Tuesday, February 6, 2007

health care future - 2020 Blog

The date is January 1, 2020.

The kinks have been worked out of the U.S. health system. We have a market-based, consumer-driven system with enlightened private-public partnerships. Doctors, hospitals, and other providers follow best practice, evidence-based protocols. They use electronic systems to communicate with informed consumers. Consumers know what they want, what to expect, what to demand, and how to control completely access to their sensitive personal health data.

The Commitment

The U.S. has committed to a health system promising greater wellness, longer lives, affordable prices, quick access, universal coverage, and uniform conformity.

Bipartisan politicians and neutral business coalitions now reign over a good society. They have reined in health spending and capped costs at 20 percent of Gross National Product , more than 16 percent in 2006, but less than 25 percent projected for 2030.1 In 2006 Cutler, a Harvard economist, released a study showing health gains from 1960 to 2000 had been worth the spending.2 Still, in 2006, waste was rampant, duplication was constant, fraud was blatant.

Good Health For All

In 2020, Americans brim with good health and delay disease until late in life. For good reasons.

• All U.S. citizens have free genomic profiles at birth predicting future diseases and instructing how to prevent and circumvent these ailments.
• At age 35, every citizen is evaluated for heart and pulmonary fitness and function using a no-risk low-stress device. The device has embedded software containing a huge database of clinical records and outcomes of hundreds of thousands of patients. The software predicts levels of fitness, existence of heart and lung diseases, and risks of hospitalization and death.

Because of genomic profiles at birth, fitness and disease testing at 35, and precise knowledge of what it takes to maintain health, U.S. citizens live on average to 90 with sane minds in sound bodies. The disciplines of artificial intelligence and predictive computer modeling make this lively longevity possible.

Individualized Gene Targeting

Researchers have made gene treatment specific for each person. Gene targeting has converted cancer into a chronic disease. In 2006, the Wall Street Journal reported gene therapy shrank two melanoma tumors 3 That event signaled the beginning of the end for cancer as a universal killer.

In 2006, genes were said not to have much to do with when you died. 4 But in 2020 we create and prolong life by deleting, inserting, or manipulating genes, thanks to techniques and links learned back in 2006.5

Indeed, David Moskowitz, a nephrologist and researcher, showed an overactive gene, angiotensin I-converting enzyme, D-D genotype, or ACE, contributed to the progressive severity of type 2 diabetes, hypertensive nephropathy, chronic renal disease, peripheral vascular disease, emphysema, and even viral disorders such as avian flu, SARS, and West Nile Virus. These diseases are now detected and treated early with existing ACE-inhibitors and angiotensin-blockers, with slowing of disease progression. These drugs also stall the advance of a many lung ailments--viral pneumonia, bronchiolitis obliterans, pulmonary fibrosis, lung cancer, and chronic obstructive pulmonary disease.6 Applying genomic research findings stops the advance of many previously irreversible fatal diseases.

Worker Health and Productivity Programs

Worker productivity and health at work rests in P’s--preventive, proactive, preemptive, prospective, personalized, and presenteeism programs. These programs prevent and control diseases through worker education, life style changes, and interactive technologies; and, as a bonus, bolster corporate bottom-lines.

The End of Cardiovascular Deaths

The U.S. has virtually ended deaths from heart disease and strokes with a daily poly-pill for everyone over 55. British researchers first described the poly-pill, made up of six medications: a statin, three anti-hypertensive drugs, folic acid, and aspirin.6 This multi-purpose pill reduces cardiovascular disease by controlling LDL cholesterol, blood pressure, homocysteine levels, and platelet function.

Life Extension

The poly-pill has extended U.S. life spans by 12 years. Alarmists in 2006 warned poly-pills would harm patients and increase Alzheimer’s cases. Not to worry. The malpractice lawyers have been neutralized, and we now have pills for every side effect, including dementia.

Didn’t critics know in 2006 combination cocktails had saved millions of AIDS victims? Speaking of AIDS, sex is now safe for everyone for all occasions, the day and night before and the morning after.

Mandating and Enforcing Health

The U.S. has outlawed junk foods, banned smoking, prohibited drinking, enforced healthy eating, mandated pedometers, restored school recesses, required suburban sidewalks, rationed driving mileage, and even policed children’s hours before TV and computer screens. Civil libertarians are exercised, but most of us are thin, sober, and exercising, though many of us are unhappy with restrictions imposed upon us. The price of loss of freedom and individualism is good health.

Controlling and Standardizing Universality

The U.S. has universalized, standardized, and controlled healthcare coverage and access, fee schedules, price transparency, pay-for-performance, diagnostic support measures, episodes of care costs, interoperable computer systems, quality indicator compliance, consumer health information, evidence-based medicine, practice variations, best practice protocols, personal health records, doctors’ charts, and medical histories. The U.S. now has universality, totality, and commonality.

Organized Systems of Care

We have regional organized systems of care. Harvard Business School Professor Michael Porter’s 2005 book, Redefining Health Care: Creating Positive-Sum Competition to Deliver Value is the breakthrough bible and framework for the present health system.

Hospitals and doctors now function in integrated systems with aligned economic interests. There are no longer any hospital systems, only large multispecialty clinics with joint physician-administrator leaders and hospital subdivisions. These clinics cover and dominate geographic swathes of territory.

In megaclinics, subspecialists and specialists use the same joint prostheses, coronary stents, and cardiac, neurologic, pain implant devices and share the resulting savings. This “gain-sharing” is widely regarded as an economic coup for reducing health costs.

Primary care doctors are an integral part of clinic systems. Primary care, on the verge of collapse in 2006, has been saved through a combination of prompt payment at the point of care by consumers bearing smart cards containing their personal health records, incentives to install electronic and personal health records, efficiencies in capturing and applying diagnostic support information at the point of care, and accelerated e-mail-based “partnerships” with consumers, who now enter their complaints and histories before being seen.

Control and Feedback at The Point of Care

The U.S. has management systems and protocols overseeing vendors, doctors, corporations, health plans, and even consumers, assuring everyone gets the right care at the right time for the right reasons. One of the principle benefits of these management systems is control of costs of supply chain companies, which in 2006, were the fastest growing component of hospital cost inflation.

The U.S. has instantaneous feedback systems, like those used by E-Bay in 2006. On the spot of care, sellers and buyers can right wrongs of care and can rate on everyone within the system, guaranteeing no one cheats, strays, or profits unduly.

By contemporaneously monitoring healthcare events, we as a country have ended misinformation, maltreatment, and malpractice. The U.S. health system has achieved precisely the right balances between legality and rationality, regulation and innovation, instantaneity and spontaneity, collectivism and individualism. All is well. All is swell.

The Kings and Queens of Healthcare

Healthcare consumers are Healthcare Kings and Queens. They control their health destinies, choose and afford the best, and rely on themselves, rather than payors and providers. They completely control their sensitive personal health information. Control of that information dictates with whom consumers do business and determines whether electronic and personal health record systems succeed or fail.8 Health consumers are true gatekeepers of their personal and private information. Only two things have been overlooked--the imponderable immeasurable personal patient-physician relationship and freedom and decision-making latitude of doctors.
And that’s the way the health system looks as of this date: January 1, 2020. You will have to admit. 2020 foresight beats 2006 hindsight every time.

Reprinted by permission from Healthleadersmedia.com, October 3, 2006

1. Kolata, Gina, Making Health Costs the Engine that Drives the Economy, New York Times. August 22, 2006
2. Cutler. D.M, Rosen, A.B., and Vijan, S. The Value of Medical Spending in the U.S, New Engl J Med, 2006: 355: 920-912, August 31, 2006.
3. Schoofs, Mark, New Gene Therapy Appears to Shrink Tumors in Two Cases, Wall Street Journal, September 1, 2006.
4. Kolata, Gina, Live Long? Die Young? Answer Isn’t Just the Genes, New York Times, August, 31.2006.
5. Wald, Nicholas, Gene Called Link Between Life Span and Cancers, New York Times, September 7, 2006.
6. Wald, N.J, and Law, M.R., A strategy to reduce cardiovascular disease by 80 percent, BMJ, 2003:3261, 1419-1426, April 1, 2003.
7. Moskowitz, David, Acute Oxygen-Sensing Mechanism, New Engl J Med, 2006: 354:975-977, March 2, 2006.
8. . Dick, Richard, You Take Control, Presentation before the Tenth Annual HIPPA Summit, Baltimore, Maryland, April 7, 2005

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