EXECUTIVE Q&A
Enabling Patient-Focused Care: A Conversation with Dr. Joseph Smith
Joseph M. Smith, MD, PhD, FACC
Chief Medical and Science Officer
West Health
Interviewed by Sam Narisi
It doesn’t take an industry expert to know that the cost of health care is rising and difficult to control. But that’s an incredibly complex challenge for all parties involved, including patients, providers, government agencies, etc.
One of the key difficulties is figuring out how to lower costs without sacrificing the quality of care. The goal of
West Health,an independent organization founded by philanthropists Gary and Mary West, is to overcome that challenge through collaboration among providers, regulators, investors, and technology firms.
Frost & Sullivan recently spoke with Dr. Joseph Smith, West Health’s Chief Medical and Science Officer, about this challenging health care environment, as well as the new opportunities technology companies have to find innovative ways to overcome those obstacles. Dr. Smith will also be speaking about the new health care climate at our event, the
19th Annual Medical Devices 2014: A Frost & Sullivan Executive MindXchange, March 9-11, 2014, at the Loews Coronado Bay Resort and Spa in San Diego, CA.
Frost & Sullivan: What are some of the biggest obstacles in the way of a successful reduction in health care costs?
Dr. Smith:
There’s a lot of vested interest in the status quo, and it’s no big surprise that people are not working to drive themselves into extinction. When the Institute of Medicine issues a report where it says a third of health care spending is fraud, waste, or abuse, I think we also have to recognize that in almost every case, those dollars represent someone’s paycheck. The system, as large and complex as it is, has a tremendous amount of inertia.
It’s challenging for any one participant to innovate themselves out of existence. No one would choose to do that. At the same time, no one stands over it to direct it. It would be ill-considered hope to imagine that the system will self-evolve into a lower-cost, more efficient system.
That’s really the impetus behind what West Health has done. We’ve got a number of people who have experience in the provider community and the vendor community figuring out what parts of the system are amenable to innovative disruption that could unleash some of the dollars being spent. We have the opportunity to look broadly and pioneer new and smarter technologies, policies, and practices to create high quality, more accessible healthcare delivery at a lower cost.
Frost & Sullivan: How can technology vendors help providers lower the cost of care?
Dr. Smith:
One thing we’ve worked on that cuts across providers and vendors is the notion of medical device interoperability. Each manufacturer of medical technology now has to imagine not just what the device does, but also how it communicates what it does with, at a minimum, some baseline enterprise EMR system.
It’s no big surprise if you go to an intensive care unit right now and look at eight or ten devices surrounding the patient, the information captured only resides in each particular device. The patient would be better served if all of those devices seamlessly shared their information. It’s kind of lunacy at the moment that if you’re getting an IV infusion of a drug that controls your blood pressure, and you have a separate device that measures your blood pressure, those two devices are blissfully unaware of each other.
We took a look at that kind of complex amalgam of communication schemes and found that somewhere between $35 and $40 billion of savings could exist, largely to hospitals, if those systems were made seamlessly interoperable. And the standards for such already exist.
Frost & Sullivan: What are some of the other opportunities for providers and vendors to work together to cut costs?
Dr. Smith:
I think there are many. One rubric I like is that we ought to learn to move data instead of people. One thing we look at is people who are recovering from injuries or joint surgeries. At the moment, after they get home from the hospital, they go back to see a physical therapist or a rehab specialist. But with some of the advances we’ve seen in technology, couldn’t you do that rehab, teaching, and measurement in patients’ homes? If we’re serious about a patient-centered health care environment then why don’t we put technology where the patient is, rather than move the patient to where the technology is?
We are also watching the reimbursement models change. It used to be that every face-to-face encounter was a revenue generating opportunity for a provider or care delivery network. However, as we move to bundled payments, patient-centered medical homes, and accountable care organizations, those encounters, while always placing the burden of travel on the patient, are now going to be an economic expenditure for the provider organization.
This will dramatically drive the pace of progress in this connected health technology space. We’re going to be looking at novel approaches to remote monitoring, predictive analytics, as well as smart and learning systems to give small titrations of therapy at a distance. I’m very encouraged by what I see as the future of health care, where doctors and hospitals are no longer in the center, and health care becomes more ambient.
Frost & Sullivan: What are some ways technology vendors could be better meeting the needs of providers?
Dr. Smith:
I think as soon as we realize that providers are going to be interested in and responsible for the care of patients that are not in front of them, that opens a whole avenue of technology development. That might be new ways of doing remote, biometric scanning, taking advantage of online symptom logs, or tapping into social media as a way of understanding how people are managing their diseases.
With those new tools, we can have a much broader and much more dynamic form of engagement with patients which is must less constrained in terms of the geographic co-location of a doctor and a patient.
Once we think about having windows into how all the patients are doing when they’re far away from us, I think that’s the real opportunity. But we do need technology pieces to do that. We need careful predictive analytics, we need to reliably measure patients’ trajectories in their chronic diseases, and we need ways of ensuring compliance with therapeutic recommendations. All of that looks like an open space for meaningful technology development.
Frost & Sullivan: Where does mobile and wireless technology fit in to these new innovations?
Dr. Smith: If we’re going to give patients what they need when and where they need it and untether healthcare from hospitals and doctors’ offices, we’re going to be using wireless technology. But it’s really just one axis. I think we’re going to see wireless technology so integrated into healthcare that we won’t talk about it anymore, just as we no longer talk about people getting electronic mail – it’s just become part of what we do.
But I do think we will enable a world where people no longer wonder whether they’re well – going forward, you’ll be able to know if you’re well because the devices in your home will be smart enough to help you with that.
We’re going to make health care something that is more ubiquitous than it has been. I’m in my bed for seven hours a day – it ought to be able to tell me my heart rate, my repertory rate, my weight – and in some cases they do. My alarm clock shouldn’t just wake me up, it should glow red or yellow or green depending on what it learned about me overnight.
Frost & Sullivan: One impact of that trend is that many of those new devices are being bought by consumers rather than health care institutions. How will that affect how technology vendors develop and sell their products? Dr. Smith:
I do think there’s a wave of that coming, and I think the proof points will be different. We used to live in a world where first you would get technology FDA-approved and then covered by CMS. But here, we’re going to be looking at technology that just makes life easier for the younger population which is not used to the same rigors of the CMS and FDA.
When you’re selling things to providers, it has to make financial sense to them. They say, “OK I might use your predictive analytics tool but only if it will really save me money. Can you prove that it will help me do a better job at a lower cost?” The proof points are changing. We’re not looking for incremental effectiveness as much as we’re looking either for ROI or convenience.
I think it’s been easy for folks to get a little depressed that there’s so much focus on the cost of health care and that the systems are changing. It would be sad if any of that cloak of depression fell on the medical device industry, because it has been a shining example of innovation that has created value and improved the lives of millions of patients. I think this is just another opportunity for the medical device industry to again innovate and lead the way into a more efficient, effective and smarter healthcare delivery system.
About the author:
In his role as chief medical and science officer of West Health, Dr. Joseph M. Smith brings strategic, engineering and clinical expertise to advance the unique, one-of-a-kind initiative’s mission to lower health care costs through the West Health Institute, West Health Policy Center, West Health Investment Fund and West Health Incubator. All of these entities focus on lowering costs by creating innovative, patient-centered solutions that deliver the right care at the right place at the right time. Dr. Smith’s role encompasses directing the West Health Institute’s medical and clinical research, managing the West Health Investment Fund and leading the policy efforts of the West Health Policy Center.
