Healthcare Tsunami Tom Peters/09.12.2004

1
Healthcare TsunamiTom Peters/09.12.2004
2
HealthCare2004Consumerism X Demographics X
IS/Internet X Quality X Information
Consolidators X Genetics Devices Revolution
YIKES!
3
Golden Age of Patient-centric, Genetics-driven
Healthcare Looms! Current status 1.3T.
30M-70M uninsured. 90K killed and 2M injured p.a.
in hospitals. 85 treatments unproven. Cure
depends on locale in which treated. 50
prescriptions do not work. 2X docs. 2X hospitals.
IS primitive. Accountability measurement nil.
And everybodys mad and feels powerless docs,
patients, nurses, insurers, employers, pharma
device cos, hospital administrators and staff.
4
1. Consumerism (Patient-centric Healthcare
Arrives)
5
Anne Busquet/ American ExpressNot Age of the
InternetIs Age of Customer Control
6
Amen!The Age of the Never Satisfied
CustomerRegis McKenna
7
The Web enables total transparency. People with
access to relevant information are beginning to
challenge any type of authority. The stupid,
loyal and humble customer, employee, patient or
citizen is dead.Kjell Nordstrom and Jonas
Ridderstrale, Funky Business
8
Parents, doctors, stockbrokers, even military
leaders are starting to lose the authority they
once had. There are all these roles premised on
access to privileged information. What we are
witnessing is a collapse of that advantage,
prestige and authority.Michael Lewis, next
9
Teens and young adults are flocking to the Web
for health-related information as much as they
are downloading music and playing games online
and more often than shopping online, according to
a national survey from the Kaiser Family
Foundation. Reuters
10
A seismic shift is underway in healthcare. The
Internet is delivering vast knowledge and new
choices to consumersraising their expectations
and, in many cases, handing them the controls.
Healthcare consumers are driving radical,
fundamental change.Deloitte Research, Winning
the Loyalty of the eHealth Consumer
11
We expect consumers to move into a position of
dominance in the early years of the new
century.Dean Coddington, Elizabeth Fischer,
Keith Moore Richard Clarke, Beyond Managed Care
12
Todays Healthcare Consumer skeptical and
demandingSource Ian Morrison, Health Care in
the New Millennium
13
Medical care has traditionally followed a
professional model, based on two assumptions
that patients are unable to become sufficiently
informed about their own care to allow them a
pivotal role, and that medical judgments are
based on science.Joseph Blumstein, Vanderbilt
Law School
14
He shook me up. He put his hand on my shoulder,
and simply said, Old friend, you have got to
take charge of your own medical care.
Hamilton Jordan, No Such Thing as a Bad Day
(on a conversation with a doctor pal, following
Jordans cancer diagnosis)
15
If healthcare organizations dont wake up, smell
the coffeeand get online with real services,
transactions, and more for these e-consumers to
dothe newly empowered e-consumers will become
even more disgruntled with the hornets nest of
paperwork that plagues the system.Douglas
Goldstein, e-Healthcare
16
It may be the most far-reaching evolution of
them all the metamorphosis of passive patient
into consumer and well-informed, assertive
consumer at that. The defining axiom of
traditional medicine doctors orders is being
turned on its head. These days its the patients
who are armed, the doctors who must get wired to
keep nimble. E-health is the new house
call.Richard Firstman, Heal Thyself, On
Magazine
17
Whats needed are comprehensive strategies that
leverage the latest technology and provide the
services that eHealth consumers are demanding,
including convenience and customized services
such as online physician interaction or online
management of health benefits and customized
disease management programs.Deloitte Research,
Winning the Loyalty of the eHealth Consumer
18
Consumerism HMO backlash (e.g., plans with
more choice). Alternative Medicine, Wellness
Prevention bias. Info availability (disease,
health, docs, support groups, outcomes). Boomers
(Im in charge! Discretionary to spend
cosmetic surgery, vision improvement, fertility,
etc.). Self-care (chronic disease). High
expectations (genetics, etc.)
19
Consumer ImperativesChoiceControl (Self-care,
Self-management)Shared Medical
Decision-makingCustomer ServiceInformationBrand
ingSource Institute for the Future
20
E-consumers want knowledgeare already
connectedwant conveniencewant it to be all
about themwant control.Douglas Goldstein,
e-Healthcare
21
Savior for the Sickvs. Partner for Good
Health Source NPR
22
No one currently owns the eHealth Consumer.
Its an open playing field.Deloitte Research,
Winning the Loyalty of the eHealth Consumer
23
We find that eHealth consumers are willing to
payand even switch health plansfor the services
they most want.Deloitte Research, Winning the
Loyalty of the eHealth Consumer
24
The curative model narrowly focuses on the
goal of cure. From many quarters comes evidence
that the view of health should be expanded to
encompass mental, social and spiritual
well-being. Institute for the Future
25
In many ways, the nursing profession is the most
qualified to respond to current changes in the
health system. Nurses training focuses more on
the behavioral and preventive aspects of health
care than does that of physicians. Institute
for the Future
26
A 7-year follow-up of women diagnosed with
breast cancer showed that those who confided in
at least one person in the 3 months after surgery
had a 7-year survival rate of 72.4, as compared
to 56.3 for those who didnt have a
confidant.Institute for the Future
27
Internet User, F4163,000 HHI64 work FT54
moms6 hours/week onlineSource NetSmart
Research
28
Self-medication is the wave of the future,
whether the pharmaceutical industry likes it or
not.Wall Street Journal
29
DTC gt ProfessionalsClaritinPravacholZybanEvis
taPropeciaPrilosecPrimeraSource JAMA
30
Make time for your most important asset. Your
health.Ad for Mayo Clinic Executive Health
Program/Jacksonville, Orlando Airport
31
Online Medical Records Seen Empowering
PatientsSource Headline, Boston Globe, re 1K
docs and 700K patients _at_ CareGroup
32
Determinants of HealthAccess to care
10Genetics 20Environment 20Health
Behaviors 50Source Institute for the Future
33
Message Patients arent. Consumers will rule.
34
2. Demographics The BOOMERS Reach 60 in 05!
35
NOT ACTING THEIR AGE As Baby Boomers Zoom into
Retirement, Will America Ever Be the
Same?USNWR Cover
36
507T wealth (70)/2T annual income50 all
discretionary spending79 own homes/40M credit
card users41 new cars/48 luxury610B
healthcare spending/74 prescription drugs5 of
advertising targetsKen Dychtwald, Age Power
How the 21st Century Will Be Ruled by the New Old
37
Boomer WorldFrom jogging to plastic surgery,
from vegetarian diets to Viagra, they are
fighting to preserve their youth and defy the
effects of gravity.M.W.C. Howgill, Healthcare
Consumerism, the Information Revolution and
Branding
38
Pick up any copy of Glamour or Mens Health, and
youll see pages of advertisements encouraging
readers to enlarge their breasts, retard
baldness, correct their vision, improve their
smile, or relieve stress through herbs, massage
therapy, acupunctureyou name it.Coddington,
Fischer, Moore Clarke, Beyond Managed Care
39
Message Boomer (1) There are l-o-t-s of us.
(2) We have the . (3) Were/Im in
charge! (4) Well take no guff from from
anyone. (5) We know the emperor has no
clothes.
40
3. The IS/Web REVOLUTION
41
Some grocery stores have better technology than
our hospitals and clinics. Tommy Thompson, HHS
SecretarySource Special Report on technology
in healthcare, U.S. News World Report (07.04)
42
Info RevolutionConsumerism (research,
consultation, B2C, etc.)Clinical Info Systems
(guidelines and outcome measurement, etc.)100
Web-based (internal) SystemsElectronic Medical
RecordsPatient-physician email-consultationTeleh
ealth-Remote Monitoring (biosensors, home
testing, etc.)Telemedicine (consultation,
invasive treatment, global medical village,
etc.)
43
Were in the Internet age, and the average
patient cant email their doctor.Donald
Berwick, Harvard Med School
44
Want email consultation 90 patients, 15
docs. Evidence Patients do not pester docs.
Time is saved. No one has sued (shows care
connectionthe absence of which is the major
cause of suits).Source New York Times
45
Henry Lowe, U. of Pitt. School of Medicine
Broadband, Internet-based, multimedia
electronic medical records
46
Doctors Without BordersWorld Clinic/Dr.
Daniel Carlin e-mail consultation treatment
for ex-pats, global execs, etc. Developing world
They have the primary care doctors, but no
infrastructure to train specialists. We become
the specialists. More Telemedicine Kiosks in
Central America. Etc.Source On Magazine
47
Telemedicine E.g. HANC Home Assisted
Nursing CareBP, ECG, pulse, temp
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Telemedicine Reduces days/1000 patients and
physician visits for the chronically
illDecreases costs of managing chronic
diseaseExpands service areas for
providersReduces travel costs to and from
medical ed seminarsDouglas Goldstein,
e-Healthcare
49
Detroit Med Center 100M IS MakeoverExperiment
Surgical residents equipped with Palm IIIxe.
Med Director Its not unusual to have a team of
5 or 6 residents responsible for the patients of
25 doctors. For each resident, that could mean
seeing 40 patients spread across 10 floors and 5
buildings. Records work was manual but Now you
export the list of patients to your Palm, with
the room number for each patient and with lab
results from the last 72 hours.
50
Patient by patient, problem by problemdrug
reactions, hospital caused infectionsSalt Lake
Citys LDS Hospital has attacked treatment-caused
injuries and deaths. One of the secrets of LDSs
success is a custom-built clinical computer
system that may serve as a national model for how
to save patient lives.Demanding Medical
Excellence Doctors and Accountability in the
Information Age, Michael Millenson
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The VHA gets it! E.g. Laptop at bedside calls
up patient e-records from one of 1,300 hospitals.
Bar-coded wristband confirms meds. National
Center for Patient Safety in Ann Arbor. Docs
and researchers discuss optimal treatment
regimensresearch center in Durham NC. Doc
measures guidelines e.g., pneumonia
vaccinations from 50 to 84. Blame-free
system, modeled after airlines. Whats needed
in the U.S. is nothing short of a medical
revolution and the VHA has gone further than most
any other organization to revamp its culture and
systems.Rand/SourceWSJ 12.10.2001
52
Our entire facility is digital. No paper, no
film, no medical records. Nothing. And its all
integratedfrom the lab to X-ray to records to
physician order entry. Patients dont have to
wait for anything. The information from the
physicians office is in registration and vice
versa. The referring physician is immediately
sent an email telling him his patient has shown
up. Its wireless in-house. We have 800
notebook computers that are wireless. Physicians
can walk around with a computer thats
pre-programmed. If the physician wants, well go
out and wire their house so they can sit on the
couch and connect to the network. They can review
a chart from 100 miles away. David Veillette,
CEO, Indiana Heart Hospital (HealthLeaders/12.2002
)
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4. Quality COULD IT TRULY BE THIS AWFUL?
54
Without being disrespectful, I consider the U.S.
healthcare delivery system the largest cottage
industry in the world. There are virtually no
performance measurements and no standards. Trying
to measure performance is the next revolution
in healthcare.Richard Huber, former CEO, Aetna
55
A healthcare delivery system characterized by
idiosyncratic and often ill-informed judgments
must be restructured according to evidence-based
medical practice.Demanding Medical Excellence
Doctors and Accountability in the Information
Age, Michael Millenson
56
As unsettling as the prevalence of inappropriate
care is the enormous amount of what can only be
called ignorant care. A surprising 85 of
everyday medical treatments have never been
scientifically validated. For instance, when
family practitioners in Washington were queried
about treating a simple urinary tract infection,
82 physicians came up with an extraordinary 137
strategies.Demanding Medical Excellence
Doctors and Accountability in the Information
Age, Michael Millenson
57
With little fanfare, a gathering revolution is
transforming the everyday practice of medicine.
Owing more to laptops than lab coats, this is an
information revolution, one that is beginning to
yield answers to the most basic questions that
haunt those who are sick Who shall live and who
shall die?Demanding Medical Excellence
Doctors and Accountability in the Information
Age, Michael Millenson
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Quality of care is the problem, not managed
care.Institute of Medicine
59
RAND(1998) 50, appropriate preventive care.
60, recommended treatment, per medical studies,
for chronic conditions. 20, chronic care
treatment that is wrong. 30 acute care treatment
that is wrong.
60
CDC 1998 90,000 killed and 2,000,000 injured
from nosocomial hospital-caused drug errors
infections
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HealthGrades/Denver 195,000 hospital deaths per
year in the U.S., 2000-2002 390 full
jumbos/747s in the drink per year. Comments
This should give you pause when you go to the
hospital. Dr. Kenneth Kizer, National Quality
Forum. There is little evidence that patient
safety has improved in the last five years. Dr.
Samantha CollierSource Boston Globe/07.27.04
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1,000,000 serious medication errors per year
illegible handwriting, misplaced decimal points,
and missed drug interactions and
allergies.Source Wall Street Journal /
Institute of Medicine
63
Answer (1) Physician order-entry system, (2)
stick to treatment guidelines for high-risk
patients, (3) adequate ICU staffing.
64
The perils/costs of folk wisdom Pills vs. IV/
100 per use.
65
Various studies 1 in 3, 1 in 5, 1 in 7, 1 in 20
patients harmed by treatment Demanding
Medical Excellence Doctors and Accountability
in the Information Age, Michael Millenson
66
RAND (1998) 50, appropriate preventive care.
60, recommended treatment, per medical studies,
for chronic conditions. 20, chronic care
treatment that is wrong. 30 acute care treatment
that is wrong.
67
YE GADS! New England Journal of Medicine/
Harvard Medical Practice Study 4 error rate (1
of 4 negligence). Subsequent investigations
around the country have confirmed the ubiquity of
error. In one small study of how clinicians
perform when patients have a sudden cardiac
arrest, 27 of 30 clinicians made an error in
using the defibrillator. Mistakes in
administering drugs (1995 study) average once
every hospital admission. Lucian Leape,
medicines leading expert on error, points out
that many other industrieswhether the task is
manufacturing semiconductors or serving customers
at the Ritz Carltonsimply wouldnt countenance
error rates like those in hospitals.Complication
s, Atul Gawande
68
Established state-of-the-art cancer careabout
which there is no longer any debateis
erratically applied.Source Institute of
Medicines National Cancer Policy Board
69
In health care, geography is destiny.Source
Dartmouth Medical School 1996 report
70
Geography Is DestinyE.g. Ft. Myers 4X
Manhattanback surgery. Newark 2X New
Havenprostatectomy. Rapid City SD 34X Elyria
OHbreast-conserving surgery. VT, ME, IA 3X
differences in hysterectomy by age 70 8X
tonsillectomy 4X prostatectomy (10X Baton Rouge
vs. Binghampton). Breast cancer screening 4X NE,
FL, MI vs. SE, SW. (Source various)
71
PARADOX Many, many formal case reviews failure
to systematically/ systemically/ statistically
look at and act onevidence.C.f., Complications,
Atul Gawande
72
Deep Blue Redux 2,240 EKGs 1,120 heart
attacks. Hans Ohlin (50 yr old chief of coronary
care, Univ of Lund/SW) 620. Lars Edenbrandts
software 738.Only this time it matters!
73
Most physicians believe that diagnosis cant be
reduced to a set of generalizationsto a
cookbook. How often does my intuition lead me
astray? The radical implication of the Swedish
study is that the individualized, intuitive
approach that lies at the center of modern
medicine is flawedit causes more mistakes than
it prevents. Atul Gawande, Complications
74
Probable parole violations Simple model (age,
of previous offenses, type of crime) beats M.D.
shrinks. 100 studies Statistical formulas gt
Human judgment. In virtually all cases,
statistical thinking equaled or surpassed human
judgment.Atul Gawande, Complications
75
Geography Is DestinyOften all one must do to
acquire a disease is to enter a country where a
disease is recognizedleaving the country will
either cure the malady or turn it into something
else. Blood pressure considered treatably high
in the United States might be considered normal
in England and the low blood pressure treated
with 85 drugs as well as hydrotherapy and spa
treatments in Germany would entitle its sufferer
to lower life insurance rates in the United
States. Lynn Payer, Medicine Culture
76
Practice variation is not caused by bad or
ignorant doctors. Rather, it is a natural
consequence of a system that systematically
tracks neither its processes nor its outcomes,
preferring to presume that good facilities, good
intentions and good training lead automatically
to good results. Providers remain more
comfortable with the habits of a guild, where
each craftsman trusts his fellows, than with the
demands of the information age.Michael
Millenson, Demanding Medical Excellence
77
In a disturbing 1991 study, 110 nurses of
varying experience levels took a written test of
their ability to calculate medication doses.
Eight out of 10 made calculation mistakes at
least 10 of the time, while four out of 10 made
mistakes 30 of the time.Demanding Medical
Excellence Doctors and Accountability in the
Information Age, Michael Millenson
78
With meticulous detail, historical accuracy, and
an uncommon understanding of the clinical field,
Millenson documents our struggle to reach
accountability. Journal of the American
Medical Association, on Demanding Medical
Excellence, Michael Millenson
79
Its (measurable, systemic) outcomes, stupid!
80
Leapfrog Group/med errors Not since Jackson
Hole Group guru Paul Ellwood, Jr., M.D., coined
the term HMO in 1970 has one idea so fully
captured the imagination of the healthcare
industry.HealthLeaders
81
Leapfrog Group
CPOE/Computerized Physician Order
EntryICU staffing by trained
intensivistsEHR/Evidence-based Hospital
ReferralDuh I Welcome to the computer
age.Duh II How about using experts?Duh
III If you do stuff a lotta times, you tend to
get/be better.
Source HealthLeaders
82
Empire Blue Cross and Blue Shield 4 quarterly
bonus for hospitals that meet Leapfrogs CPOE and
ICU-staffing standards.Source HealthLeaders
83
The Benefits of FOCUSED EXCELLENCE
Shouldice/Hernia Repair 30-45 min, 1
recurrence. Avg 90 min, 10-15
recurrence.Source Complications, Atul Gawande
84
Computerized Physician Order Entry/CPOE 5 of
U.S. hospitalssource HealthLeaders/06.02
85
When a plane crashes, they ask, What happened?
In medicine they ask Whose fault was it?
James Bagian, M.D. former astronaut, now
working with the VHA.
86
Winning By Acknowledging FailuresWernher Von
Braun, the Redstone missile engineer who
confessed the bottle of champagne. Award to
the sailor on the Carl Vinsonfor reporting the
lost tool. Amy Edmondson the successful nursing
units with the highest reported adverse drug
events.Source Karl Weick Kathleen Sutcliffe,
Managing the Unexpected
87
5. The Consolidators Fat or Thin?
88
WebMD (or heirs and assigns)
89
Virtual health care webs force providers to
focus on their areas of excellence and to invest
in areas where they can generate a sustainable
competitive advantage.Healthcare.com Rx for
Reform, David Friend, Watson Wyatt Worldwide
90
The future of hospitals is murky. A combination
of technological advances, managed care, and
changes in Medicare reimbursement policy means
that the underlying demand for inpatient services
will continue to fall.Institute for the Future
91
America has twice as many hospitals and
physicians as it needs.Med Inc., Sandy Lutz,
Woodrin Grossman John Bigalke
92
Message Somebody is gonna get this right!
93
6. Genetics, Devices, the Future of Big Pharma
94
Recognizing that a single misspelled gene means
the difference between being poisoned and being
cured was the first victory for the new science
of pharmacogenetics.Newsweek
95
Genetic data 2X every 6 months.Source
Financial Times
96
Genetics DevicesPharmacogenomics
(minibusters, rational drug design,
personalized medicine, gene therapy,
vaccines--20 to 50 prescriptions not
work)Neural Stem CellsMinimally invasive
surgeryAdvanced imaging
97
Pharmacogenomics could fundamentally change the
nature of drug discovery and marketing, rendering
obsolete the pharmaceutical industrys practice
of spending vast amounts of time and money to
craft a single medicine with mass-market
appeal.The Industry Standard
98
E.g., Genentechs Herceptin, useful in 25 of
advanced breast cancer cases. Would probably have
been uneconomic if subjected to 9X patients in
phase III clinical trials.Source FT
99
Pharmacogenomics End of Blockbusters by
End-of-Decade (Reuters)Barrie James, Pharma
Strategy Consulting Were moving from a
blunderbuss approach to laser-guided munitions,
and it marks a sea change for the industry. The
implications for existing business models are
devastating. Allen Roses, SVP Genetic
Research, GlaxoSmithKline minibuster. Rob
Arnold, Euro head of life sciences, PWC Once
you start dealing with minority treatments, small
biotechs who are more nimble and dont need
500-million-a-year drugs to make money could be
at a real advantage.
100
BIG DRUG MAKERS TRY TO POSTPONE CUSTOM REGIMENS.
Most drugs dont work well for about half the
patients for whom they are prescribed, and
experts believe genetic differences are part of
the reason. The technology for genetic testing is
now in use. But the technique threatens to be so
disruptive to the business of big drug companies
it could limit the market for some of their
blockbuster products that many of them are
resisting its widespread use.The Wall Street
Journal (06.18.2001)
101
Forbes100 from 1917 to 1987 39 members of the
Class of 17 were alive in 87 18 are in 87
F100 the 18 F100 survivors underperformed the
market by 20 just 2 (2), GE Kodak,
outperformed the market from 1917 to
1987.Source Dick Foster Sarah Kaplan,
Creative Destruction Why Companies That Are
Built to Last Underperform the Market
102
Biotechs Amgen, Genentech, Biogen, Genzyme,
Celltech, ImClone Systems. Bioinformatics
Accelrys, Cognia, Double Twist, IBM Lifesciences,
NetGenics, SAS Institute.
103
Imagine the day that your surgeon performs your
heart bypass sitting at a computer thousands of
miles from the operating table. That day may come
sooner than you think.Newsweek
104
There is no question in my mind that the future
of heart surgery is in robotics.Dr. Robert
Michler, OSU Med Center, upon the FDAs approval
of robotic partial-bypass surgery
105
Message pharacogenomics (1) There is a drug
revolution coming. Pretty damn fast. (2) My bet
Most Big Pharma will get run over!
106
The Future of Reps Whoops
107
Consultative selling requires dialogue and the
time for that dialogue. Unfortunately, this
seldom happens in todays hurry-up complex world
of pharmaceutical selling.newspost/spbt
108
Study of 500 Reps 65 had face-to-face
conversation with the physician for less than 30
seconds per visit. In fact, more than half of the
65 admitted that the average time is less than
15 seconds.Source newspost
109
Research reveals no evidence of overall superior
selling behavior related to experience beyond
five years. Quite the opposite newspost/spbt
110
Pediatric cardiologist practice head I dont
see them, period. I study, write papers, use the
Web, attend a minimum of 4 or 5 major conferences
a year. My staff may see them, but I in general
find their views uselessly prejudiced. Call it,
Im afraid to say, hucksterism.
111
Urologist A few of thema very feware
excellent. The good ones are self-deprecating. If
their product is not all that great, theyll
admit it. Mostly, its a waste of my time. I let
the staff handle it.
112
Family Practice Office (3 Docs, Midsize
town) AdministratorTP How often does Dr. X
see Reps?PA He doesnt. Emphatic.TP
That was sharp in tone! Why?PA We used set
aside a two-hour block, once a month. But a lot
of the Reps missed appointments. That, however,
was the least of it. The biggest problems were
the Reps who kept pushing the same thing, visit
after visit. They had absolutely nothing new to
say.TP So how does Doc X keep up?PA The
Internet. T.O.V. What else?
113
Internist (Silicon Valley) The Web is generally
better. I spent a year of painstaking study, and
now I have a system that keeps me informed in a
push fashion. I began as a skeptic, harassed by
a few of my techie patients, and Ive become a
believer and proselytizer.
114
Oncologist They are, or can be, helpful to the
two-thirds of docs, to be frank, who dont study
much. Ive got one or two Ill call, but
otherwise Im not available.
115
Pharmaceutical exec Truthfully, we hire
attractive women as much as we can get away with.
That plus pens are huge influencersits what our
focus groups tell us. (The attractive young
women theme was a constant refrain. I find it
laughable, to a point, a female M.D. told me.
What I fear is that it works.)
116
ER doc/exec Its pathetic. The docs are half
assed in their learning styles. Most dont even
pretend they are keeping up. Reps? She who has
the best pens wins. Health care is out of
controland laughingly unscientific. Whatever
your nightmare stories are, trust me, the reality
is much worse.
117
Plastic surgeon practice head My practice has
changed 100 in the last 10 years. Sadly, thats
not true for three-quarters of my colleagues.
Information technology is a big part of it. Its
extremely user-unfriendly. It took me and my
partners and office staff a year to customize our
approachand as we did so the role of the reps
became less and less important. I wont even let
our staff schedule time with them. Its
inefficient, and most of them are humorously
biasedand insult us by imagining its not
transparent.
118
Big Pharma (Summary) (1) Discovery too
complex, wrong scientific emphasis. (2)
Distribution reps role under heavy fire. (3)
Solution More consolidation Stupid. (D D
G???) (4) Short your stock.
119
7. Conclusion.
120
Golden Age of Patient-centric, Genetics-driven
Healthcare Looms! Current status 1.3T.
30M-70M uninsured. 90K killed and 2M injured p.a.
in hospitals. 85 treatments unproven. Cure
depends on locale in which treated. 50
prescriptions do not work. 2X docs. 2X hospitals.
IS primitive. Accountability measurement nil.
And everybodys mad and feels powerless docs,
patients, nurses, insurers, employers, pharma
device cos, hospital administrators and staff.
121
Message Summary (1) An unparalleled time for
imagination and bold action. (2) A time of
unprecedented opportunities. (3) A time of
unprecedented risk.
122
HealthCare21
123
HealthCare21 21 Ideas for Century211.
Hospitals kill people. (And many of those they
dont kill, they wound.) (And they deny it.)
(ERRORS RULE!) And Hustling ambulances kill
pedestriansand dont save patients.2. Doctors
are spoiled bratswho dont like measurements.
Or any form of interference. Docs are also
cover-up artists. The REAL Hippocratic Oath
DONT RAT ON A FELLOW DOC. 3. Most
prescription drugs dont workfor a PARTICULAR
patient. Current drugs Blunderbusses.4. Think
WELLNESS. Think PREVENTION.5. THERE IS
LITTLE SCIENCE IN MEDICINE. (See state to
state variations country to country variations
the general lack of agreed-upon
treatments.)6. You could save thousands of lives
(think Schindler)if you just outlawed
handwritten prescriptions.7. Detailers will
disappear when GenX docs arrive.
124
HealthCare21
(Cont.)8. IS/IT in hospitals is sub-primitive
(despite enormous expenditures).9. Systemic
IS/IT is worselinks between docs, insurers,
providers, patients.10. ELECTRONIC MEDICAL
RECORDS TO UNIFORM STANDARDS. (NOW.)
(PLEASE.) 11. THE WEB WILL LIBERATE. (Info
Power.) (BELIEVE IT.) 12. 80M BOOMERS RULE.
(. Desire for c-o-m-p-l-e-t-e
CONTROL. NOW. LEADERSHIP OF AGING
PROCESS.)13. Drug Discovery processes at Big
Pharma are hopelessly over-complicated.
(??? Bye Bye Big Pharma.)14. 90 of the
healthcare fix HARVEST THE LOW-HANGING
FRUIT. They are NOT the Enemy. I have
seen the enemy and it am me. Damn it.
125
HealthCare21 (Cont.)15. The
number of U.S. un-insured is the nations 1
disgrace. That said, insured consumers
are spoiled brats. They/we/me act as if
healthcare were a free good and believe
that an incipient hangnail calls for at least a
CAT scan or two. ANSWER MAKE US FEEL
THE PAIN.16. Genetic engineering biotech
change EVERYTHING. (Within 15
years.)17. New Medical Devices change
EVERYTHING. (Within 15 years.)18. IS/IT
changes EVERYTHING. (Within 10 years.)19. New
Docs change EVERYTHING. (Within 10 years.)20.
New Patients change EVERYTHING. (Within 5
years.)


126
HealthCare21 (Cont.)21.
ALL THIS ENORMOUS OPPORTUNITY. The
Opportunity of Several Lifetimes. (For the Bold
Brave.) HCare WILL be TOTALLY re-invented
in the next two decades. (And, hey, it is our
largest industry.)
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HealthCare2
128

• 
  Healthcares 1-2 Punch
• Hospital quality control, at least in the
  U.S.A., is a bad, bad joke. Depending on whose
  stats you believe, hospitals kill 100,000 or so
  of us a yearand wound many times that number.
  Finally, they are getting around to dealing
  with the issue. Well, thanks. And what is it
  weve been buying for our Trillion or so bucks a
  year? The fix is eminently do-able which makes
  the condition even more intolerable. (Disgrace
  is far too kind a label for the condition.
  Whos to blame? Just about everybody, starting
  with the docs who consider oversight from anyone
  other than fellow clan members to be
  unacceptable.)
• 2. The systemtraining, docs, insurance
  incentives, culture, patients themselvesis
  hopelessly-mindlessly-insanely (as I see it)
  skewed toward fixing things (e.g. Me) that are
  brokennot preventing the problem in the first
  place and providing the Maintenance Tools
  necessary for a healthy lifestyle. Sure,
  bio-medicine will soon allow us to understand and
  deal with individual genetic pre-dispositions.
  (And hooray!) But take it from this 61-year old,
  decades of physical and psychological self-abuse
  can literally be reversed in relatively short
  order by an encompassing approach to life that
  can only be described as a Passion for Wellness
  (and Well-being). Patientslike meare catching
  on in record numbers but the system is highly
  resistant. (Again, the doctors are among the
  biggest sinnersno surprise, following years of
  acculturation as the man-with-the-white-coat-who-
  will-now-miraculously-dispense-fix
  it-pills-for-you-the-unwashed. (Come to think of
  it, maybe Ill start wearing a White Coat to my
  doctors officeafter all, I am the
  Professional-in-Charge when it comes to my Body
  Soul. Right?)