Managed Care - January 2009 - (Page 13)

The innovations that we list here are not unfamiliar, but don’t underestimate them. As they mature, they will have strong effects. required you to go to a hospital in the past,” Hwang says. “More of this would happen, but the reimbursement system and the political clout of existing players in the system block innovation.” In all, the authors believe a host of disruptive innovations could end the health care crisis if entrenched providers allow disruptive businesses to compete and take a share of the health care load. The argument has wide implications for payers. “Payers must shift payment models to begin rewarding precision diagnostic tests and precision diagnostic abilities of providers to begin to create a more rational system,” Hwang adds. Support for this view comes from a variety of influential sources, among them, Andrew Grove, PhD, co-founder and former chairman of Intel, who said in 2006 at City College of New York that the country could meet health care costs by encouraging development of disruptive technologies. “Any transformative solution requires the inclusion of disruptive innovations that leverage technology,” says a 2008 Deloitte Center for Health Solutions report, “Connected Care.” George C. Halvorson, chairman and chief executive officer of Kaiser Permanente, and Health and Human Services Secretary Michael Leavitt and Secretary-designate Tom Daschle, also support disruptive innovation. Retail clinics, telemedicine, medical tourism, and personalized medicine are among innovations likely to grow and be assimilated by the system, if the establishment permits. ing. Consumers embrace innovations because they represent value — savings, convenience, access, quality, or a combination of these. Health plans help determine acceptance. If plans pay for new technologies, they are more likely to be accepted; if they do not, as with routine full body scans, the technology along with its business model, can fold up its tent and slide into obscurity. In all industries, when an upstart company using a new technology challenges the status quo, it undercuts a market leader and itself becomes a leader. The new guy eventually takes over all or most of a market as quality improves and capabilities expand. Sony’s ascent and dominance in television receivers is legendary. Here, then, are five disruptive innovations that could make a big difference in how health care is reshaped in the coming decade. We’re not saying they are the only five, or even the five biggest (who can know at this point?), but they have the earmarks that disruptive innovations have shown in the past. RETAIL CLINICS Retail clinics are a disruptive innovation because they operate outside conventional physician offices, disrupting existing business models of primary care. The technology driving their acceptance is the electronic medical record (EMR) with computerized physician order entry and sometimes e-prescribing applications embedded in the EMR. Prompts, alerts, and reminders using evidencebased decision support allow nurse practitioners, who staff 80 percent of the clinics, to make sound medical decisions and to extend their scope of practice. At least 96 percent of clinics use EMRs with varying levels of capabilities, according to the Convenient Care Association, the clinic trade group. The clinics fit with the quest by Christensen et al for expanded health care and for increased precision. “A lot of what happens in medicine is guess- Promise and threat All innovations threaten livelihoods. However, as price sensitivity soars, the barriers to acceptance fall, especially for those with no insurance, those with only catastrophic coverage, those in high deductible health plans, and others whose copayments are ris- JANUARY 2009 / MANAGED CARE 13

Table of Contents Feed for the Digital Edition of Managed Care - January 2009

Managed Care - January 2009 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Health Care's Disruptive Innovations Q&A With Clayton Christensen 'Disruption' May Be Plans' Best Bet Avoid the PBM Rebate Trap HealthPartners Puts Diabetes on Notice Formulary Files Plan Watch Tomorrow's Medicine Ad Index Outlook Unmet Needs in the Management of Plaque Psoriasis Impact of RSV: Implications for Managed Care

Managed Care - January 2009

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