Nearly every physician and anyone involved in the healthcare profession agree that the American healthcare system is ailing. It is expensive: according to CMS, the United States spends $4 trillion on healthcare annually, nearly 18% of the gross domestic product.(1)
We may have the most expensive healthcare system on the planet, but we don’t have the same outcomes and longevity as other Western countries. Our patient satisfaction scores are decreasing, with patients having difficulty accessing care. Unfortunately, we have paid more attention to and spent more money on the most complicated diseases while paying insufficient attention to the needs of the patients with more common ailments such as diabetes, cardiovascular disease, cancer, and neurodegenerative disorders.
Disruptive innovations are radical changes that often overturn the usual way of doing things to such an extent that they have a positive ripple effect throughout the industry. One potential solution to the sickness of American healthcare is for all the players to embrace disruptive innovation. This may make healthcare less expensive and more convenient, with better outcomes and better patient satisfaction scores. Healthcare systems that embrace these disruptive innovations will be profitable, stemming the financial hemorrhaging that is draining the current healthcare system and making it unsustainable.
The healthcare industry in the United States could resolve the crisis by lowering the cost of care, providing higher quality care, and providing greater convenience than is currently available.
How will disruptive innovation solve the healthcare crisis? Disruptive innovation will create a system that matches clinicians’ skill levels to the level of medical difficulty being encountered. Disruptive innovation can manage simple problems, such as strep throat, flu, uncomplicated urinary tract infections, and mild hypertension, and encourage clinicians such as primary care doctors, and allied health providers such as nurse practitioners, physician assistants, and medical assistants, who can follow predictable algorithms for diagnosis and treatment.
Many uncomplicated infectious diseases fall into this category. Another example is type I diabetes, where symptoms of blurred vision, increased thirst, weight gain, and frequency of urination lead a clinician to the appropriate diagnosis. Standardized treatment protocols are instituted once a diagnosis is confirmed with fasting glucose and hemoglobin A1C levels.
Through evidence-based investigation, we have learned that easily recognized conditions can be reliably diagnosed and treated by less highly skilled professionals. Disruptive innovation will create processes that funnel complex problems to physicians with skills appropriate for these second-tier conditions. However, various practitioners will argue against this approach to common conditions.
According to Dr. Clay Christensen, Professor of Business Administration at Harvard Business School, disorders that previously were managed in a problem-solving mode will be managed, instead, in a pattern-recognition mode, and those that must be addressed through pattern recognition, the rule-based approach will be sent to the appropriate clinician with the skill level that is matched to the difficulty of the medical problem.(2)
Another example is precision medicine, which has become possible with human genome mapping. Just a few decades ago, leukemia was considered a single disease, and its diagnosis and treatment were considered a complex problem. However, we have discovered that no two patients responded identically to the same treatment. This required the problem-solving skills of a highly trained oncologist, with a greater understanding that leukemia is at least six different diseases. Each of these different leukemias is characterized by a specific genetic pattern, and patients can be diagnosed precisely by matching their patterns to a template. Now the treatment is customized for each patient, which results in better outcomes.
It is possible to expand the roles of nurse practitioners, physician assistants, and medical assistants as primary care providers and give them tools to accurately refer more complicated conditions to physicians with more sophisticated diagnostic abilities. Physicians should embrace this disruptive innovation. Rather than objecting to having nurse practitioners (NPs) step on their turf, doctors should accept that NPs should use advances in diagnostic and therapeutic technologies to perform services previously done in hospitals and with the oversight of specialists. Enlightened physicians accept this disruptive innovation and do not fight with primary care doctors and allied health professionals. Ultimately, this is how technological progress and patient needs will be met, improving outcomes and lowering the cost of care.
Some managed care organizations offer primary care doctors a financial incentive not to refer patients to specialists. This encourages primary care doctors to try to provide care for conditions they are not equipped to treat.(3)
Second, disruptive innovation would invest more money in technologies that simplify complex problems and less in high-end, costly technologies. Most research and development funding goes toward complex solutions for complex problems that require the most skilled physicians and that could not be managed by primary care doctors and AHPs. It would be better to funnel money to projects focused on technologies that simplify diagnosis and treatment for the more common, less complicated diseases. We should encourage major healthcare companies, perhaps with tax incentives, to invest in disruptive innovation that could generate significant growth and profit with less financial investment.
Finally, it is necessary to overcome the inertia of cumbersome regulation. Instead of preserving the status quo, regulators should create pathways to enable disruptive innovation to emerge. For example, U.S. automakers depended on import quotas to keep disruptive Toyota and Honda from competing in the U.S. markets. Regulators are inclined to be even more protective of stodgy, antiquated professions and institutions in healthcare than they were of U.S. automakers. The connections among healthcare institutions, insurance companies, and federal and state regulators are strong and are focused on preserving the status quo. That is why, for example, ophthalmologists and their national organizations prevented optometrists from instilling eye drops until just a few years ago, and why NPs were forbidden in many states from diagnosing and treating simple, non-complex illnesses.
For example, if a new portable x-ray machine could be used in the office setting rather than sending patients who required x-rays to the hospital or expensive imaging centers, this would reduce costs for patients and insurance companies. Regulators could support the new technology and address any concerns regarding risks. This would include a requirement that all images interpreted by non-radiologists be transmitted electronically to a second-opinion center. There, skilled radiologists could provide oversight and confirm or reject the initial diagnosis. This benefits the patient, and also the primary care doctors, who will experience enhanced efficiency and reduced costs.
My take-home message is that by using disruptive innovation to change the existing system, regulators need to accept changes in the job descriptions of the disruptors. There is a need to enable disruptive innovation to emerge and not resist it so vehemently.
Bottom Line: Disruptive innovation will emerge when stakeholders work together rather than regulating the existing system and standing in the way of disruption. The stakeholder needs to remove the barriers that have prevented disruptions. The current system cannot sustain itself. Essentially, there are three approaches to consider:
Control costs by consuming less healthcare. This appears as rationing of healthcare, and that will not work.
Impose reimbursement controls that force providers to become more efficient.
Consider having the government subsidize the high cost of healthcare for segments of the population that doesn’t have access or can’t afford healthcare.
Let’s go forward with disruptive innovation, which will create higher-quality and more convenient care at a lower cost.
References
National Health Expenditure Data. Centers for Medicare and Medicaid Services. www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical .
Christensen CM. The Innovator’s Dilemma. Harvard Business School Press; 1997.
Shortell SM, Gillies RR, Anderson DA, Erickson KM, Mitchell JB. Remaking health care in America. Hosp Health Netw. 1996;70(6):43-44.