Notes from the Road: Global South Summit 2013

NASHVILLE | At the Global South Summit last week, I moderated a panel on one of my favorite topics: transforming healthcare into health.

There is much discussion about how the current model of healthcare is “broken.” But the fact is, the system is producing exactly what it was designed to produce. The problem is that the current healthcare model was designed around brick and mortar buildings supporting the delivery of services and procedures. It is a sector with misaligned and misplaced incentives that leads to inefficiency and lowered productivity.

Calling it “broken” suggests that we need to return it to a previously working state. The truth is we need a radical redesign.

In tackling that question, I was joined by a panel of some of the top innovators in the country.

  • Jean Claude Saada, Chairman, Cambridge Holdings;
  • Dr. Clare Pomeroy, President and CEO, Lasker Foundation;
  • Dr. Jeffrey Balser, Vice Chancellor, Vanderbilt Medical Center;
  • Bill Gracey, President and CEO, Blue Cross/Blue Shield, Tennessee; and
  • Dr. Eric Bing, Director of Global Health, George W. Bush Institute, Southern Methodist University.

As Chairman and CEO of Cambridge Holdings in Dallas, Jean Claude Saada is launching a new strategic initiative to create “mindful living communities” and innovation hubs in major cities and research centers around the US and world: oneC1TY.

The idea, Saada said, came from speaking with his own grandmother. She lives in a small community surrounded by her friends and family. She walks to the market, to church, eats and cooks at home daily and grows her own produce. Her life and relationships are centered on a community within walking distance and includes everything she needs. The anecdote is backed by research into communities where people live the longest. Researchers found that they tended to have leaner diets and access to fresh food. They were active. They kept their minds active. They conversed more with family and friends and lived outdoors. Saada was inspired to deliberately build similar communities that enable healthy living.

Before Claire Pomeroy took her role as President and CEO of the Lasker Foundation, she served as Vice Chancellor and Dean of the UC Davis Health System. She knows that the mission—health—is often forgotten. When looking at the determinants of health, only 10% is actually health systems, she said. The rest is determined by behavior, genetics and social determinants. For example, the largest driver of children’s health is the educational status of mom!

Health outcomes just don’t improve unless you address the social determinants of health, and Pomeroy called for community partnerships to address the biggest needs, whether that’s violence, mental health, or dental care. We also have to address education, transportation and food deserts, she said. (Read a great article from the Washington Post on the food deserts in our country). The focus must shift and non-traditional partnerships must emerge. Pomeroy called for a culture change, a look at the big picture, and “health in all policies.”

I asked Jeff Balser at Vanderbilt Medical Center what role university medical centers should play in helping us move health and healthcare forward. He stressed the importance of research, and noted that it is changing as well. The system of doing research, publishing it and hoping it is impactful in 20 years is not the current case, he said. Now researchers could watch the discovery of a gene in their training lab actually guide drug design and make it to the market in a clinical trial within the time it takes to complete their PhD.

Big data, Balser said, is emerging both as a research resource and a care resource. For example, each case of diabetes is different with a different prognosis and outcome because the natural history of a diagnosis is patient specific. My mother’s diabetes is not my best friend’s diabetes, so offering them both the same treatment plan is not maximizing the impact of the health intervention.  Personalization of treatment based on not just genetics, but the social determinants of health can be a challenge but it is also an amazing opportunity.

Bill Gracey took on the questions of the financial and business model shifts as we change our thinking from “healthcare” to “health”. Bing echoed Pomeroy: To look at money, structure and lifestyle issues individually and not collaboratively is a road to nowhere. The health insurance industry, in an attempt to bring various aspects together, has invested several million dollars in wellness portals that incentivize wellness, Bing said. Not for having better health, he noted, but for doing the right things. Blue Cross Blue Shield has also focused on palliative care and chronic disease management as a space needing more integration but facing challenges in current payment models.

Eric Bing brought a global perspective to the topic. After the genocide in Rwanda, communities had massive health needs and minimum resources. So they innovated. Each community nominated health workers that were in charge of going house to house to determine issues as basic as “Who is ill here?” and  “Who is pregnant here?” and “Do they have a toilet here?”  This information was relayed to doctors using cellular phones to aggregate data so resources could be organized. There was also significant task-shifting to mid-level providers and non-medical professionals to save costs.  While these interventions may seem simplistic, they were lifesaving.  Simple needs assessment and allocation of resources in the most efficient way seems like a no-brainer, but in an economy where we have so much, we tend to forget these principles.  But in the circumstances of a crisis, they are the only hope.  As the U.S. approaches the rising healthcare crisis, though not as acute, we should consider these types of simple solutions.

Bing agreed with a tenet I’ve long believed to be true: disease knows no boundaries and health care is a great way to do diplomacy. U.S. leadership in HIV has made a huge difference across the board, Bing said. It has made a difference in maternal health and clean water and other issues. The US commitment is steady right now, but he challenged that it could be more.