Healthcare needs a revolution - why many healthcare systems around the world will become unsustainable by 2015

In many countries, despite the herculean efforts of dedicated healthcare professionals and the promise of genomics, regenerative medicine and information-based medicine, costs are rising rapidly; quality is poor or inconsistent and access or choice is inadequate.

In Ontario, Canada, for example, healthcare is expected to account for 50 per cent of governmental spending by 2011, two-thirds by 2017, and 100 per cent by 2026, unless a radical approach to healthcare is adopted. These problems, combined with emergence of globalisation, consumerism, demographic shifts, the increased burden of disease, and expensive new technologies and treatments are expected to force fundamental change in healthcare within the coming decade.

Healthcare systems that fail to address this new environment will likely ‘hit the wall’ and require immediate and major forced restructuring - a ‘lose-lose’ scenario for all stakeholders.

Change must be made; the only questions are when and how.

In the IBM win-win scenario, healthcare systems can be come national assets rather than liabilities. They can help the citizens they serve lead healthier, more productive lives, and their countries and companies compete globally.

They will also help these countries win a competitive advantage in the emerging global healthcare industry.

Specifically, IBM recommends that:

• Healthcare providers expand their current focus on episodic, acute care to
  encompass the better management of chronic diseases and the life-long prediction
  and prevention of illness.

• Consumers take personal responsibility for their health and for maximising the value they receive from a transformed healthcare system.

• Payers and health plans help consumers remain healthy and get more value from the healthcare system and assist care delivery organisations and clinicians in delivering higher value healthcare.

• Suppliers work collaboratively with care delivery organisations, clinicians and patients to produce products that improve outcomes or provide equivalent outcomes at lower costs.

• Societies make realistic, rational decisions regarding lifestyle expectations, acceptable
  behaviours, and how much healthcare will be a societal right versus a market service.

• Governments address the unsustainability of the current system by providing the leadership and political willpower needed to remove obstacles encourage innovation, and guide their nations to sustainable solutions.
  

The care delivery transformation

A key element in the win-win transformation of healthcare is a fundamental shift in the nature, mode and means of care delivery. By 2015, we expect that the notion of preventive healthcare itself will expand, combining eastern and western approaches and the best of the old and the new.

Consumers will seek this care in new settings, such as retail stores, their workplaces, and their homes. They will realise lower prices, more convenient and more effective delivery channels than traditional healthcare venues. Preventative care will be delivered by mid-level providers – including doctor’s assistants, nurse practitioners, nutritionists, genetic counsellors, and exercise experts – in close co-ordination with doctors.

By 2015, we believe chronic patients will be empowered to take control of their diseases through IT-enabled disease management programmes that improve outcomes and lower costs.

Patients and their families, assisted by health infomediaries, will replace doctors as the leaders in chronic care management, a shift that will eliminate a major contributor to its cost.

We also anticipate that standardised approaches to acute care, developed through the careful analysis of clinical data and the unrelenting documentation of patient variation, will be a widespread starting point in care delivery.

The availability of high quality care information will enable the treatment of non-urgent acute conditions, such as strep throat and sinusitis, at the patient’s home via the use of telemedicine or at retail settings that provide low cost, good quality and convenience.

This will free doctor time and encourage the transformation of today’s massive, general purpose hospitals into ‘centres of excellence’ devoted to specific conditions and combination triage centres, and post treatment recovery centres, in which patients are monitored before returning home.

Win-win transformation

The transformation challenge facing many healthcare systems globally is daunting. They must expand their primary focus on often poorly co-ordinated management of preventive, acute and proactive chronic care.

This expansion must be achieved with limited incremental funding in an increasingly competitive global economy and healthcare environment. This task will further require the establishment of a clear, consistent accountability framework supported by aligned incentives and reconciled value perspectives across key stakeholders. But, the rewards of successful transformation are correspondingly high. Successful transformation will require all stakeholders to actively participate, collaborate, and change.

Written by Kevin McGowan, IBM Institute for Business Vaue.

This article is based on report written by the IBM Institute for Business Value which develops fact-based strategic insight around critical industry-specific and cross-industry issues.

The report can be downloaded from the web at http://www.ibm.com/healthcare/hc2015. Kevin McGowan can be contacted at kevingow@ie.ibm.com