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Can Health Care Innovation Get Past the Big Players?

Posted Jan 20 2012 12:00am

The difficulties that innovators will have breaking into the were no more clearly illustrated than by the talk given by Dr. Sam Ho, of United Health Benefits Group, on the third day of -based health incubator Rock Health’s  Health Innovation Summit. After two days of exciting stuff about design and development, CEO day presented the cruel reality of the market .

Dr. Ho began by admitting the system was broken. Payments, he admitted,  didn’t align with objectives, and outcomes were an afterthought.  But now things are in the process of change, partly because of the passage of (although he didn’t mention it by name), partly because of the too-temporary tenure of   at , and partly because in a worldwide recession, we can’t afford our costs any longer.

So the big players, fearing innovation from without, have decided to try to innovate from within, and came up with a slogan called “The “Triple Aim:”  a slogan that embraces how to improve the individual experience, improve , and control inflation of per capita costs. Dr. Ho believes these three aims are separate now, but they must be aligned  to succeed.

For United Health, this means Care Management Programs, Transparency and Premium Designation Programs, Hi Performing Preferred Networks, Benefits, and Value-Based Contracting. These can be read as forms of rationing and cost shifting by the more cynical among us. However, for him,  it mans developing more and more incentives for changing consumer behavior. For example, patent premiums will get lower and benefits richer if consumers enroll in a diabetes plan and stick to it. If they manage their blood pressure or lipid levels, they will also have richer benefits. But what if they try and fail? I’m all for outcomes-based medicine, but we have to be careful we are measuring things that are within the control of either patient or provider. And how do we judge?

United Health is moving from a volume-based payment system to providers to an outcomes-based system. Providers have historically been paid on how much they do, but now the better they do, the more they will get paid. What will this mean for really sick patients? Will doctors be less anxious to treat them, for fear it will impact their outcome-based compensation?
This is all the more frightening when I hear that Dr. Ho is not a true believer in technology as a way of helping solve health care’s problems. Ho cautions us that  any type of innovation has to fit these already-moving shifts, which can be translated as “don’t try to innovate, just try to fit into what we are already calling innovation.”
Thus, he tried to warn his audience of (mostly) Millennials: if your innovation doesn’t fit into our box, we won’t let you in.
I hope the excited young entrepreneurs at Rock Health didn’t hear this talk the way I did.

 

 

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