A Forum on Disruptive Innovation in Healthcare

Jul 19, 2008, 11:04 AM, Posted by Paul Tarini

The Innosight Institute, the non-profit think tank founded by Harvard B-School Professor Clayton Christensen, put on a conference last week called, A Forum on Disruptive Innovation in Healthcare.

Prof. Christensen developed the theory of disruptive innovation and is currently working on a book on the subject. One of his co-authors is Jason Hwang, MD, MBA, who served as a judge for the Disruptive Innovations competition Pioneer sponsored through Changemakers. Those of us at the meeting were treated to a glimpse of the still-being-drafted book, which was pretty interesting. I’m keen to read the final version.

Elliott Fisher, MD, of Dartmouth Atlas fame, set the stage for the forum by taking us on a flyover of "everything that’s wrong with health care in America." Fisher then presented seven causes, which I thought was a pretty succinct list:

  1. There’s a lack of clarity in the US on the aim of health care;
  2. There’s inadequate evidence to evaluate the effectiveness of both biologically-targeted interventions and delivery systems. Fisher asserted that the current discussions around comparative effectiveness were not paying nearly enough attention to the effectiveness of different types of delivery systems;
  3. There’s a public assumption that more care is better care (Fisher has published results demonstrating that more care can actually lead to poorer outcomes);
  4. Medicine is practiced (and taught) in a model of professional autonomy and authority that is outdated;
  5. There’s a lack of accountability for capacity, quality and costs;
  6. Current quality measures reinforce fragmentation, in that they’re too focused on performance within individual care settings and don’t track quality across the continuum of care; and
  7. Payment incentives are flawed.

Wow.

Another big chunk of discussion focused on the development of more precise diagnostic tests, how they will drive the move to personalized medicine and disrupt the current paradigm of “trial and error medicine,” according to speaker Mara Aspinall, former president of Genzyme Genetics, which provides diagnostic services. As example of new precision, Aspinall noted that we can now diagnose 38 different types of leukemia and 50 different types of lymphoma. That increase in diagnostic precision tracks with the increase in five-year survival rates.

Looked at through the lens of Disruptive Innovation, what you see is a technological innovation—increased diagnostic precision—commoditizes expertise. The growing development and use of more precise diagnostics moves us closer to rules-based—and evidence-based—practice.

And the ability to use rules to guide activity—care—is an important pre-condition that permits a Disruptive Innovation. Once you have evidence-based rules that determine a course of action, you don’t need someone with the highest level of training to take that action, because you don’t need as much judgment and intuition. In the case of health care, this means less expensive caregivers can do more complicated things.

Then came Christensen’s discussion of how Disruptive Innovation can transform the health care system. Christensen’s take is that the network effects of the existing health care ecosystem (the relationships among hospitals, providers, plans) make it impossible for our current system to change sufficiently to solve the problems we have with health care today. I think he would assert that the current system simply can’t improve its way out of its current limitations, so the only way to fix the problems we face is through disruptive innovations.

The cool part came when Christensen reframed of the current business models in health care in such a way so as to identify opportunities for disruption. I don’t want to steal the thunder of the forth-coming book, so just when this blog is getting interesting, I need to stop. But suffice it to say, I plan to read this book carefully when it’s published.

This commentary originally appeared on the RWJF Pioneering Ideas blog.