Last week I had the pleasure of joining my fellow Healthcare Businesswomen’s Association (HBA) RTP Chapter members in hosting Dr. Brian J. Kelly, president of Payer & Provider Solutions at Quintiles, as our speaker for our Signature event, The Future of Healthcare held at GlaxoSmithKline. Dr. Kelly provided insights and his predictions for our changing healthcare system.
I found the insights very informative and well-stated through the lens of the business of healthcare. As one can tell from my previous posts, I am committed to elevating the value of the patient perspective in healthcare. As such, following the great lecture from Dr. Kelly, I had a number of potential patient-specific concerns come to mind as our healthcare evolves. In doing so, I am not disagreeing with Dr. Kelly’s perspectives and predictions, rather raising concerns that I have in terms of direct patent impacts and outcomes if those predictions become reality.
Dr. Kelly praised the increasing prevalence of genomics and population-targeted clinical trials. While I welcome the advancements that allow us to move from a shotgun approach to a more targeted, intentional approach with therapeutics, a very valid question was raised by the audience when Dr. Kelly mentioned this. “Won’t these more segmented and smaller clinical trials with sub-populations of patients further serve to exacerbate the disparity and disproportionate lack of representation of racial minorities (and women for that matter) in clinical trials? So in order to benefit from all that genomics has to offer, perhaps we need to be cognizant of this potential unintended consequence and start investing in R&D with various sub-populations. My hope is that organizations such as the National Center on Minority Health and Health Disparities (NIMHD) will be mindful of this and take action and make investments now. Doing so will help us to realize the benefits of more personalized approaches to clinical drug development, while still ensuring that all people are represented and thus benefit.
In addition, Dr. Kelly felt strongly that we would be moving to an Accountable Care Organization (ACO) model, which in our region likely means that patients will have a choice of aligning with one of the major hospital systems – Duke, UNC, or WakeMed. Again, audience comments were insightful and asked if this were harkening us back to the old Health Maintenance Organization (HMO) days. Kelly concurred that the future model will likely be very similar to those older systems. While from a cost containment purpose it makes sense, it is also is a bit concerning with respect to limiting choices. One additional concern with this approach that I have is that if we are asking patients to be more cost-conscious to make an informed decision, we MUST be able to provide them with the data on costs of items such as procedures, office visits, hospital stays, and lab work. A recent post by Corey A. Siegel stated it well: “So, why does it [cost] have to be so obscure in healthcare?” With that lack of real clarity with prices, how can we expect patients to make informed decisions? Before we move the risk bearing to the patients in terms of costs, we owe it to them to have transparency of costs so they can begin to make truly informed choices.
Another prediction from Dr. Kelly is that costs of healthcare will become key economic drivers in a region. He went on to say that if the obesity rates, and in turn the costs of healthcare in the Raleigh-Durham region for example, were not sufficiently low, then that would have future negative economic impacts. This would be due to companies seeking areas with healthier populations, and thus lower healthcare (and thus overall operating) costs. While that makes sense from a business case, it raises some serious concerns for how we as a country are addressing the overall health and well-being of our citizens. What happens to areas that have higher poverty and higher obesity rates already? Are they destined to slip further into economic despair with the upcoming changes in healthcare?
It is true that technology has been moving forward to help promote healthy lifestyles. There has been a growing movement in digital health and the quantified self movement [for more see John’s Nosta’s Forbes post]. This includes lots of health monitoring apps and tools like wristbands. However, the adoption of these tools and apps are not yet widespread and most certainly not widely adopted by those with the most health deficits. And regardless of apps and cool gadgets, we still have a big problem with the overall health of our nation.
When are we as a country going to get serious about making healthy living a fundamental focus and a priority for our country? As another savvy member in the audience said, “when are we going to have government incentives for healthy living, like we have done for energy and other areas for years?” If healthcare costs and overall health is such a key economic factor in the US, why are we not making policy decisions that support that? I would have to concur, if we really want to impact healthcare costs, we know how to do it – have a healthier population. Invest in programs, policies, and incentives that seek to enhance the health, well-being, and education of all people. Instead, with regard to our policies, we are seeing trends in government where those are the areas being cut the most. If we are serious about wanting to contain healthcare costs, we need to act now. When looking for ideas on how to do that, one can look to organizations like the Robert Wood Johnson Foundation. They are taking a ‘roll-up-your sleeves” approach to understanding and implementing ways to create healthier communities for all and reducing the incidence of obesity and other chronic diseases, especially in those most vulnerable populations.
In summary, I appreciated Dr. Kelly’s insights and predictions on the Future of Healthcare. I feel that by hearing about these informed ideas, we can seek to address other future, possibly detrimental, impacts now instead of waiting and accepting the outcomes forced upon us. We now have the opportunity to act to make real tangible positive changes for patients that will also favorably impact our healthcare system, and more importantly the overall health and well-being of our nation.