Medical Device Daily Executive Editor
SAN FRANCISCO – Thrust. Drag. Lift. Gravity.
Like the principles involved in aeronautics, Dorman Followwill, a Frost & Sullivan partner and group vice president of healthcare and life sciences, constructed a "four forces" model to discuss "The Future of Healthcare" during the firm's annual Medical Devices Executive Summit at the Hyatt at Fisherman's Wharf.
Referring to his presentation as "a 30,000-foot view of our space," Followwill said thrust force No. 1 is patients. "Everything we do, we do for patients," he said, characterizing patients as "the great drivers of this space."
Noting that healthcare has seen "a vast surge of demand," he said this demand has been accompanied by "an upsurge of patient awareness," with the patient of today being "totally different from the patient of 10 to 15 years ago," thanks to the vast amount of health-related information on the Internet.
Patients have become "self-determining drivers of healthcare, dictating what technologies will be developed and made available, demanding greater and easier access to care and suggesting therapy alternatives," he said.
"Patient awareness is shooting through the roof" at the same time as they are aging, he said, adding: "These are what we call power patients.'"
He cited champion cyclist Lance Armstrong as a prototypical example of a power patient, noting that upon being diagnosed with testicular cancer, Armstrong "devoured" information about the disease and determined his own therapy path.
"He said, I want to be treated at Indiana University Hospital, and I want this treatment path,'" Followwill said.
Referring to the advent of the super-informed patient as "an amazing revolution," he said "the patient of today and tomorrow will be more like Lance Armstrong" than were those of prior generations who simply accepted what their physicians told them as gospel.
"This is not a singular phenomenon," he declared. "It is a huge trend."
Noting that 80% of Americans have searched for health information online, he said this dovetails with such Bush administration initiatives as posting "report cards" of hospitals' performance on the Internet.
Thrust force No. 2, Followwill said, is "the huge amount of money flowing into healthcare," both in terms of investment in healthcare-related companies and in healthcare infrastructure.
One of his accompanying slides indicated that $12 billion to $25 billion would be spent annually on hospital construction over the next 10 years. An accompanying quote from an executive of a construction firm specializing in hospital projects crystallized what is occurring in that sector: "We are essentially rebuilding the infrastructure of our healthcare system. It's the strongest construction market that I've ever seen in 40 years in healthcare."
Offsetting the thrust forces is Followwill's "drag force" No. 1: a collection of factors he lumped together under the omnibus title "Financial Madness" – among them, the pool of uninsured, which he said cost hospitals $20 billion a year and is growing rapidly. And paperwork is taking a huge bite out of healthcare budgets as well.
"We're hamstringing our providers with paperwork requirements," he said, noting that, as just one example, "every hour of actual patient care provided in the emergency room requires one hour of paperwork."
You'd think that would be better, say, for home health.
Not so, Followwill said. In that setting, an hour of patient care averages out to 48 minutes worth of paperwork.
Then there is what he characterized as "the unsustainable profit model of Big Pharma, with fully 85% of pharmaceutical firms' profits resulting from their U.S. sales and those firms posting an average profit margin of about 19%."
Drag force No. 2 in Followwill's model is regulatory slowness. The unanswered question, he said, is "Can the FDA streamline its regulations for great technology?" For instance, citing the technology advances that are helping speed the drug-discovery process, he asked rhetorically: "Does that accomplish anything if there's still a bottleneck in the approval process?"
Regulatory slowness, he said, "is still a significant drag."
On the "lift" side of his aeronautical analogy is lift force No. 1, what Followwill described as "point-of-care heroes" at the provider level. Citing a personal example, he said, "a lot of these folks are heroes in the trenches."
He noted that, while we hear a lot about dissatisfaction with healthcare, surveys have shown that a large majority of patients actually are satisfied with the quality of medical care provided. He cited one survey that showed just 8% of respondents who said they were "not too satisfied" or "not satisfied" with their care. And this, he said, despite the "regulatory morass" that healthcare providers have to face on a daily basis.
Lift force No. 2, Followwill said, is data and technology. Healthcare is poised to be "revolutionized" by information technology, he said, as we move into an era of "information-based medicine."
He said we'll see integration of all relevant information about a patient's "medical, genealogical and environmental history," adding that providers in all clinical settings will be able to "seamlessly access and add to a patient's medical history."
Noting "a vast data explosion going on" measurable "in truckloads of information," he said that "management of this data will separate winners from losers" among companies in healthcare.
A countervailing gravity force No. 1 in his model is the slowness of technology adoption by healthcare providers. "When you go to a doctor's office," he said, "you're met with a sea of paperwork."
And, Followwill added, drawing a knowing laugh from his audience, "some grocery stores have better technology than do our hospitals."
Gravity force No. 2, he said, is the strapped provider infrastructure in the U.S., with "razor-thin profit margins" overburdening hospitals at a time when they are being inundated with more patients who are sicker patients but also more educated and more demanding about receiving the latest treatments available in the marketplace.
The next 10 to 15 years will be "a bumpy ride for healthcare," Followwill said, but that the investments being made in infrastructure "will pay off, and technology will provide a strong lift" for the sector.