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Genetics and Health Care Reform
The Long View
From…a novice non-crystal baller
John J. Mulvihill, Heartland
(Thanks to ACMG President Bruce Korf)
Disruptive Innovations Over Time
 Computers:
Abacus; IBM/DEC main frame; HP
calculator; PC/Mac; massively parallel processors
 Communication: Smoke signals; pony express;
telegraph; wired telephone; cellular telephone;
Internet
 Education: Tutor; University; Community
College; On-line
Access by wealthy to access by all
Disruptive Innovations: Elements
1. Technology enabler
2. Business model
3. Valued network
Disruptive Innovations 1
Technology Enabler
Intuitive medicine
What’s the diagnosis?
 Past: Infectious disease; Future: All diseases
Empirical medicine What to do? How to fix?
 Past: Trial-and-error; Future: Mechanism based
Precision medicine Exact diagnosis and therapy
 Past: Strep throat; Future: Genetic diagnosis and Rx
Disruptive Innovations 2
Business model
Solution Shop
Hospital/clinic Mayo/Cleveland
 Fee-for-service; complex; no guarantee
Value-added process Hospital/clinic Heart Hospital
Eye Institute
MinuteClinic
 Fix it; fee-for-output; simple; guaranteed
Disruptive Innovations 2
Business model
Solution Shop
Hospital/clinic* Mayo/Cleveland
 Fee for service; complex; no guarantee
Value-added process Hospital/clinic* Heart Hospital
Eye Institute
MinuteClinic
 Fix it; fee-for-output *But, Crossing the Quality Chasm;
To Err is Human; cost
Disruptive Innovations 3
Insurance
Membership
Value Network
Mutual help Health Club; WebMD
fee
Profit for wellness
Disruptive Innovations
Business model
Solution Shop
Hospital/clinic* Mayo/Cleveland
Gene
 Fee for service; complex; no guarantee
Diagnostics
Value-added process Hospital/clinic* Heart Hospital
Eye Institute
Gene therapy,
pharmacogenomics
MinuteClinic
 Fix it; fee for output
Disruptive Innovations
Insurance
Membership
Value Network
Mutual help Health Club; WebMD
fee
Profit for wellness
Anticipatory
guidance; EMR;
Genetic Alliance;
Social networking
Other thoughts*
Forced productivity gains
Cadillac coverage
Simplified forms
Electronic medical records
Reform of delivery system
Independent commission
Managed competition
A public plan/option
Comparing treatments
Negotiating drug prices
Malpractice reform
*New York Times
November 15, 2009
Editorial, p 9
Other thoughts*
Forced productivity gains
Cadillac coverage
Simplified forms
Electronic medical records
Reform of delivery system
Independent commission
Managed competition
A public plan/option
Comparing treatments
Negotiating drug prices
Malpractice reform
*New York Times
November 15, 2009
Editorial, p 9
Questions?
Comments?