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Unlocking Innovation in the United States and Germany: Coverage, Quality, Cost, and Regulation

Unlocking Innovation in the United States and Germany: Coverage, Quality, Cost, and Regulation. The Perspectives of Patients, Doctors, and Pharmacists. Glenn S. Forbes, MD CEO, Mayo Clinic Rochester July 17, 2007.

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Unlocking Innovation in the United States and Germany: Coverage, Quality, Cost, and Regulation

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  1. Unlocking Innovationin the United States and Germany:Coverage, Quality, Cost, and Regulation The Perspectives of Patients, Doctors, and Pharmacists Glenn S. Forbes, MDCEO, Mayo Clinic Rochester July 17, 2007

  2. In 1997 at 21, Tiger Woods becamethe youngest player ever to winthe U.S. Masters golf championship with an unprecedented 18 below par Changed his swing! So what did he do next?

  3. One of the greatest obstaclesto innovationis “entrenched success”

  4. Leadership/vision Structure/process Human element External environment Ingredients for Innovation 1 +/– +/– + – 2 3 4

  5. 1 Leadership/vision There is no clear visionfor a health care system from within our society, nation, or individuals

  6. McClure Dilemma… We can have 2 or maybe 3 …Choose LowCost HighQuality AccessAvailability High TechScience 1 Leadership/vision What do we want?

  7. “What level of careis a right versus privilege?” 1 Leadership/vision

  8. “What type of needs of individualand society should be prioritized?” 1 Leadership/vision

  9. “What is the responsibility of the individualto society and society to the individual?” 1 Leadership/vision

  10. “What is the appropriate level of resourcesthat should be used for health care?” 1 Leadership/vision

  11. No nation has the perfect model… government–profession–public ...must work together 2 Structure/process

  12. Models Vary 2007 Population 300M 82M 60M 33M 9M USA UK Canada Sweden Germany 2 Structure/process

  13. Outcomes • Cost • Access/availability • Perverse incentivesby government/market • Fragmentation Challenges in USA 2 Structure/process

  14. Best value does not existin health care as in other service or commodity areas • Lack of system engineering • Inadequate and inefficientmodels • Perverse incentives 2 Structure/process

  15. Suggested Discussion • Each nation must createthe environment that allows appropriate models to succeedthat achieve society’s goals • Each nation must align laws, payment, training, incentivesto achieve this goal 2 Structure/process

  16. 3 Human element • Culture of innovation • Professional teamwork • Communication

  17. 4 External environment Perverse incentives • Focus on processrather than outcomes • Financial model

  18. 4 External environment Financial ModelIssues in play Cost Shifting Insurance for All End-of-Life Care Integrated Care Focus on Technology Pay for Value Pay for Performance

  19. 4 External environment Outcomes(results) Process • Focus on compliance to processruns the risk of inhibiting innovationby the best providers • Only effective way to addressvalue in health care is to rewardends–results–outcomes rather than process

  20. Is there an innovative solution?

  21. Reactive(defense) Proactive(offense) Illness Wellness Art Science Episodic Lifetime Fragmented Integrated Portion(piece) Comprehensive(1° thru 3°) Tomorrow’s Health Carethrough Practice Transformation

  22. Climb… It is human nature to grow,improve, innovate… • Achievenew heights Reach…

  23. IndividualizedMedicine Population Medicine Human Genome

  24. Prediction Prevention Diagnosis Treatment Understanding Prognosis/Palliation Individualized Medicine

  25. Outcomes Patient Data Objectives Enterprise Data Trust Computational Biology Genetic epidemiology Research Etiology Progression Risk analysis Prevention Clinical Clinical Biological Diagnosis Prognosis Decision Support Informatics/Computation Data Governance EDT Treatment Patients Staff Educational Public Profession Cure Wellness Qualityof life Value Services • Education • Laboratory • Imaging • Consulting Business Licensing Implementation of Individualized Medicine

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