A recent NBC/Wall Street Journal poll again demonstrated that health care is the top government priority among voters. So how are our political leaders tackling the question? For Democratic presidential candidates, the debate is mostly about a new “Medicare for All”—somehow expanding government coverage for every American (alas, with little discussion about how to fund it). Republican leaders have focused primarily on dismantling Obamacare, though President Trump last week called for bi-partisan legislation to reform provider billing practices. Yet such issues are only a fraction of the tangle of healthcare challenges that, as Mr. Trump once noted, “nobody knew could be so complicated.”
A Bigger Strategic Monster
That complexity, besides being mind-numbing, has also blocked more serious strategic thinking in our public debate. Expanding access and reducing costs are important for many voters—but nobody’s talking about a bigger strategic monster: our need to ramp up healthcare innovation. How will we accelerate growth of new knowledge so our overall system can actually perform better long term—to achieve higher quality and financially sustainable patient care? What are the breakthroughs to turn around today’s losing battle: we’re spending on healthcare faster than we can afford, even as positive outcomes per dollar keep sinking versus those of other developed nations?
Finding more innovation for better results and sustainable performance is not unique to healthcare. It’s the imperative that any organizational leader wrestles with every day. You know what keeps you up at night: how to keep experimenting, learning, and growing your longer-term strategy, so you can meet future challenges–even as you’re executing for results today?
Tapping The Experience Of Dr. Laurie Glimcher
Dr. Laurie Glimcher is no stranger to such issues as President and CEO of the Dana-Farber Cancer Institute, consistently ranked among top U.S. cancer centers. A distinguished immunology scientist, she also heads an enterprise that delivers globally-renowned cancer care even as it pushes the boundaries of new knowledge that are shaping future horizons of treatment.
Dr. Glimcher and I recently spoke about reforming—and ultimately transforming—American healthcare. She began by ticking off several familiar problems-to-be-solved (fragmented insurance models, overall system complexity, care that differs by zip code, over-reliance on expensive emergency rooms) — but soon shifted more broadly towards accelerating innovation-sparking knowledge and industry-wide learning. Five themes about that emerged from our discussion.
1.Beware the rising tsunami of chronic diseases. Glimcher peppered our conversation with heart-stopping data about illness fast multiplying by aging demographics, environmental changes, and other population risk factors, e.g. increasing obesity. “When you look at healthcare costs today, multiple chronic diseases take a significant proportion of our national spending: diabetes, cancer, osteoarthritis, Parkinson’s, etc. Thanks to recent research, cancer mortality is now dropping– but cancer incidence is actually rising, particularly among younger people: half of all men and one-third of all women will experience it in their lives. Meanwhile the biggest cost in our system has become mental health, especially dementias like Alzheimer’s disease. One out of every 2-3 people over the age of 85 will develop dementia. By 2050 they will consume over $1 trillion of our national healthcare budget of $3.6. That’s just not sustainable.”
2. Dealing with the tsunami critically depends on basic research. The lay public—and many policy makers—often lack the scientific background to understand why basic research is needed to revolutionize the treatment of diseases, and also “bend the curve of costs” that are undermining our healthcare’s financial sustainability. As Glimcher commented, “If we don’t figure out, for example, how to cure Alzheimer’s or at least delay its onset—it will break our system. We have to analyze why some people’s neurons get destroyed while other people stay mentally sharp into their nineties. It’s basic research that will allow us to understand why this happens, and the causes and mechanisms in the brain.”
“For cancer, more basic research is needed about why the incidence of that disease is increasing. How is the epidemic of obesity adding to that? Why are some cancers, (e.g., breast and prostate) now highly treatable, while others, like pancreatic, still not? In the last fifteen years, research has delivered two major revolutions for many cancer patients’ survivability and quality of life—the development of precision medicine, i.e., highly-targeted, personalized therapies, and immunotherapy, using the body’s own defenses to battle the disease. But these are only the tip of the iceberg, and we’re still a long way from understanding the mechanisms of many cancers.”
3. Transforming the structure of the overall healthcare system will enhance allocation of skills and resources for research while also improving primary care. Glimcher highlighted how today’s patchwork of different providers sub-optimizes both front-line care and higher-skilledtertiary treatment and research: “Family doctors and internists are experiencing ‘burnout’ because of the complexity of paperwork, defensive practice against litigation, and pay scales. Meanwhile, though people come from all over the world for specialized treatment in our academic medical centers, these centers—the crown jewels of American medicine– are too often used for more routine problems, at higher cost. This hinders strategic focus on state-of-the-art research whose excellence we need to expand. A vision for a future approach might be a ‘hybrid system’ that distributes everyday medical care of different kinds more widely and fairly in communities while also enabling specialized academic medicine to deploy more talent and funding for best-in-class therapy and research. A future system should also benefit from the increasing use of ‘big data’ and the emerging application of machine learning and AI.”
4. Research capability system-wide can be boosted by strengthening the culture of collaboration and learning. Throughout our interview, Dr. Glimcher alluded to several principles and practices she’s seen accelerate development of innovative medical knowledge. Some of these were pioneered at Dana-Farber, others have been “best practice” for some time—but are unevenly applied throughout today’s medical ecosystem.
- A patient-centric mindset: “Research has to stay focused on always improving the patient’s health, and understanding the full journey of every patient’s disease, including across family generations.”
- Strive for big breakthroughs: “Though research always builds on what’s come before, we mustn’t over-invest in ‘me-too’ drugs or simply incremental solutions. We need to keep reaching for large leaps.”
- From bed to bench and bench to bed: “We make faster progress when researchers and clinicians work closely together, and when researchers stay close to actual patient cases. Treatment of disease is increasingly about bringing all the different dimensions of research, data, and practice together for every individual patient.”
- The power of cross-functional teams: “Problem-solving and discovery today cannot be siloed. At Dana-Farber, for example, we’ve seen huge progress with special teams combining the knowledge of oncologists, biologists, chemists, statisticians, immunologists and other professionals collaborating. Researchers have to embrace industry knowledge too. If a pharma company knows something we don’t, we have to take advantage of that.”
- Share knowledge for the greater good. “We all need to be open about what we’re learning, and share both data and insights as widely as we can—to help everyone else make progress faster. We have to worry less about personal glory and authored publications, and more about putting patients first.”
5. Now, more than ever, U.S. leadership in medical innovation must be strengthened. Glimcher finished with a blend of optimism and concern. “When I look at all the revolutions in cancer treatment, and the promise of big data and AI, it’s a tremendously exciting time. American medical research more broadly is pushing lots of new horizons. But funding for the sector is shrinking in real terms, even as research costs, with all the new technology, are rising. The NIH (National Institute of Health) budget is now $39 billion. China, in contrast, has committed spending $60 billion a year, for the next five years. Medical research here is becoming an ever-thinner sliver of the overall Federal pie. Now is not the time to give up the leadership we’ve built over so many years in our history.”