jan kremer's presentation on "innovative prescription"

Jan A. M. Kremer

Nijmegen 25-2-2009

Introduction

• Healthcare is not complex, we have made it complex.

• Sustaining innovations make good things better• Disruptive innovations make things simpler and more affordable

• Transformation of expensive complicated products into high quality, low cost and conveniently accessible is not unique for healthcare

• Disruptive innovations are rarely initiated by leading companies.• Disruptive innovations are not kind for the current companies, but is good for mankind.

Elements of disrupted innovation

1. Technological innovations

2. Business model innovations

3. Value network innovations

Technological innovations

Intuitive medicine Empiric medicine Precision medicine

• Molecular genetics• Diagnostic images• EBM, QBM • Connectivity

Three kind of business models

1. Solution shops: diagnose problems and recommend solutions (fee-for-service)

2. Value-adding process businesses: treating diagnosed problems through a standard sequence of steps (fee-for-outcome)

3. Facilitated networks: professionals and patients exchange with and help each other (fee-for-membership)

Disruption of hospital business model

• General hospital is not a viable business model. • The want to diagnose and treat any disorder that anyone might have.• Overhead is determined by the plant scale, the number of processes

and the number of business models.

Disruption of hospital business model (substitie)

• Disrupt in focused solution shops, VAP’s and networks• Bring the solution to the patient in stead of bring the patient to the

solution

Disruption of general practise

Personal Health Record as coordinator

PHR must be constructed from the point of the patient (Toyota)

Chronic diseases

• Facilitated networks is the best business model

Quality-cost paradox

High quality, high costs?

No!• Affordability comes from reducing complexity driven overhead• Quality comes form rational integration around the patients

Education

Less highly specialized doctors and more nurses, NP and PA

Other medical trained professionals (IT, coaches )

Disrupt the pricing and reimbursement

Problems with present pricing: • Hospitals price all services on a fee-for-service basis. Therefore

there are no transparent prices • Price formulas do not account for supply, demands, systemic values

created, or the differences in business models• All present business models profit from patients’ sickness, rather

than wellness

Who is the orchestrator for this disruption?

1. Long-time perspective2. Make money by keeping us well, not beginning when we become sick3. Know and care about us personally4. Be in my region5. Be capable to implement the needed changes

Integrated fixed fee providers? The patient him/herself? (If MijnZorgNet succeeds in

facilitating the patient)