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Genetics and Health Care Genetics and Health Care Reform Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

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Page 1: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Genetics and Health Care ReformGenetics and Health Care Reform

The Long View

From…a novice non-crystal baller

John J. Mulvihill, Heartland

(Thanks to ACMG President Bruce Korf)

Page 2: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Page 3: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Disruptive Innovations Over TimeDisruptive Innovations Over Time

Computers: Abacus; IBM/DEC main frame; HP calculator; PC/Mac; massively parallel processors

Communication: Smoke signals; pony express; telegraph; wired telephone; cellular telephone; Internet

Education: Tutor; University; Community College; On-line

Access by wealthy to access by all

Page 4: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Disruptive Innovations: ElementsDisruptive Innovations: Elements

1. Technology enabler

2. Business model

3. Valued network

Page 5: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Disruptive Innovations 1Disruptive Innovations 1Technology Enabler

Intuitive medicine What’s the diagnosis? Past: Infectious disease; Future: All diseases

Empirical medicine What to do? How to fix? Past: Trial-and-error; Future: Mechanism based

Precision medicine Exact diagnosis and therapy Past: Strep throat; Future: Genetic diagnosis and Rx

Page 6: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Disruptive Innovations 2Disruptive Innovations 2

Business modelSolution Shop Hospital/clinic Mayo/Cleveland Fee-for-service; complex; no guarantee

Value-added process Hospital/clinic Heart Hospital

Eye Institute

MinuteClinic Fix it; fee-for-output; simple; guaranteed

Page 7: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Disruptive Innovations 2Disruptive Innovations 2Business model

Solution Shop Hospital/clinic* Mayo/Cleveland Fee for service; complex; no guarantee

Value-added process Hospital/clinic* Heart Hospital

Eye Institute

MinuteClinic Fix it; fee-for-output

*But, Crossing the Quality Chasm;To Err is Human; cost

Page 8: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Disruptive Innovations 3Disruptive Innovations 3

Value Network

Insurance Mutual help Health Club; WebMD

Membership fee Profit for wellness

Page 9: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Disruptive InnovationsDisruptive InnovationsBusiness model

Solution Shop Hospital/clinic* Mayo/Cleveland Fee for service; complex; no guarantee

Value-added process Hospital/clinic* Heart Hospital

Eye Institute

MinuteClinic Fix it; fee for output

Gene Diagnostics

Gene therapy, pharmacogenomics

Page 10: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Page 11: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Page 12: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Disruptive InnovationsDisruptive Innovations

Value Network

Insurance Mutual help Health Club; WebMD

Membership fee Profit for wellness

Anticipatory guidance; EMR;Genetic Alliance; Social networking

Page 13: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Page 14: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Page 15: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Page 16: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Page 17: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Page 18: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Other thoughts*Other thoughts*Forced productivity gainsCadillac coverageSimplified formsElectronic medical recordsReform of delivery systemIndependent commissionManaged competitionA public plan/optionComparing treatmentsNegotiating drug pricesMalpractice reform

*New York TimesNovember 15, 2009Editorial, p 9

Page 19: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Other thoughts*Other thoughts*Forced productivity gainsCadillac coverageSimplified formsElectronic medical recordsReform of delivery systemIndependent commissionManaged competitionA public plan/optionComparing treatmentsNegotiating drug pricesMalpractice reform

*New York TimesNovember 15, 2009Editorial, p 9

Page 20: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Questions?

Comments?

Page 21: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Page 22: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Page 23: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Page 24: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Page 25: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Page 26: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Page 27: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

Page 28: Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

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