October 1, 2012 – The Healthcare Businesswomen’s Association (HBA) Boston Chapter held its provocative panel discussion on the impact of healthcare reform on innovation, on Thursday, September 13, 2012 in Boston. Local healthcare business leaders discussed how their organizations are using new business models, novel partnerships, and out-of-the-box thinking to change how healthcare is delivered.
According to panelists, 2012 has already been a big year in the healthcare industry, with more changes anticipated. The recent Supreme Court ruling, new FDA regulations coming into effect and the upcoming presidential election are having an unprecedented impact on the state of healthcare – quality, cost and delivery.
All sectors of the healthcare industry are impacted – from pharmaceuticals to hospitals, health plans to medical devices. Panelists believe that the key to sustainable change is for the industry to work together to understand overall goals and obstacles, and then propose new solutions. They have already begun this collaborative effort, and they shared some of their strategies at the Forum.
Six senior Boston leaders from organizations across the spectrum of healthcare participated in a panel discussion about the impact of reform on innovation, sharing examples of how reform is driving novel initiatives within their organizations, the challenges they are facing, and what they are planning for the year ahead.
Martha Bebinger, WBUR Healthcare Reporter, moderated the following panel of distinguished speakers, discussing how they are handling the new challenges. The panel discussion focused on of delivering quality care in a cost-conscious environment. Panelists each had their own solutions from within their organizations.
Martha Bebinger, healthcare reporter at WBUR, guided the panelists into critically evaluating the implications of the Affordable Care Act (ACA) through a conversational question-and-answer format. Despite uncertainty caused by ACA reforms, the panelists spoke about each challenge as an opportunity to build more efficient healthcare processes and to continue innovation under an affordable healthcare model.
Justine Carr, MD, chief medical officer at Steward Health Care System
Dr. Carr has led multiple initiatives in clinical integration, including standardization of policies and best practices in clinical excellence and prevention of harm. She spoke about high quality, low-cost and reproducible models of care, including telemedicine (giving more cost-effective care in home), customer satisfaction feedback, and prevention methods such as use of “health coaches,” as well as defraying the cost of medical education. She focused on the concept of total healthcare costs versus incidental opportunities for savings that might be associated with fee-for-service thinking.
Naomi Fried, PhD, chief innovation officer at Boston Children’s Hospital
Dr. Fried is building the innovation acceleration program, aimed at improving care quality and assisting the hospital in shaping the future of healthcare at Boston Children’s Hospital. The program focuses on integrative models of care such as using more cost-effective delivery of health (telehealth – remote delivery of healthcare, at home and at school); looking at the “whole patient” – a paradigm shift from sick care to health care; moving toward a service model with emphasis on quality, not volume; resourcing grass roots innovation; and identifying unmet innovation opportunities. She raised the concept of physicians being paid by outcomes instead of by volume. Fried also raised the issue of providing medical innovation for children (stocked products need to have varying sizes, as an example), and the challenge of providing care for an entire family when a child becomes critically ill.
Nancy Gagliano, MD, chief medical officer at CVS MinuteClinic
Dr. Gagliano is responsible for physician oversight and expansion of services and clinics,
as well as internal operations at the CVS MinuteClinic organization. She pointed out that 45 million Americans are expected to be insured at the same time as we are facing a 40,000 primary care physician shortage. She discussed the “medical home” concept in which a patient’s home base becomes the source of care. CVS’ MinuteClinic strives to be part of a less expensive option, the “medical neighborhood” concept. It uses nurse practitioners and physician assistants who see approximately two million patients annually at its 500+ locations, to increase community healthcare access in an environment of primary care physician shortage. At the same time, this program helps to reduce healthcare costs. The structure and delivery targets for the CVS MinuteClinics allow the organization to develop complete, standardized protocols for visits they are able to take care of, referring patients to physicians for the matters they cannot. Delivery in these circumstances can therefore be 40-70% less expensive that that provided by a typical physician practice.
Tamima Itani, PhD, vice president of global regulatory affairs and regulatory compliance at Boston Scientific Corporation
Dr. Itani’s responsibilities include strategic regulatory, clinical and quality systems leadership for a broad range of class II and class III medical devices, pharmaceutical products, and combination products. She stated that the Affordable Care Act is a unique challenge for the medical device industry due to the ACA being partially funded by manufacturers: a 2.3% medical device excise tax. Companies faced with this expense have the challenge to not slow down innovation and not to pass too much cost on to patients. She cited a shift to medical care delivery at home and a challenge to focus product development on decisive technologies that decrease patients’ costs.
Christina Severin, president of Network Health
Under Ms. Severin’s strategic leadership, Network Health has launched several new and competitive plans for healthcare delivery. Using modeling techniques to reduce expenses while providing better member service, Network Health has developed a social care management program that has become the Medicaid Managed Care Organization industry standard. Under her leadership, Network Health has earned top National Committee for Quality Assurance (NCQA) ratings, a result of “patient-centered and patient-directed” care. A large portion of her service base apparently consists of Medicaid patients and she discussed the challenges of providing anti-poverty and social justice programs in the current environment. She echoed the need for a focus on medical outcomes.
Samantha Singer, vice president of corporate strategy and portfolio management
at Biogen Idec
Ms. Singer is currently chief of staff for Biogen Idec’s CEO, leading corporate strategy and process. She said there should be an increased emphasis on value and adaptation in the face of healthcare reform. If value that is truly innovative can be provided, then the healthcare system is willing to pay for the product, according to Singer. Medical products companies face a challenge in cutting costs. Many companies have already pared down operations costs to a minimum and the only remaining place for discretionary cost-cutting is in R&D; cutting costs in R&D imposes challenges for the future of the company. Product companies therefore must look for true unmet need and provide the value.
Under Bebinger’s skilled guidance, panelists addressed topics and concerns which have arisen from the ACA and other changes taking place:
• Panelists appear to believe that the ACA will remain in place regardless of election outcomes; the difference between parties may be in the level to which provisions are monitored and enforced
• Panelists pointed out that the ACA prompts participating provider organizations to take ownership of a given patient population and promote savings in healthcare delivery. However, the organizations can only retain the savings if they meet the provisions of 32 measures provided by the act
• Value of care provided versus volume will become more important for providers
• Patient-directed care may become more important, and patient responsibility for follow-through with medical orders will gain more attention
• Changes from within healthcare provider organizations and product development organizations may evolve as frequent, subtle changes
Panelists discussed the main challenges they face under current healthcare reform:
• For product manufacturers, the key challenge is to find savings within their organizations to pay for the increases in costs brought about by universal healthcare coverage
• Manufacturers must also strive to find and develop value in meeting true unmet medical need with their new product introductions
• Providers face a pending shortage of primary care providers in the face of increasing numbers of patients covered by health insurance. They must look for innovative ways to meet the need. Deploying service delivery across a range of healthcare providers, not just physicians can allow each provider type to function at the maximum capacity for which they are trained and not to be bogged down completing tasks which an alternative provider can complete
• Panelists cited a fear that the government could lose patience with the pace of change under reform and not allow changes to reach fulfillment
• To really impact outcomes, panelists cited, patients must have “skin in the game” and help to drive outcomes by taking responsibility for their own lifestyle and behaviors that impact health. Providers are challenged to implement education and guidance to impact such patient participation
• Providers and manufacturers must partner with payers for data and better understanding of outcomes. There needs to be a bridge between the different types of organizations to truly impact health outcomes
Ideas for constructing the bridge between different groups to help improve outcomes came forward in the discussion but it was clear that more work needs to be done in this area. Some of the ideas:
• Pay for performance and outcomes
• Look at the European models for health technology assessments
• Clinical trials for new products and services that have patient-reported outcomes
• Stating targets and holding healthcare costs to that target
Audience questions were equally provocative:
• Raising the issue of the costs for medical education: the panelists suggested ways of defraying costs, such as agreements to provide service in underserved communities, providing incentives for graduating physicians to go into primary care versus into specialties
• Raising the issue of potentially cutting costs for drugs and devices: the panelists cited their understanding that drugs are not the key cost of care and that sometimes paying more for drugs and using them in appropriately-suited patients can lower overall medical costs. More data is needed on the outcomes of drug and device usage and how they impact quality of life, ability to return to work, and other measures. Risk contracts (between manufacturers and providers) have also been considered. Panelists lamented the fractionated healthcare system in the US that makes such innovations difficult and cited examples of team medicine which helps to overcome the fractionation
• Raising the issue of how to get information on changes to patients: panelists acknowledged this as a challenge, but also emphasized the importance of patients becoming involved in the changes. Panelists cited a low level of health literacy in our country and the complications of overcoming this. Shared decision-making (patients and providers) will become more important in the future
Topics and discussion continued on a variety of concerns specific to Massachusetts and its ability to move to the “next stage” of healthcare reform: setting target cost growth, helping or hindering the innovations companies are trying, payment reforms, challenges of dealing with home-bound patients.
Local sponsors supporting the forum represented a cross-section of companies and services in Boston's healthcare market: Alexion Pharmaceuticals, Alkermes, Biogen Idec, Blue Cross/Blue Shield of Massachusetts, Boston Scientific Corporation, Cubist Pharmaceuticals, Inc., Millennium: The Takeda Oncology Company, Ping Identity, Sanofi, Shire, Thermo Fisher Scientific, and Witt/Kieffer.
“We thank our panelists and moderator for an illuminating and very informative discussion, with a record turnout of members and others, the highest number of attendees in the chapter’s history. The national board has recognized the outstanding marketing efforts of the Boston chapter in
considering our nomination and award of Best Chapter for the year. A real feather in our cap!” said Keri Collette, President of the HBA Boston chapter.
About Healthcare Businesswomen’s Association (HBA) and the Boston chapter
Healthcare Businesswomen’s Association (HBA) is in its fourth decade as a global not-for-profit organization dedicated to furthering the advancement of women in healthcare worldwide. With 15 chapters throughout the US and Europe, HBA provides educational opportunities for women and men to develop cutting-edge healthcare industry knowledge and leadership skills, recognizes outstanding women and men in the industry, provides opportunities for networking, creates greater visibility for women in the industry, fosters mentoring relationships and serves as a conduit and sponsor for research on career advancement issues. HBA has nearly 6,000 individual members and over 130 corporate partners, and is widely recognized as a catalyst for leadership development of women in healthcare worldwide. The Boston chapter has over 700 members and a network of over 2,000 followers. The Healthcare Forum initiates the theme of “Being Equipped for Change” that will be carried through in Boston programs for 2013.