Tuesday, May 08, 2012

Path to Patient

Patient-centered medicine! This phrase gets mentioned a lot nowadays. What does it exactly mean and while thinking about improved patient care what do the stakeholders need to be cognizant about? Here is a an excerpt from the Maizes et. al. (2009) article on integrative medicine and patient-centered care (Commissioned for the IOM Summit on Integrative Medicine and the Health of the Public). "Patient-centered care is defined as care that informs and involves patients in medical decision making and self-management; coordinates and integrates medical care; provides physical comfort and emotional support; understands the patients’ concept of illness and their cultural beliefs; and understands and applies principles of disease prevention and behavioral change appropriate to diverse populations."

A number of articles talking about patient-centered hospital design, new business models (the shift from product-centric culture to a more integrated patient centered company) and other ways to differentiate the drugs/devices with surrogate + value driven outcomes keeps the conversation active. Charles L. Bardes, M.D. gives his perspective on defining patient-centered medicine through this article in NEJM. He mentions an important aspect of patient and doctor working together without any inhibitions. I like the way Dr. Bardes puts it across: 'The patient and the doctor must coexist in a therapeutic, social, and economic relation of mutual and highly interwoven prerogatives.'

The number of smartphone apps are on the rise targeting patient monitoring, health education, data aggregation, and other aspects of the care cycle. New innovative companies are using next generation technologies and leveraging the mobile phones for diagnostic medicine especially targeting developing countries. The number of business opportunities for all emerging entrepreneurs and the life sciences industry are abundant. In the medical device industry, typically 3-5 companies control almost 70-80% of the respective markets and the other 20-30% smaller companies is where disruptive innovation happens. Of course, most of these companies get snapped up by bigger players sooner or later. M&A has been the strategy for many of the big players in the industry. Covidien is an excellent example which has grown significantly due to acquisitions has been very active in buying companies (Barrx Medical, Oridion Systems, Newport Medical Instruments, Reverse Medical, superDimension) within the last year spread across different business units. This again brings back the topic to niche focus and helping patients, in effect, answering the questions - where is the unmet need and how can we solve it?

The strategic focus on keeping the patient at the center affects your marketing and business planning,  R&D innovation, decision making and the most important thing - execution. From medical device and pharmaceutical perspective two emerging themes which address the patient aspects are reverse innovation and personalized medicine. A couple of months back Babson College organized the Healthcare and Life Sciences forum which was based on the theme: Path to Patient. 

Rodrigo Martinez of IDEO brought up an interesting point during this panel - why do we keep discussing about patient experience in healthcare? Some of his thoughts are captured here:
  1. Connect with people – stop thinking about only treating patients 
  2. Health information usually serves a transactional goal – needs to be engagement platform 
  3. Healthcare isn’t a system, it is an emergent network – we should collectively fail, learn and improve 
  4. Market research often confirms the past – needs to open creative doors 
  5. Business goals keep trumping patient experience 
Patient participation is imperative as payers and providers address the cost effectiveness of adherence. The Patient Centered Outcomes Research Institute (PCORI) was created to measure and establish the best practices to deliver more effective care to the patient (compare the effectiveness of health treatments and strategies through research to make informed decisions). Medtronic's Omar Ishrakh had recently brought up the important aspect of delivery model in emerging markets which also relates a lot to the topic of this article.  He emphasized the new patient-centered approach due to lack of medical infrastructure and awareness. The growing fields of HEOR and market access continue to capture the patient perspective focusing on clinical, economic and patient-reported outcomes. The new entities formed as part of the recent reforms can provide the platform to the changing doctor patient relationship. Patient Centered Medical Homes (PCMH) and Accountable Care Organizations (ACO) are bringing the care provider especially the primary care physician  in focus for the entire care delivery process. It will be interesting to see over the next couple of years how these aspects affect the changing dynamics and how participatory medicine integrates with the current system.

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