The word innovation gets a lot of use in the offices of healthcare executives these days, most of the time in reference to some type of technology.
Technologies and new applications in health care are nice, but innovation is a lot more than technology. We should have a broader view of innovation than simply a high-cost new medical device or something we plug into a smartphone.
Don’t get me wrong—technology can enable some great innovation in all industries. As a pilot, I use technology to assist with flight planning and balancing the airplane to make flying safer. Having navigation in my iPad makes it easier to get where I need to go efficiently and safely. But that technology might never have come along unless someone asked the question, “How can I avoid looking between a chart and instruments while bouncing around in the clouds?”
Innovative thinking in health care has a long way go to make those same sorts of advancements. Certainly, we have to consider how to make healthcare delivery more efficient, how to make the financing of care sustainable while maintaining needed margins, and how to deliver better value to patients. Technology can be an enabler of those changes, but the change we need goes far beyond just technology. In the world of healthcare financial management, I suggest technology ought to come last. We have to adopt the mentality of asking, “What’s wrong with this picture?” Only then can innovation really happen.
There are countless opportunities for innovative thinking in health care. Readmissions and opioid addiction are just two examples.
Hospital readmissions are all too common, and they sometimes come in a chain of events that starts with a patient fall. If we could prevent that initial fall, perhaps we could prevent the subsequent complications that follow, along with a readmission penalty. There are smartphone apps for predicting fall risks that are being touted as a must-have for seniors, but it might be more effective to determine and address factors that put the patient at risk in the first place.
For example, many seniors could work on balance as part of a simple exercise routine and mitigate the fall risk through that one simple activity. In other words, let’s work to understand our patient population and triage care resources to address those simple but important needs. With such an approach, the innovation is not the treatment modality; it’s the application in the bigger picture of a patient’s care.
It also is worth noting that while we struggle with costs, paying for apps rarely gets us to that cost-reduction goal.
Another opportunity for innovation is in the vexing problem of opioid deaths. There’s no denying it calls for innovation—we must address the problem of patient pain somehow. But we all know the stories that describe a sequence of events from post-op pain to dependence to death. The industry needs to find ways to break that chain and strike the balance between analgesia and addiction; doing so will save money and allow providers to focus on improving population health.
Some want to take a treatment approach—looking for ways to get naloxone in more places to treat overdoses, for instance. But that’s a bit like throwing a life jacket to someone who as fallen off of a ferry and then turning the ferry around to retrieve the person. What we need is a way to keep the person on the ferry and the ferry steaming toward its destination. Innovation in health care can help identify a systematic approach to addressing the opioid challenge. Are there options that involve more face-to-face care to a patient? Changing post-op activity? Other secondary analgesics five days post-op? (Some here in Colorado say that marijuana or related variants could reduce risks and increase comfort.) No app is necessary to keep patients comfortable while lowering addiction risk.
Innovation with a Value Focus
What about value-based financing of health care? That seems to be a good example of innovation —or at least an attempt at it. The industry has tried bonuses, risk pools, process goals, and delivery system changes, such as accountable care organizations. Most of us would agree these are imperfect incremental steps—well intended, but not true solutions.
This area of health care probably best represents our “holy grail” and calls for our best efforts at innovation. Some argue a global budget is the way to get there, but beware the Canadian experience on that idea. Remember, the biggest incentive with global budgeting is to limit access to stay within that budget target—something that runs against the expectations of our patients. Perhaps there are ways to tweak that approach to achieve fair payment while creating sound economic incentives to provide access and high-quality care. Are there fixed elements in a global budget to cover access that could combine with incentive elements to promote quality? Although there are valid reasons to object to such an approach, an innovative mindset should be open to considering options that might at first seem untenable.
Value-based payment is just that sort of challenge needing more analysis focused on identifying opportunities to strike a difficult balance. Again, it’s not a problem that calls for technology. It calls for big-picture thinking. That’s the innovation we need.
The Call for Innovative Thinking
Health care presents profound challenges that can be exhilarating to tackle and solve. But a new app is not the answer. We need to think about incentives, downstream effects, sustainability, efficiency, and margins—the same things we wrestle with every day. As we look at the picture of our industry that includes those elements, let’s step back and say, “What’s wrong with this picture?” Let’s keep asking how we can improve our processes. Maybe an app or a new technology could help. But in most cases, I bet it’s not the solution. Let’s put on our thinking caps. Rearranging the pieces of a process or a system is the root of true innovation.