Something’s Holding Back Healthcare Innovation—And It’s Hiding In Plain Sight

Collecting data for major innovations requires smart incentives at the clinical level that make it worthwhile for both physicians and their patients.

Starting with the big J.P. Morgan Healthcare investor conference in San Francisco, this year is seeing drug makers and technology companies eagerly sharing news on personalized medicine, telehealth, big data and targeted therapies. Any of these could be transformative.

But insurance, government and the public are growing impatient that the cost of innovation is not translating fast enough into real benefits.

While CEOs and investors talked through investor presentations and mixed over dinner and drinks around the conference’s Union Square headquarters, presidential candidates in Des Moines talked about how to bring healthcare prices down. Now, well into primary season, it’s clear we will be talking about that all the way to November, and then beyond.

In the healthcare industry, we can’t ignore what appears to be the core issue of this presidential election — inequity. Part of that is an idea that companies and the wealthy are talking about innovation, but the public doesn’t see enough of the benefits. All we see is the price tag.

Genetics anyone?

Take molecular diagnostics and excitement around genetics and its implications for cancer.

Studies have found 75% to 98% of oncologists say they believe genomic testing can improve care for patients with cancer. Yet they also say they only order genomic tests for 4% of their own patients.

Why? Because less than 50% of physicians feel confident in their ability to interpret the test results. And only 10% are confident in their ability to use test results to guide the process of prescribing treatment.

Here is what that looks like in cancer centers today: A patient has a biopsy performed on a growth and is told that it shows they have cancer. If their physician orders a molecular diagnostic test, the results most likely won’t come back for a week or several weeks. Questions about whether insurance will cover the test can add further delay and stress. The patient may be anxious they are losing precious time, and that treatment decisions shouldn’t wait for the test’s return if it won’t recommend any major changes.

When the test does come back, the oncologist receives a 45-page report, and too often physicians feel they don’t receive enough clear direction that can be translated to patients. Most often oncologists are left just looking for confirmation of their original conclusions. If the report points in a different direction, how can it be trusted?

The outcome is likely that the time and expense invested in the test does not result in a change to the treatment plan. That’s not necessarily because there wasn’t information that could point to a refinement of care, but because of time and lack of clarity.

Seeing this play out over and over, insurance companies have concerns paying for molecular diagnostics despite studies showing the benefits of these tests.

Variations of this same problem play out across healthcare. Big data and genetics might solve cancer, but not if testing isn’t done. Not if doctors can’t use the results more easily. Not if new high quality data can’t be gotten from doctors in the first place and shared with researchers.

Taking a dystopian page from the movie Field of Dreams, if you build it and nobody comes, you just have a baseball diamond with corn around it.

Grassroots Get-It-Done

But on the other hand, authentic innovation is starting in surprising places far from Silicon Valley or the big banking centers.

Enabled by cheaper virtual servers and open source software, the administrative teams, nurses and physicians on the frontline are taking it on themselves to develop systems that bring payers, providers and patients together around data that has an immediate utility for quality of life and costs — and then becomes part of aggregate data that researchers can use to beat cancer.

In Greenville, South Carolina, The Center for Cancer Prevention and Wellness is offering free wellness screenings for patients, along with recommendations for lifestyle modifications to mitigate their risk of cancer. During these annual screenings, the center collects blood, urine and cheek swab samples from participants for bio banking at the Institute for Translational Oncology Research.

What’s the ultimate goal? “As we collect and study this data from CCPW, we anticipate that we will eventually be able to identify a molecular alteration in its early stages and intercede before cancer truly appears,” Dr. Larry Gluck, medical director of the Prisma Health Cancer Institute, told the Greenville Journal.

What Gluck and his team understand is that collecting data for major innovations requires smart incentives at the clinical level that make it worthwhile for physicians and their patients.

In Florida, cancer researchers are combining forces with self-insured employers to offer a wide range of services to cancer patients, from personal care management to streamlined authorization, telemedicine visits and distribution of medical records.

Announcing the launch of the Florida Oncology Connections Program, Florida Cancer Specialists and Research Institute (FCS) highlighted how improved management of care can help drive down the costs of cancer care for employers. But the benefits to patients and physicians — streamlining care and offering digital support — will be just as crucial to the program’s success.

The program launched with a handful of employers in central Florida, but hopes to expand. If the FCS model shows promise, the enormous pool of self-insured employers — and their millions of employees — could become a crucial patient population for cancer researchers across the country.

In both the Florida and South Carolina models, there is immediate feedback when data is collected. In Greenville, patients get instant recommendations for lifestyle changes based on the screening results. In central Florida, physicians can benefit from streamlined approval for prescriptions or procedures based on test results.

Physicians don’t want to be told how to treat their patients, but they are willing to deploy new software and tools if it places valuable information at their fingertips. I call this “grassroots get-it-done” clinical innovation.

That’s where we start by studying the day-to-day workflow of the individuals we want to partner with, and begin by finding ways to solve the irritations that get in the way of them doing what they really want to do. It’s a two-way process, and requires jumping into the trenches with doctors, nurses, administrators and patients, and seeing their battle from the mud up.

For doctors, the little things that can trip them up can be the hard-to-remember label on a complicated drug that shows how a therapy should be used, what kind of patients benefit and why. That is incredibly important information and if you’ve ever looked at a chemotherapy label, for instance, there is no way to remember all of it and how it relates to the many different patients a physician sees.

That’s why when a physician enters data about a patient and therapies, the system shows the label for those therapies. In product design this is sometimes called a variable reward. Products that become habits reward us every time we use them. In this case the reward is useful and immediately actionable insight that is different almost every time the product is used.

This can drive a cascade of progress as more data becomes available through more use of the product.

So, if it’s so obvious…

But if this has been done before, why isn’t it being done now?

It is being done—but not enough. Engineers and product designers can’t easily see these opportunities for relevant variable rewards if they don’t live where the product will be used. Let’s face it, many great Silicon Valley product developers design products for people like themselves. They harness their own behavioral experiences and there are incredibly few doctors who are software engineers.

And it could be, that the very best insights come from the support roles around the doctor, who pick up many of the administrative tasks that spin out of the doctor’s work. To find the right insights requires a lot of controlled testing in a specific hospital, around a specific condition and being right there in person. As Bill Gurley at Benchmark Capital points out, you have to start small and focused to understand how to get traction. Develop products from the physician out.

If we can figure that out, we might have a different story to tell about healthcare, one about how the right medicine is getting to the right people, and the costs are taking care of themselves as the best therapies and medicine rise to the top.

Carla Balch
Carla Balch is the former President and CEO of Flatiron Health's Altos Solutions, and has served as CEO of multiple health technology businesses. Today she serves on multiple health tech and public boards focused on healthcare.