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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?