The Health Care "Innovation Divide"

Nov 7, 2007, 1:34 AM, Posted by Robert Hughes

Last week I attended the Health Affairs Health Policy Summit in the nation’s capital. It was a stimulating day of presentations on quality improvement, CEO perspectives, and health reform views from a panel of presidential candidates’ health policy advisers. But the most intriguing session for me was the opening set of remarks on the value of innovation.

The ideas presented and the dominant theme that emerged are especially salient for RWJF’s Pioneer Portfolio, which promotes potentially ground-breaking innovations in health. Every speaker commented on some facet of what can be called an “innovation divide” in health care. Innovation thrives in one part of the health sphere and languishes in the other. Let me illustrate with some examples.

Elias Zerhouni, Director of the National Institutes for Health, set the tone by noting that innovations in therapies, products, and devices are robust and have life cycles, and the health care system needs to respond to these cycles. But he noted that while innovation in medical research and clinical investigation is thriving, the care and financing systems struggle to respond to these new developments.

Ronald Williams, Chairman and CEO of Aetna, Inc., continued the theme. He reported that in his discussions with business leaders around the country, they see excellent innovation in clinical work, but innovation in health care delivery and information technology is lacking.

The innovation divide was described in various terms. Mark McClellan, Senior Fellow at the Brookings Institution, drew on his Health Affairs editorial Board experience and talked about coverage and technology as two spheres with low and high attention to innovation, respectively. Jamie Robinson, new editor of Health Affairs, talked about “the product side and the management side,” with much innovation in the former and little innovation in the latter.

In summary, all the speakers reflected the schism that characterizes innovation in health care: it is well developed and valued in the business sector and in the development of new clinical interventions and techniques. But innovation finds an inhospitable environment in our delivery and financing system. Indeed, outlets for change in this environment are few and far between.

Does this matter? Yes, for at least three reasons. First, our system is doing a lousy job in providing quality health care. Second, it is doing an equally lousy job of assuring access to care for our entire population. And third, it is doing all this inefficiently – costs are rising and not reflecting value. Innovation is a logical avenue to learn how we can do these things better. More important, quality, access, and value are inextricably linked.  And the advent of potential health care reform is providing the stimulus to reach across the innovation divide to connect these three.

McClellan brought home the message that the current health care delivery system has inadequate tools to control costs. The system needs an overhaul into a new configuration that he described as a learning health care system, one that would effectively bridge the innovation divide so that the care delivery and financing of health care would be aligned with the development of new products, clinical practices, and therapeutic interventions to produce better value.

The big question, of course, is whether the two sides of the innovation divide can indeed be aligned for the public good. It is a very tall order.

This commentary originally appeared on the RWJF Pioneering Ideas blog.