Friday, August 14, 2009

Health Innovators Series: Betsy Dietz and the medical home for a global workforce

Betsy Dietz is one of the executive leaders in IBM's Global Business Services Healthcare Practice. She is passionate about improving efficiency and outcomes in healthcare and is a strong proponent of the patient centered medical home initiative.

Can you introduce yourself?

I'm a partner in IBM's Global Business Services Healthcare Practice. I have been the executive managing our WellPoint partnership for the last several years. I'm participating in the X-Prize initiative because I think it will drive innovation that matters in making a positive difference in the quality of people's lives. Innovation that matters is what motivates me and in fact it's one of IBM's core values.

As a very large employer, what challenges does IBM face in providing healthcare?

IBM certainly has a challenge in providing health care and insurance to over 300,000 people in IBM. All too often our employees receive woefully inadequate care from their physicians. The New England Journal of Medicine actually says that Americans receive only about half of the recommended evidence-based care that they require. Our employees get frustrated when they can't get timely appointments with their physicians or when their office experience feels like riding an assembly line conveyor belt. They also get frustrated when they don’t get calls back or their calls returned or when they can't get information like their lab results. We also hear from experts that as much as half of the American healthcare spend provides no benefit to Americans.

We really need - we would love to have - a plan that would provide alignment between incentives and compensation to the value that our employees receive in the medical system. We've been active participants in the Patient Centered Medical Home that begins to focus on the relationships between all the entities involved in care processes -patients, physicians, other providers, payers, and plans. I can imagine that one of these teams might want to compete for the X PRIZE by leveraging a medical home strategy as their approach.

Describe the competitive challenges that you face in relationship to rising medical costs?

As a nation we have the highest per capita healthcare spend among developed nations. We are more than 2-3X most other countries despite our democratic, free-market economy. Unfortunately, this gap is widening which is causing American Companies to lose their competitive edge as we compete in a global economy. IBM has been a pioneer in integrating a global workforce and we are attempting to help our worldwide clients do the same. We understand the challenges of leading multinational and multicultural teams in multiple time zones. We certainly have been taking on the challenge of increasing health care cost in the United States which clearly impacts the price of IBM products and services.

How does healthcare and health insurance impact the productivity of your workforce?

Well I think to address the productivity challenges that we have we really need to move from a healthcare system that is reactive, that only treats people after they're ill, to one that focuses on prevention and wellbeing. We would love to work with our partners to provide coaching for our employees. We believe that we need health coaching to help our employees permanently adopt healthier lifestyle and make the changes they need in their lifestyle and behavior choices. We think we need health value coaches that will help our employees navigate the healthcare system and to find optimal value. This would also include assistance with transparency, including helping employees find high quality providers, alternative treatment modalities, and traditional consumer decision making tools in making health decisions. They need not only to select the best plans for themselves and their families but also begin to plan their health care expenses over their lifetime just like they do with other retirement or financial planning expenses. We hope this focus accelerates that transition to a healthcare system that's centered around the patient.

What are the challenges that the healthcare industry faces as a whole?

Despite having many fine care delivery organizations and caregivers, the US healthcare system is badly broken. I'll assert that our current system is not sustainable. We have high and rapidly rising cost. And there's no linkage between that cost and the quality of care in our system and we have nearly 100,000 people dying each a year from preventable medical errors. We have another 57,000 people dying from inadequate care. And we have almost 90,000 people a year dying from hospital-acquired infections. it must be an absolute imperative that we improve the quality of care in America.

If you look at America compared to other developed countries, out of the top 30 countries we're actually 22nd in life expectancy out of 30; 28 in infant mortality; and rock bottom last in obesity. These are serious problems that have to be addressed. We also see a fourfold variances in cost for the similar or same outcomes being achieved by others. Can you imagine buying a car that is four times as expensive for the same level of function and quality as an alternative? This happens every day in healthcare because we have no idea where to turn for quality. I also think that these problems can't be solved by just turning to government intervention. Certainly can't be solved by throwing more money at it either. I think this is an "all hands on deck" urgent call! We are going to need radical innovation in order to make this happen. Again, this is where I really believe that an X PRIZE competition can create an environment for this radical transformation to occur.

Given the recent economic change that we've had how do you think we should approach healthcare?

The economic difficulties in the United States and the world are gonna affect possibly all aspects of our lives and certainly healthcare is no exception to that. We will continue to see the high number of Americans who are uninsured today, and those numbers could go higher. This highlights again that there has never been a greater need for innovation. We need to see, um, major reform on several fronts. We need to see individuals accept responsibility for their own health and well being and start making those healthy lifestyle changes they know they need to make. We need to enable our primary care physicians to treat the whole person and to provide the medical home that we've been talking about. And with these economic conditions above all we must find a way to deliver higher value, higher quality and safety at an affordable price.

Why do you think the X PRIZE model is a good way to address those challenges?

I think an X-Prize is an excellent way to address these challenges because incremental innovation is not adequate to meet the demands that we face as a nation. Historically companies have focused on innovation at the product and services level. And we have seen tremendous advances as a result: 3D imaging, advanced pharmaceuticals, new devices, etc. We have more recently seen companies innovate at the business process level. E-prescribing is a great example of that. It really streamlines the process between the patient and the provider and the plan while providing measurable gains in quality and cost containment.

But today plans really need to innovate at the business model level to redefine how healthcare is provisioned and financed in this country. I think that the X-Prize is an excellent way for us to drive radical innovation forward in these revolutionary times. I believe we can create a forum for employers and providers, health plans, government leaders and individuals to come together to not only define these challenges issues but foster the innovation solutions that will help us overcome this incredibly complex issues. X PRIZE has as demonstrated history of using prizes to reward revolutionary change.

What kinds of outcomes do you hope will result from this process?

I am delighted to be working with key WellPoint leaders on the Healthcare X PRIZE iniative. I can envision a system wherein primary care physicians treat the whole patient and where an individual's information is collected and analyzed for insight that can power the entire ecosystem. This will require care continuity between physicians, more more aligned incentives, and compensation based on outcomes versus volume. The X PRIZE provides a framework in which we can really drive to higher quality and safety at a significantly lower price. I am confident that the Healthcare X PRIZE competition can actually accelerate our transition to a sustainable healthcare system that is centered around the patient.
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