I had the honor of taking part in a panel on the future of hospitals today at the World Economic Forum in Davos, Switzerland. The central question before us was this: “How can providers be more effective at addressing the social determinants of health before more patients arrive at the hospital door?”
We started with the bad news. An estimated 100 million people a year are pushed into poverty because they cannot afford to pay for the health care they need. And too many people do not have access to the advances of medical care. That is as true in my home town of Philadelphia, which hosts prestigious academic health institutions, as it is in Johannesburg or Durban. Philadelphia has the dubious lead among major U.S. cities when it comes to the greatest difference in average life expectancy between any two zip codes. (There is a 20-year gap.)
But there were also clear themes in panelists’ answers today, from India, the United Arab Emirates, and other locations around the globe. Here are a few of my take-aways:
- We need to use technology to create “health care with no address.” We cannot build enough hospitals, or spend enough money, to treat everyone with legacy hospital-based systems of care. Telemedicine will be the treatment platform of the future.
- In an age in which augmented intelligence will take over the tasks of memorization and robotics, we need clinicians who are selected and trained to be human, to be creative, and to be empathetic.
- We need to merge population health and personalized medicine to ensure highly targeted care for individuals and communities identified with genetic risks for disease. Personalized medicine may in fact give us a breakthrough in risk stratification for populations.
- We need to understand what’s called complex care, targeting the 5 percent of patients who account for 50 percent of health care costs by focusing on mental health, physical health, and social health.
- We need to think globally and borrow from each other. Health care in Durban is much like it is in Philadelphia: excellent health care in one neighborhood but huge barriers to access that care in another neighborhood. One of the revolutions we need to see in medical education is creating the “global physician,” able practice seamlessly in different nations, and to cross-fertilize the best ideas.
- We need a far more diverse group of clinicians. Instead of selecting students based on standardized tests, we should be selecting them for experience and emotional intelligence. We must excite young women and men from all backgrounds about the profession of health care, give them the confidence to pursue it, and then accept them into our schools.
My overarching thought after the World Economic Forum is this: I can’t wait for a future Davos when we talk less about self-driving cars, and more about self-healing humans. That future is close. If we can combine ideas from consumer industries about engaging with people and applying the technology that gives each of us control of our own health data, we can disrupt legacy health care delivery in profound ways.
Panelist Shobana Kamineni of Apollo Hospitals in India said it best. “In India, we cannot build enough hospitals. The mobile phone is the disruptive technology, and that is where the hospital will move.”
That disruptive vision can be made to work across income levels. It is easier to move health care to a phone than it is to move hospitals to remote communities. In fact, I believe we must get care to where patients are instead of getting patients to where care is located. That is a revolution that is starting now.
To help power this new disruptive platform we will need a new clinical workforce. Today’s medical education tends to suck the creativity out of students in pursuit of a century-old model of making doctors into robots. A hundred years ago, we needed doctors who could remember details stretching from biochemistry to anatomy. Today we need doctors who can interpret computer analysis and make sense of it for real people. We need doctors to answer the question “What does this mean?”
Last year at the World Economic Forum, Jack Ma, the founder of Alibaba, said, “When we invented cars, we didn’t try to teach our kids to run faster. When we invented planes, we didn’t teach them to fly.” A computer will always know more than a physician, but it will never be as wise. Clinicians need to be the humans in the room, even if that room is virtual.
As an obstetrician, the example that makes this clear to me centers on a baby with Down syndrome born to parents who weren’t expecting it. The first question the parents usually ask is some form of “What does this mean?” I’ve seen good obstetricians answer by describing the genetic basis for Down syndrome. I’ve seen great ones answer by saying “It means you’ve delivered a beautiful baby who will love you very much. And we will connect you with other parents who have delivered beautiful babies like yours so you can share experiences.”
The future empathetic, creative, and communicative clinical workforce will have one great challenge: understanding that 80 percent of what determines a person’s health comes from factors outside of direct medical care. We know health depends on employment, education, and opportunity. We know that your zip code is a better predictor of your health than your genetic code. We know less about how to translate that knowledge into better health care that reduces disparities in outcomes between groups and communities.
But we have some powerful starting points for bringing our understanding of social determinants of health into direct health care.
We need to stop separating mental health from physical health. We keep them apart through our thinking, our billing, and our siloed disciplines. Yet we know that adverse childhood events cause chronic diseases, that isolation kills, and that heart failure and depression are deeply linked.
We also know that the interventions that save the most money are often simplest. Taking the time to teach makes as much difference in treating a chronic illness as the wonder drugs we can prescribe. As Upton Sinclair wrote, “It is difficult to get a man to understand something, when his salary depends upon his not understanding it.” Translated to health care, that means if we pay for procedures and drugs, we’ll get more surgeries and prescriptions.
If we fail to embrace disruption, the consequences of clinging to legacy systems of care will become even greater, further growing a fragmented, expensive, inequitable health delivery system. The U.S. has strung together popsicle-stick-and-glue federal policies that continue to graft Star Trek-level medicine onto a Fred Flintstone delivery platform. It’s not working for us, and it won’t work globally.
According to Vanessa Candeias, who heads the initiative for the future of health care at the World Economic Forum, “Half of the world’s population still does not have access to a basic package of health care services. We have a very long road ahead.”
My prescription for an optimistic future for health care is straightforward: Embrace disruption. Make the patient the boss. And remember that our challenge as we create an optimistic future for health care, is envisioning communities of people who are physically, mentally, and socially healthy.
Stephen K. Klasko, M.D., is the president of Thomas Jefferson University and CEO of Jefferson Health.