then asked each other two questions on flight safety.
When they got back to Rotterdam Eye Hospital, the managers asked themselves why couldn’t they add a similar feature to their own “team-start” huddles? After all, in some ways, the situations were similar: A group whose members may not have worked together before must form a close-knit team quickly and execute their duties in
A study of surgical patients, across 168 hospitals, showed that 23% of patients experience a major complication during their stay. We like to think of complications as atypical events. However, the unfortunate truth is that they are quite common. While most medical complications are easily identified and are treated in a timely manner, not all are recognized soon enough. And delayed intervention means fewer treatment options and poorer outcomes.
My mother, Florence Rothman, was one of these patients whose complications were recognized too late; she died in 2003 in a hospital of avoidable causes. Her deterioration went unnoticed, and my brother and I have spent the last 15 years working to help prevent that next avoidable death.
There is one question that a clinician does not want to have to answer, “Why didn’t we see this patient’s problem sooner?” To deliver better care, doctors and
The growing availability of real-world data has generated tremendous excitement in health care. By some estimates, health data volumes are increasing by 48% annually, and the last decade has seen a boom in the collection and aggregation of this information. Among these data, electronic health records (EHRs) offer one of the biggest opportunities to produce novel insights and disrupt the current understanding of patient care.
But analyzing the EHR data requires tools that can process vast amounts of data in short order. Enter artificial intelligence and, more specifically, machine learning, which is already disrupting fields such as drug discovery and medical imaging but only just beginning to scratch the surface of the possible in health care.
Let’s look at the case of a pharmaceutical company we worked with. It applied machine learning to EHR and other data to study the characteristics or triggers that presage the need
Facing escalating costs of medications and technology, health care patients and providers in the United States continue to search for opportunities to reduce overall costs while maintaining and improving health care outcomes. At the Mayo Clinic Comprehensive Stroke Center Practice, we conducted a project to design and deliver care more customized to the needs of individual patients while reducing cost and resource constraints. It is a risk-stratified approach that could be applied to treating many medical conditions.
The Mayo Stroke Practice used time-driven activity-based costing (TDABC) to study costs associated with alternative protocols for stroke care (see the graphic below). TDABC uses a bottoms-up approach to identify the actual clinical processes and resources used to care for a patient over a period of time. TDABC works from a process map of a patient’s care pathway, attributing costs to the time of each resource used at each step
One of the hardest things about introducing innovation or change in organizations is getting people on board. This is especially true in health care.
As health care organizations are being pressured to cut costs, reduce medical errors, and adopt both standardized processes and new innovations, providers are being asked to give up established and comfortable ways of working. They are having to spend more time on documentation, see more patients in a day, and use unfamiliar processes and tools. For many staff, physicians, and nurses, these changes mean less time healing patients and fostering wellness — the reasons they became health care professionals. Naturally, many start to question the direction of their organization, as these new behaviors and practices appear to conflict with the values of their profession.
When staff view innovations and changes as clashing with longstanding patient care values, they are less likely to adopt new behaviors
Medicine involves leadership. Nearly all physicians take on significant leadership responsibilities over the course of their career, but unlike any other occupation where management skills are important, physicians are neither taught how to lead nor are they typically rewarded for good leadership. Even though medical institutions have designated “leadership” as a core medical competency, leadership skills are rarely taught and reinforced across the continuum of medical training. As more evidence shows that leadership skills and management practices positively influence both patient and healthcare organization outcomes, it’s becoming clear that leadership training should be formally integrated into medical and residency training curricula.
In most professions, the people who demonstrate strong leadership skills are the ones who take on greater leadership responsibilities at progressive stages of their careers. In medicine, physicians not only begin managing and directing teams early in their careers, but they rise through the ranks uniformly.
I recently stood in front of a group of emergency room residents at my hospital and asked an unusual question. “Has any of you ever judged your attending physician for not trying hard enough to save a patient’s life?” Then I looked around the room. But like every time I’d given this presentation, there were no takers.
I can’t say I was surprised. I was piloting a new program which uses storytelling to help young doctors reflect on how they handle the emotional and psychological toll of caring for suffering patients. In my experience, engaging in honest exchange about these dimensions is rare in medical culture—in fact, it is tacitly discouraged.
“Well, let me tell you about a time when I was that attending,” I said. Then I steeled myself, and launched into my story.
The patient was a young woman, healthy up until the moment of her
Providing healthcare to the growing Medicare population is one of the biggest oncoming challenges that America is facing. It is a train barreling down the tracks towards us all: our population is both growing and aging, healthcare costs and service …
A key determinant of everything that matters when it comes to health interventions — the experience, cost, and results — has been hiding in plain sight. It is the buildings and spaces in which patients are treated. The size and layout of a room, whether a bed sits in the middle or against a wall (even which wall), how much space is maintained for patients to walk versus how many beds or operating equipment can be accommodated, have not been considered predictors of health outcomes in the past. That’s changing, as architects and health care organizations come together to incorporate principles of social design into the built health care environment.
“Social design,” a term whose roots go back several decades, fully entered the lexicon around 2006. It refers to the design of relationships, including those that are invisible and intangible. Unlike design thinking, an iterative process for developing alternative
To make progress against knotty problems, break them down — dissect the causes and analyze their impact on different groups. That analysis inevitably leads away from dubious “magic bullet” solutions and toward multiple, targeted interventions that are more likely to be effective. The measures and data to perform this type of analysis are now becoming available for burnout, a problem that is growing in all sectors, but is particularly challenging in health care.
To better understand the sources of burnout and resilience against it, we analyzed data for two characteristics associated with burnout for more than 80,000 health care personnel from 40 healthcare systems nationwide (approximately 19,000 nurses, 5,000 physicians and 60,000 non-nurse/MD personnel). The first of these characteristics, “activation,” is the extent to which a person is motivated by his or her work and feels it is meaningful. The second, “decompression,” is the degree to