HEALTH CARE INNOVATION: a A Vision for the 21st Century Creating the WAKSTorn) ealth care make us healthier, rather than just it work to alleviate the social causes of illness? Can health care be responsive to our differences as biochemically unique individuals? Yes. It can because of the tremendous creative energy in those who are trying to make America’s health care system more and support cost effective, efficient — and caring. If we foste energy, innovation in all parts and at all levels of our health stem will yield the health gains we seck thi lish exactly To leverage this creativity, we need co estal what it is we asa nation want to achieve through health care innovation. We need a vision of health care innovation. Such a vision is outlined in this document. A vision is a compelling statement of ating. Strategy. tactics and operations are essential to what we commit to ¢ this commitment, bur they can lead in the wrong direction unless we are absolutely clear about what we war tocreate. Thus, this pyramid places vision at the top directing strategy, which in turn drives the choice of tactics and operations While many of the conditions needed to achieve our vision for health care innovation exist today, we have placed our vision statement 25 years in the future — far enough into the 21st century to shed our current blinders, acknowledge that profound change will occur, and focus on what we want that change to be What Is Health Care Innovation? Health care innovation covers advances in health promotion, disease prevention and treatment through riew andl cchnologies used in clinical, personal and ona spectrum of better therapy and public health practice. Innovation reli , applied, biomedical, behavioral research — ba epidemiological — and development. It encompasses dramatic breakthroughs as well as incremental improvements. This definition provides a jumping-off point. Innovation also must take on a broader focus if health care is to address the root causes of ill health (such as poverty and crime) or make society more caring and contribute to a more socially responsible culture. To meet chose goals, tomorrow's health care innovation must more clearly incorporate into research human values and social priorities.Be taNeut Care InnovaTi ON THE Brink OF TRANSFORMATION As we look to the future, several trends are likely to change the very nature of health care innovation: ‘The movement toward “accountability” in health care, supported by outcome measures (itself a health care innovation begun in the 1980s), will refocus R&D toward long-term health gains, ‘The revolutions in the information infrastructure, as well as in our knowledge systems, will change how innovation is physically accomplished. Health care will shife its focus from treating symptoms after they arise to preventing illness over the life course, concentrating on syndromes of risk rather than on specific diseases ‘The availability of unique, biochemical information about individuals. will provide powerful tools for customizing health care for each individual. Enhanced information databases will improve the rational use of resources but also pose considerable ethical and social dilemmas with regard to privacy, insurability and knowledge of as-yet-undeveloped genetic diseases, Health care providers increasingly will incorporate newer, diverse approaches into their services — including some from alternative and complementary medicine. Inaddition wo these trends, we are also seeing profound transformations in the traditional engines that drive innovation: Universities face growing costs, declining revenues and the potential of an accountability movement as significant as the one faced by health care. ‘Academic medical centers are threatened by health care reform and by changes taking place in the demand for physicians, particularly the declining need for many specialties. While some pharmaceutical companies are broadening their focus to become “health companies” that opti health gains, the pharma- ceutical industry as a whole faces revenue and profit decline, and sees health care cost-containment efforts as a threat to their capacity for innovation, Although health care delivery is becoming more cost effective systemwide, itis doing so in ways that could threaten to stifle the very innovation needed to enhance its operations and outcomes. For example, current forms of basic research and clinical trials are losing support About the Belmont Vision Project & Health Care Innovation Our effort to develop a vision for health care innovation ‘grows out of the Belmont Vision for Health Care in America. The Belmont Vision is a statement of the best that health care in the United States can be, It was developed to raise the level of the health care debate beyond Important, but tactical, ques- tions, such as financing and ‘access, to 8 level that asks what ‘we want the system to be In the ‘early 21st century. The Belmont Vision has been widely used throughout the United States and beyond as a guide for those prepared to look seriously at the future of health care. ‘One of the main tenets of the Belmont Vision is a call for cost-effective Innovation that enables the health care system to make its greatest contri- bution to health gains. The Belmont Vision describes a 21st century health care system based on “a dynamic model that: both encourages and responds to innovation.” - » Innovations that have ‘resulted from investments in research and development have been incorporated into, the system with greater scrutiny of their effectiveness, cost and the extent to which they meet the needs of society. Economic ‘rewards flow to those systems and those products and services that have the lowest delivery cost with the best health out-comes ond the _greatest patient satisfaction.Exetorinc Avrernative Patuways ror INNOVATION Health care innovation promises to enhance our health and quality of life significantly. Of that, there is no question, But, given the diversity of the trends above, fundamental uncertainties remain about the path that innovation will take. To explore these uncertainties, we developed four scenarios — alternative images of how the future might turn out ‘These scenarios are a convenient way to examine various assumptions about, threats to and opportunities for health care innovation. The full text of these scenarios is available from the Institute for Alternative Futures. Scenarios — Scenario 1: Steady Innovation Focused on Outcomes ‘Accountability and the search for cost-effective care frame the reward structure for pursuing health care innovation, While some major breakthroughs occur, the greatest advances are in terms of disease management and the budding partnerships betw providers and R&D organizations. sn managed care Scenario 2 Innovation Stagnates The escalating costs of discovery and development — coupled with federal funding retrenchment, price controls on drugs and devices, slugeish regulatory approval processes, health care provider-initiated constraints on using expensive new therapeutics, and the failure of biotechnology to produce appropriate breakthroughs — has led to an even riskier RGD environment. There is only marginal health care innovation, and any players deop Scenario 3: Paradigm Shifts Accelerate Innovation New genetic knowledge enables biochemical customization of therapies. Concurrently, enhanced therapeutic and behavioral cools are being developed in partnerships that include leading entertainment and information com: panies. Development costs have been lowered and approvals accelerated due to bio- monitoring, more effective health care provider involvement and dramatic ¢ regulatory processes. Nurses and other health. care practitioners can access specialist knowledge through expert systems and thereby perform many functions and services more cost effectively chan physicians Scenario 4: Innovation That Moves Beyond Treating Individuals The line between innovation and care delivery has blurred as new models provide ways 10 move upstream on many chronic diseas Alternative therapies and community regularly integrated into therapeutic dec ng. The public actively participates in health care innovation, setting priorities for public research dollars and volunteering for clinical tials, approaches