Transform 2017, held a few weeks ago, was the tenth annual healthcare innovation conference hosted by the Mayo Clinic Center for Innovation (CFI). Each year it brings together stakeholders from around the world to “challenge assumptions, collaborate, and share results to create the future of health care.” This year the conference focused on Closing the Gap Between People and Health, and more than 30 speakers led discussion on various topics, ranging from policymaking and healthcare spending to social determinants of health. In this article we aim to touch on some of the highlights.
Most of us agree that the current healthcare system in the United States is broken in a number of ways. The U.S. spends about a fifth of its GDP on healthcare, far more than any other industrial nation. However, the U.S. healthcare system tends to rank low among the industrial nations when it comes to health efficiency, equity, and outcomes, an embarrassing statistic considering the high expenditure. Transform 2017 aimed to discuss and address the long list of problems facing the struggling U.S. healthcare system.
The event kicked off with a welcome speech from the moderator of the event, Dr. Elisabeth Rosenthal. Dr. Rosenthal is a trained physician disheartened by the pitfalls of the American healthcare system, who decided to pursue journalism to better highlight these issues and be a force of change. Her latest book, “An American Sickness,” contains countless examples of how patients and physicians alike are becoming increasingly frustrated and fed up with the U.S. healthcare system. She says, “Patients are feeling angry – abandoned by a government and a system that feels like it doesn’t care… They are upset about paying higher premiums, drug prices, out of pocket costs, and deductibles that are outpacing their salaries.”
Day One
During the first session of the conference, titled “Mind the Gap,” various distinguished speakers took to the podium to discuss what they believe is wrong with our healthcare system.
First to speak was Andy Slavitt, who served as the Acting Administrator for the Centers for Medicare & Medicaid Services under President Obama. Mr. Slavitt reviewed the evolution of Medicare & Medicaid Services and highlighted some of its turning points. He proceeded to talk about the ongoing debate in healthcare and the flip-flopping that occurs with the policy makers in government. He believes that in order to build a system that continues to move forward regardless of the leading political party of the time, the new healthcare system should include a set of policies that at least 60-70 percent of Americans support. He also proposed that these policies be tested at the state level before being applied nationally.
Next to speak was Dr. James Weinstein, former CEO and President of Dartmouth-Hitchcock. Dr. Weinstein expressed his concerns on the unsustainability of the current healthcare system. He said that about 10,000 new people are enrolled in Medicare every day, while the number of people actually paying taxes continues to decrease. Therefore, we are facing both a short-term and a long-term problem when it comes to adequately funding a system we already cannot afford today. Dr. Weinstein suggests that the American healthcare system continues to spend billions each year on unnecessary procedures and interventions while ignoring the social determinants of health, such as food, education, and housing. Dr. Weinstein then led an interesting discussion on how one’s zip code could be the strongest predictor of one’s life expectancy.
Dr. Rita Redberg, M.D., Editor-in-Chief of JAMA Internal Medicine, then took to the podium. Dr. Redberg commented on the current attitude among patients that agreeing to another medical test “can’t hurt.” She underlined the importance of properly educating patients on their treatment options and recommendations. Providers need to spread the message “that medical care really needs to be the right test and right treatment for the right patient at the right time… if a test or treatment has no benefit, then no risk is acceptable.” Based on her many years of experience as a physician working closely with the government, Dr. Redberg believes that trying to reform the healthcare system, with all of its fixed, entrenched interests, is very difficult. Public consensus around the new health system is necessary to achieve any major transformation.
Next to take the stage was David Mitchell, co-founder and President of Patients for Affordable Drugs, a national patient group focused on advocating for polices that lower prescription drug prices to make them more affordable. Mr. Mitchell states, “There is a fundamental truth, drugs don’t work if people can’t afford them.” Americans pay two to three times more for prescription drugs than citizens of other developed countries. Sixty to seventy percent of new prescription drugs are developed using taxpayer funding, and Mr. Mitchell and those at Patients for Affordable Drugs believe that if prescription drugs are developed using taxpayers’ money, “there is a special obligation on the part of drug companies to justify the price of those medications.”
Day Two
Day two of Transform 2017 opened with a discussion on overcoming inertia by Dr. Rosenthal. She noted that, “What I discovered in my time as a journalist and observer of the system is that people who try to change these very imbedded, hard-wired systems, find themselves up against a lot of institutional resistance.”
Dr. Robert Pearl, M.D., who served as the CEO of the Permanente Medical Group for the past 18 years, highlighted the importance of moving away from a fee-for-service reimbursement system towards a more capitated model. He talked about the fragmentation of the American healthcare system and the crucial role technology should play to keep it moving forward. He said, “The time for change is now. It needs to be capitated, integrated, and technologically enabled.”
Andrea Walsh, President and CEO for Minnesota-based HealthPartners, took to the stage to discuss the importance of providers embracing a more holistic, broader view of health when it comes to patient care. She described HealthPartners’ new summary measures of health and wellbeing, which assesses a patient’s current health status, sustainability of health, and life satisfaction. “We know from the evidence that only about 20 percent of mortality and morbidity relates to what we do in our clinics and hospitals. We know that 80 percent of health and wellbeing relates to what is going on in our schools and in our communities.”
Scott Wallace, the Managing Director of the Value Institute for Health and Care at Dell Medical School in Austin, Texas, highlighted the importance of changing the way we train our next generation of physicians to better meet the demands of a new, more holistic healthcare system. The Dell Medical School is unique in that its curriculum was specifically designed to meet this goal. He said, “One of the biggest inertial forces in medicine is how we train doctors. We train doctors in organ systems and expect them to provide holistic care. We train doctors to be solos and expect them to perform together. That cannot continue if we are going to dramatically change healthcare…we need to train doctors to think not about illness, but about health. That is the fundamental aspect of the experiment of the Dell Medical School.”
Dr. Bon Ku, M.D., director of JeffDESIGN at the Sidney Kimmel Medical College at Thomas Jefferson University, continued on the topic of optimally training healthcare providers for the next generation of healthcare. JeffDESIGN is a program that teaches future physicians how “to apply design thinking to solve healthcare challenges.” The program engages medical students, residents, and faculty members in workshops to teach them to become more innovative, empathetic, and connected to the community.
For the next session of Day Two, a multidisciplinary team from the Mayo Clinic Health System shared their experience with building CODE-X. CODE-X is a system that collects real-life data extracted from the electronic medical record and turns it into something meaningful for providers. Treatment guidelines based on the results of tightly regulated studies help healthcare providers offer evidence-based treatments to their patients. However, physicians are sometimes faced with situations where supporting literature is not available, and they are left with uncertainty in how to proceed. This is where providers can use CODE-X to help. By utilizing an application titled Patient Like Mine, a physician can select a few, key patient characteristics to see how similar patients have successfully been treated in the past. 
Svetomir Markovic, M.D., in the division of medical oncology, reported, “CODE-X will collect our experimental data [on a topic], analyze it in a statistically valuable way, so we make the right decision on the first time and give the patient the best care across our institution.” In addition to guiding clinical care, CODE-X can also be utilized for research. Dr. Markovic added, “Real life data could potentially turn how clinical research is done on its head.”
Day two concluded with a live debate moderated by Intelligence Squared, a non-partisan, non-profit organization that stages debates around the world. The question driving the debate was: “Is the U.S. healthcare system terminally broken?” The debate was filled with interesting perspectives from both sides, but ultimately, attendees voted and decided that the healthcare system is not terminally broken: there is still hope, but work needs to be done. The debate in its entirety is available to watch for free online at www.intelligencesquaredus.org.
Day Three
The third and final day of Transform 2017 focused on how to move forward and implement some of the ideas discussed over the course of the conference to narrow the gap between people and health. Dr. Douglas Wood, M.D., Director for the Mayo Clinic Center for Innovation, shared his opinions on how to transform American healthcare and the importance of changing the experience of health to better meet peoples’ needs.
Dr. Gianrico Farrugia, M.D., CEO of Mayo Clinic in Florida and Vice President of Mayo Clinic, discussed the roles of a servant leader and change agent as well as how to maintain the balance between these two roles. He explained how a servant leader emphasizes a team approach to maximize trust and better serve the needs of the patient. A servant leader needs to have a clear vision and make the rest of his team feel empowered to achieve this vision. “If you want to change health care you need to be a servant leader. Why? Because when you make change, it’s better with support. It’s much more likely to happen. It is much more likely to advance and is less likely to be reversed.”
Clayton Christensen, an icon in innovation, spoke during the final session of Transform 2017. Christensen discussed the theory of disruption and how to bring innovation and new technologies together to disrupt healthcare. He stated, “I actually believe deeply that the only way healthcare can become more affordable and accessible, higher in quality and lower in cost, is if we disrupt it.” He explained the importance of using technology to build new venues of care away from an actual hospital to a more affordable environment. He believes it is time to stop building new hospitals and expanding existing ones, and instead, focus on building a system that maintains the health of the population in all its aspects: from lifestyle and fitness to emotional relationships and community collaboration.
Following each of the conference’s sessions, attendees had the opportunity to ask the panelists questions, participate in discussions, and meet face-to-face with the speakers. Overall, Transform 2017 did an excellent job of fostering a desire to discuss and address the many issues facing our current healthcare system. It stressed how changing our failing healthcare system will not be an easy task, but it is crucial. Transform 2017 offered opinions and observations on how to go about this necessary change before the American healthcare system does, in fact, become terminally broken.
Link: Transform 2017 homepage…