Healthcare innovation requires reconciliation of 'competing visions'

Powerful social forces will drive the healthcare industry to innovate, overcoming institutional and political inertia, says healthcare consultant and futurist Ian Morrison. But things may not get 'serious' until 2018.

Morrison served up the opening keynote at the National Healthcare Innovation Summit on May 14 in Boston, delivering a somber message concerning the urgent need for innovation in healthcare. The two-day summit, organized by the Healthcare Information and Management Systems Society, is focused on how to spur and sustain innovation.

Morrison told the innovation summit audience that in the short term, there would be lots of agitation and planning. There are two competing visions for the U.S. healthcare system, he said: The Berwickinian Nirvana (named for Donald Berwick, former CMS Administrator) of the large ACOs that encourage rationalization of the delivery system and the atomistic view of a consumer armed only with high deductible health plans that will impose market discipline on providers."

"Those two visions need to be reconciled," he said.

There is so much work left to do that requires innovation. Morrison rattled off a few: clinical integration, health IT as platform, learning to live on Medicare, managing business model migration, building a culture of quality and accountability.

"We have the anatomy of an accountable care organization but none of the physiology," he commented.

"When you get in the Triple Aim work, you have to think in different kinds of innovations," Morrison said. "You have to open your mind. You've got to get serious. I don't think we're going back to the 1970s. The purchasers have had it; they’re not going to take it anymore."

Some of what he's observed about the U.S. healthcare system as he's traveled around the country include:

• A move toward both public and private health exchanges for the purchase of health insurance.
• The country is learning to live on Medicare, which means reducing costs by 10 to 20 percent. "All the assets in the old model become liabilities in the new model," he said.
• Massive consolidation of hospitals continues with the expectation that there will be 100 to 200 large regional systems around the country. The accepted view is "you have to be big, and you have to be integrated," Morrison said, adding the question: "How do you get these behemoths to really innovate?" He later noted, "More of these large behemoth businesses are willing to take the risks. They are getting into the health plans."
• Employers, who have been purchasers of health insurance for their employees, are showing signs of an exit. "Every purchaser has become an activist about wellness – some would say 'Stalinist,'" Morrison said.