New Systems – The Future of Hospitals & Institutions

Patient Care Area inside a vacant psychiatric hospital

Patient Care Area inside a vacant psychiatric hospital

Blog by Dave Chase, Leonard Kish and Colin Hung

On Tuesday June 9th, the #HCLDR community gathered to discuss “The New Health Ecosystem” based on the #95Theses work of two healthcare luminaries: Dave Chase and Leonard Kish. [Note: if you missed that chat you can read the highlights on our Storify Summary]. Both Kish and Chase were honored guests on our June 9th chat.

That chat was so successful and generated so many interesting tweets that we decided to schedule an encore. So this week on HCLDR we will be exploring the “New System” section of the #95Theses:

  • #90. Hospitals have provided amazing service for the last 100 years, but location is becoming less important for healthcare. Care can happen almost anywhere at lower cost. What conditions hospitals treat, and how hospitals serve their communities will dramatically change over the coming decades.
  • #91. Health systems, your technology procurement process must be up to the task. Systems grown and optimized for the waning fee-for-service often have the polar opposite design to what will optimize the fee-for-value era. Virtually every new healthcare delivery organization that is outperforming on Triple Aim objectives, has deployed new technology re-imagined for the fee-for-value era.
  • #92. Outside of healthcare, millions of organizations have reformulated how they interact with their ultimate customers with better communications tools. Next generation healthcare leaders understand that tools will focus on communication over billing.
  • #93. Health system leaders, learn from the another local oligopoly in your community — the venerable daily newspaper. While they spent the last couple decades worrying about cross-town and traditional media company competition, it was death-by-a-thousand-papercuts that has been their undoing. Newspaper executives dismissed an array of new asymmetric competitors including eBay, craiglist, Monster.com, Cars.com, Facebook, Groupon, ESPN, CBS Marketwatch and more who stole advertising, media consumption or both. Health system executives are doing the same thing today, and the issue is the same: how valuable content will be delivered in the future. The content is different, but the issue of distribution is the same.
  • #94. Winning healthcare delivery organizations recognize that the Quadruple Aim will deliver sustainable success. The “forgotten aim” is a better experience for the health professional. Layering more bureaucracy on top of an already-overburdened clinical team ignores that the underlying processes are frequently under-performing and that a bad professional experience negatively impacts patient outcomes.
  • #95. Healthcare organizations wanting to reinvent can harness the new opportunities by unshackling their smart, innovative team members and outside thinkers to reinvent their organizations for the next 100 years. Those that enable their customers will emerge as the leaders for the next 100 years.

It’s fun to think about the future of hospitals and large healthcare institutions. Will they even exist in the future? Will they be more specialized or cater to only the most severe of health crisis?

In preparation for this upcoming chat, Chase wrote the following in an email to me:

I was thinking more about the latter part of the Theses — “New System”. My point of view on the “hospital of the future” is shared by many including Eric Topol. Just take a look at what Eric put in this tweet.

We have a paradox that the most dangerous place to be (at least in America) is a hospital yet we continue to see massive consolidation that tends to make the big, bigger. As this insider/expert on health reform outlined in a talk, there is a massive over-capacity of hospital beds (watch for 60 seconds from this point in the video). Hospital beds are also incredibly expense. Some of that is required but a lot is redundant. 

I was told that it costs ~$1-2M/hospital bed. By comparison, I was told that a luxury resort with a golf course, spa, etc. can be built for ~$200k/bed. That’s a big spread and I know which place I’d rather be if I could get good care. 

In my home province of Ontario, for example, the cost to provide palliative care is:

  • $1,100 per day in an acute-care hospital bed
  • $630 to $770 per day in a palliative-care unit
  • $460 per day in a hospice bed
  • Less than $100 per day where at-home care is provided

(Source: http://www.homecareontario.ca/home-care-services/facts-figures/publiclyfundedhomecare)

If I have a choice, like Chase, I would definitely prefer to be at home or in a 5-star luxury resort rather than a hospital. In fact, as costs continue to sky-rocket and patient safety continues to improve only marginally [see our HCLDR discussion with Richard Corder on Leading a Culture of Safety], more and more people will seek alternatives to hospitals.

Thankfully avoiding hospitals is becoming easier and easier with advancing technologies such as telehealth, personal health tracking and personalized/precision medicine. This last area of innovation is fascinating and is something that Kish would love to explore more deeply with HCLDR:

I’m on a kick about openness and it’s relation to precision medicine after yesterday’s White House event. I’d love to do a question on the “new science”. Event yesterday did a great job of tying together the need for data to enable better personalized, precision medicine.

Precision medicine is defined in a National Academies of Science report as follows:

“Precision medicine” refers to the tailoring of medical treatment to the individual characteristics of each patient. It does not literally mean the creation of drugs or medical devices that are unique to a patient, but rather the ability to classify individuals into sub-populations that differ in their susceptibility to a particular disease, in the biology and/or prognosis of those diseases they may develop, or in their response to a specific treatment.

To unlock the power of precision medicine we will not only need to advance our clinical understanding, but we will also need to unlock/un-tether health data that is currently stored in inaccessible silos. Luckily healthcare is making strides on both fronts. It will not be long before precision medicine becomes an everyday reality and when it does, what will that mean for hospitals and large institutions? Will they be needed at all? Will they be able to morph into centers for individual health?

Chase says it best:

If we don’t re-imagine a better future for hospitals, they’ll fight that much longer to hold on to the old model.

Join the #hcldr weekly tweetchat on Tuesday July 14th at 8:30pm Eastern (for your local time click here) where we will discuss the following topics with special guests Leonard Kish (@LeonardKish) and David Chase (@ChaseDave):

  • T1 What are some creative/effective ways patients can use to avoid hospitalizations?
  • T2 >50% of people die in hospitals/institutions in the US. In Denmark 92% die at home. How can we shift?
  • T3 How will personalized & precision medicine change the need for hospitals? How can we accelerate this new science?
  • T4 Imagine if one day ½ of hospitals aren’t needed. How might that real estate/buildings be used? (health edu ctrs, assisted living?)

Resources

“4 Fatal Newspaper Mistakes Health Systems are Making“, Dave Chase, LinkedIn, June 20 2015, https://www.linkedin.com/pulse/4-fatal-newspaper-mistakes-health-systems-making-dave-chase?trk=mp-reader-card, accessed July 11 2015

“Hospitals, Office Visits of Little Use in the Future”, Eric J Topol MD, Medscape, January 14 2013, http://www.medscape.com/viewarticle/777327, accessed July 11 2015

“The Future of Medicine Is in Your Smartphone”, Eric J Topol, Wall Street Journal, January 9 2015, http://www.wsj.com/articles/the-future-of-medicine-is-in-your-smartphone-1420828632, accessed July 11 2015

“Facts & Figures – Publicly Funded Home Care”, Home Care Ontario, 2015, http://www.homecareontario.ca/home-care-services/facts-figures/publiclyfundedhomecare, accessed July 11 2015

“Hospital Adjusted Expenses per Inpatient Day”, The Henry J Kaiser Family Foundation, 2014, http://kff.org/other/state-indicator/expenses-per-inpatient-day/, accessed July 11 2015

“Is this a Hospital or a Hotel?”, Elisabeth Rosenthal, The New York Times, September 21 2013, http://www.nytimes.com/2013/09/22/sunday-review/is-this-a-hospital-or-a-hotel.html?_r=0, accessed July 11 2015

“Seven Questions for Personalized Medicine”, Michae J Joyner MD and Nigel Paneth MD, Journal of the American Medical Association, June 22 2015, http://jama.jamanetwork.com/article.aspx?articleid=2344586, accessed July 11 2015

“What is ‘Precision Medicine’ and Can it Work?”, Gary An MD and Yoram Vodovotz PhD, Elsevier, March 9 2015, http://www.elsevier.com/connect/what-is-precision-medicine-and-can-it-work, accessed July 11 2015

“Personalized medicine: Time for one-person trials”, Nicholas J Schork, Nature, April 29 2015, http://www.nature.com/news/personalized-medicine-time-for-one-person-trials-1.17411, accessed July 11 2015

Image Credit

Vacant Psychiatric Hospital Hallway – Freaktography – https://flic.kr/p/qWTwv8

3 comments

  1. Reblogged this on HealthcareVistas – by Joseph Babaian and commented:

    #hcldr this week!

  2. Joseph Temple · · Reply

    I agree that the innovation surrounding personalized or precision medicine is very exciting.
    However, I believe that rather than using dna to identify predisposition to disease processes, more immediate impact will come from identifying an individual’s ability to metabolize specific medications or medication classes. By focusing on this aspect of personalized medicine, through pharmacogenetic testing, we will be able to personalize individual formularies, dramatically reduce medication errors, and reduce overall pharma spend.

  3. Joseph Temple · · Reply

    Further, the individualization of formularies will be particularly impactful for poly-pharmacy patients, most of whom are super-utilizers of health care.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: