Connected Health: Reform offers great opportunity for innovation

BOSTON—The challenges of healthcare reform present enormous opportunity for innovation, said Gary L. Gottlieb, MD, MBA, president and CEO of Partners HealthCare System in Boston, speaking at the ninth annual Connected Health Symposium on Oct. 26.

Healthcare reform is “a major commitment to society we need to take on together,” Gottlieb told his audience. If the aging population, increase in those with chronic conditions and rising healthcare expenditures “goes unchecked, our accountability to society also goes unchecked.”

There is potential for tremendous effects, he said. However, “the opportunity to do greater good could be diminished if we focus on cost alone.”

With 20 percent of workers in Massachusetts employed in life sciences or healthcare, the state serves as a leader and could become a template for national healthcare reform, including coverage reform and overall payment reform. Massachusetts’ healthcare insurance reform law, also referred to as Chapter 58, has reduced the number of uninsured in the state from 7.4 percent to 1.9 percent—a “striking and remarkable” change, Gottlieb said.

The conversation about healthcare cost focuses on less reliance on fee-for-service care and a greater emphasis on utilization, population health and value, he said. “Reducing the total medical expense creates a different set of incentives.” There are numerous issues to work out, however, as Gottlieb said that among the 1,200 attendees, there were probably 785 definitions of accountable care.

Greater coordination will lead to more effective and more efficient care, Gottlieb said, citing the statistic that 30 percent of what we spend on healthcare is wasted. “We know that transactional fee-for-service medicine creates fragmentation. No coordination with other components will only use resources that appear to be near to home. Even with the most sophisticated EHRs, without connectedness between patients and families and providers and a series of other providers, we will fail.”

Measurement of quality metrics “has been embarrassing,” Gottlieb said. Citing the Institute of Medicine’s 1999 report of medical errors, he said that something similar “needs to be at the heart of this discussion. First and foremost, we must focus on the quality, safety and improvement of the human condition. Then we can focus on cost.”

Partners is using science to “inform our care and train our future.” The organization is trying to be leading providers of population-based care. Partners has chosen to focus on high-risk patients because “if we can deal with that high-risk population and do that more efficiently and create savings there, that takes the pressure off elsewhere.” That population is where providers need data the most, as well as remote health and telehealth. It represents “the greatest opportunity to do the greatest good.”

Partners will continue to build upon its clinical strengths to make care more affordable and more coordinated, he said. “If we operate in silos we will continue to promote this inefficiency. Fragmentation reinforced by traditional fee-for-service is not part of the future.” In fact, Partners has reopened its contracts and entered into new contracts with risk for trends. “Ultimately, moving to take risk for 500,000 patients creates changes to the structure of the system.”

Gottlieb envisions the creation of precision medicine. IT will play a huge role as we deploy information-rich patient registries and develop tools identifying patients in need of follow-up care.

“The downward pressure on cost creates innovation and each step requires new information.”