The Innovator's Prescription: A Disruptive Solution for Health Care [ハードカバー]

It is a commonplace that the U.S. healthcare system is broken, but the discussion often degenerates into a debate about who is responsible. This book takes a different approach, focusing on what is wrong with the healthcare system and needs to change so it can work better.

The proposed solution is to discard the current fee for healthcare service model, in which healthcare providers are systematically paid to treat illness without recompense for fostering welfare, and create a three-track system:

(1) Fee for service would continue to apply to diagnostic services, where - due to the nature of the patient's condition and the state of medical knowledge - there is a high need for intuitive investigation versus results-based treatment for conditions that are well understood. (The process described brings to mind episodes of House, a TV show in which a brilliant but irascible doctor challenges a team of colleagues to find the problem before the patient dies.)

(2) Fee for result would apply for treating conditions that are well understood and have a clearly defined solution -- colonoscopies, laser eye surgery, implantation of stents, etc.

(3) User networks for patients with chronic conditions/ unhealthy practices to learn how they can help themselves and be motivated to do so.

As is pointed out again and again, disruptive changes will be needed to get from A to B. Thus, hospitals must be redirected to focus on diagnostic services and cede provision of standardized care and wellness coordination to specialized clinics and other agencies. Primary care physicians (the traditional "family doctor") should concentrate on diagnostic services at a lower level rather than acting as "gatekeepers" for referrals to specialists. Enabling changes in reimbursement rules, health insurance arrangements, and medical record keeping are spelled out in detail.

When the dust settles, there will be fewer hospitals (with the survivors focused on enhanced diagnosis, like the Mayo Clinic), fewer medical specialists (who currently operate in narrow niches, often without a full grasp of a patient's situation), more primary care physicians and nurses with augmented responsibilities, a new model for pharmaceutical companies that focuses on targeted medications for precisely defined conditions versus the development and marketing of "blockbuster" drugs that only help a fraction of the users and require enormously expensive mass clinical trials, and a lot of medical work performed by less highly trained personnel with better diagnostic tools.

Andy Kessler presented an analogous vision in "The End of Medicine: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor," Harper Collins (2006). His book is very entertaining, but this one covers the ground in a more disciplined and comprehensive manner. I would recommend "The Innovator's Prescription" for anyone who is seriously concerned about the current healthcare system.

Doctors, hospitals, and other healthcare providers cannot make the needed changes on their own, because they do not control all the levers. Having the government take the lead is said to be problematic, for reasons that are dispassionately stated and I happen to agree with. The authors suggest that the best candidate entities for leading the transition to healthcare in the new mode might be employers that profit from the good health of their employees. Then there is the intriguing possibility of expanding the role of integrated healthcare providers,e.g., Kaiser Permanente.

Let's hope our country chooses the right path.

I have been an active participant in healthcare developing and commercializing over twenty medical technologies across nine medical specialties since the 1970's. I have also lectured on the medical industry as an Assistant Professor of Surgery at Creighton University Medical Center and as a guest lecturer at Anderson School of Management (UCLA), Haas School of Business (University of California), and Graziadio Business School (Pepperdine University), and spent significant time in the 1990's on FDA reform.

I have been privileged to have had a front-row seat observing the major changes that have shaped today's healthcare system - industry consolidation for both the supplier (pharma, med-tech, and diagnostic) and delivery (hospital, clinics, physician practice) segments; the move from unregulated fee-for-service to regulated fee-for-service; the growth of medical malpractice and its impact on the cost of healthcare; the use and misuse of technology; the draconian regulatory burden (FDA and CMS) associated with developing new life-improving or life-saving technologies; and, as a result, the growth of healthcare as a share of GDP from 6% to 16%. To this industry insider, healthcare is a system in critical condition and needs radical surgery.

Clayton Christensen who authored one of the best books on innovation ("The Innovator's Dilemma") has now teamed up with Jerome Grossman, M.D. and Jason Hwang, M.D. to bring well-researched insights into a disruptive solution for effective value-added health care in "The Innovator's Prescription." Christensen and company outline the technological enablers of disruption then show us how various aspects of the healthcare system can be effectively disrupted to produce better, more cost-effective healthcare for all Americans. These include the hospital business model, the physician practice business model, the care of chronic disease, the reimbursement system, medical education, the development of pharmaceuticals, medical devices, and diagnostics and regulatory reform. The authors leave no stone unturned and provide an integrated plan to make it happen.

"Innovator's Prescription" is a must read for all who participate directly in the funding and running of our healthcare system whether as members of the private sector or public sector, patients, or voters. Christensen and colleagues have done an extraordinary job in outlining the fundamental issues but more importantly, in providing a thoughtful way out of our current mess.

The decade worth of research spent understanding, studying, and ultimately offering solutions to make the health care system more accessible, higher quality, and affordable is clear. Unlike other books, the authors avoid the traps the plague most other solutions by taking a completely different perspective by looking at other industries where products and services offered were "so complicated and expensive that only people with a lot of money can afford them, and only people with a lot of expertise can provide or use them." Yet convincingly through plenty of examples, it shows how telephones, computers, and airline travel moved from only accessible to those with the resources to become available and affordable to all.

The book tackles every aspect of health care and asks how will those in health care be disrupted and subsequently surpassed by other providers which deliver care that is more convenient, higher quality, and lower cost.

What will hospitals need to do as increasingly more surgical procedures are performed in high volume specialty hospitals?

How will doctor practices sustain themselves as new diagnostic tools and research makes the identification and treatment of problems more precise that nurse practitioners with clear protocols can deliver care previously required by physicians?

What mechanisms exist to streamline and integrate the various players of health care (doctors, hospitals, purchasers, insurers) so that all are focused on the benefit of wellness and outcomes of patient care rather than maximizing each of their own financials? (Hint: large employers will integrate health care and others will only purchase care delivered by integrated healthcare delivery systems).

What should medical schools do to prepare the next generation of doctors as current training is steeped in tradition, relevant a century ago, but woefully inadequate for the future?

How should pharmaceutical, medical device manufacturers, and diagnostic equipment makers position themselves for the inevitable changes that will affect them the same way previous leaders in other industries were overtaken by competitors and disruption?

How must the reimbursement system and regulators adapt to foster the innovation to make these changes occur?

If there is anything close to a crystal ball on what health care delivery will look like in the United States that will be increasingly affordable, higher quality, and accessible to all, this is it. The authors, respected Harvard Business School (HBS) professor, a doctor who also was the Director of Health Care Delivery Policy Program at Harvard Kennedy School, and another doctor and graduate of the MBA program at HBS have convincingly demonstrated the likely path as well as indicated why a single payer nationalized system will stifle the innovation needed to improve our health care system. Those who wish to succeed in the new world of health care as predicted by this comprehensive and thoughtful analysis would be wise to consider this book.

For those trying to navigate the increasingly frustrating, confusing, and expensive health care system as it current exists, Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System would be the perfect guide book.