For totally different reasons I've always enjoyed the term "innovation" and the phrase popularized by the NPR CarTalk program "shameless commerce division". With regard to "innovation" I've always assumed the term implied that something wasn't just new, but that it was also better. My recent check of the definition of the word in multiple dictionaries, however, does not support this - all the definitions I find just emphasize newness and novelty - not necessarily improvement. Hmm. With regard to the "shameless commerce division" line ... how can anyone who has enjoyed CarTalk not love such a straightforward laugh-at-themselves reveal of marketing hype? It's delicious.
These two notions came together in my mind while reading the recent JAMA "Viewpoint" piece ... "Delivery Models for High-Risk Older Patients; Back to the Future?" by Powers, Milstein, and Jain.
These two notions came together in my mind while reading the recent JAMA "Viewpoint" piece ... "Delivery Models for High-Risk Older Patients; Back to the Future?" by Powers, Milstein, and Jain.
The article briefly describes two models of care for high-risk older adults focusing on continuity of physician care, one model being the "Extensivist" model developed by CareMore. Two of the authors are employed by the CareMore Health System, a subsidiary of Anthem Inc., which is actively marketing its model to others, and in the piece they report that "The effects of these programs is still being evaluated. Early observational data (based on internal analysis of CareMore Health System data) ... points to substantial reductions in hospital length of stay ... and 30-day readmission rate ..."
OK, so the fact that the evidence presented isn't derived from a rigorous trial design, doesn't actually address total cost, and seems not to have been peer-reviewed is apparent as is the affiliation of Powers and Jain with CareMore in the conflict of interest disclosure information at the end of the article. So while to the careful reader it is apparent that what is offered is a concept for a model that is not yet "proven" or robustly evaluated ... there is little doubt that being able to cast their work in JAMA as promising is a valuable advertising and marketing opportunity.
In an accompanying Editorial by Bauchner, Fontanarosa (both editors with JAMA) and Berwick (IHI) in which the framework and rationale for the Innovations in Health Care Delivery series (to which the above mentioned Viewpoint was a contribution) is explained, one section states that ...;
OK, so the fact that the evidence presented isn't derived from a rigorous trial design, doesn't actually address total cost, and seems not to have been peer-reviewed is apparent as is the affiliation of Powers and Jain with CareMore in the conflict of interest disclosure information at the end of the article. So while to the careful reader it is apparent that what is offered is a concept for a model that is not yet "proven" or robustly evaluated ... there is little doubt that being able to cast their work in JAMA as promising is a valuable advertising and marketing opportunity.
In an accompanying Editorial by Bauchner, Fontanarosa (both editors with JAMA) and Berwick (IHI) in which the framework and rationale for the Innovations in Health Care Delivery series (to which the above mentioned Viewpoint was a contribution) is explained, one section states that ...;
"Innovations in health care delivery, like innovations in other sectors, often depend on start-up funding and sponsorship, such as from corporations, venture capitalists, or philanthropists. Many authors who pursue innovations may have a financial interest in the intellectual property that might derive from successful innovations and therefore will have actual and potential conflicts of interest. As with all articles published in JAMA, all authors will be required to report these interests and financial relationships, so readers will have this information available as they consider the innovation. In addition, many of the innovations that will be described will represent great ideas with much promise, but with limited data to assess their success. We will ensure that the authors do not overstate the value of their ideas."
I can only hope that these editorial guardians understand how completely revved up the shameless commerce division has become throughout most U.S. health care institutions (all sectors). I strongly suspect they do. Finding some balance between early sharing of innovative concepts and inadvertently promoting models that may ultimately prove ineffective will not be easy. Health care has largely fallen victim to what Edward Tufte describes as "pitching out, corrupting within." My biggest fear is that we will just come to accept this as the only way to improve our health care system - tinker with payment reforms while trusting to the commercial market and only the commercial market to redesign care delivery.
Imagine the possibilities if our nation committed to truly, effectively undertaking the serious and disciplined applied research required to discover better models of care to address the monumental, sacred societal responsibility of caring for our aged and chronically ill. I'll bet we could do wonders ... and ultimately come to better understand what really works. The money spent on multiple, large, long-term trials to gain such insight would be a mere pittance compared to what we, in our ignorance, as a society waste today. Though the money does go somewhere ... and why would the somewhere want to see this status quo change?
Imagine the possibilities if our nation committed to truly, effectively undertaking the serious and disciplined applied research required to discover better models of care to address the monumental, sacred societal responsibility of caring for our aged and chronically ill. I'll bet we could do wonders ... and ultimately come to better understand what really works. The money spent on multiple, large, long-term trials to gain such insight would be a mere pittance compared to what we, in our ignorance, as a society waste today. Though the money does go somewhere ... and why would the somewhere want to see this status quo change?