Morrison is the author of several books including, most recently, Leading Change in Healthcare: Building a Viable System for Today and Tomorrow and The Second Curve - Managing The Velocity of Change. We frequently write about medical innovation, including a recent guest post by Jack Lewin, MD, the President and Chief Executive Officer of the Cardiovascular Research Foundation.
"We have to innovate," Morrison said at the Boston summit. "We have hit a wall." Morrison described several nationwide healthcare trends that create an urgent need for change and new ideas.
A move toward both public and private health exchanges for the purchase of health insurance.
- The country is learning to live on Medicare, which means reducing costs by 10 to 20 percent. "All the assets in the old model become liabilities in the new model," he said.
- Massive consolidation of hospitals continues with the expectation that there will be 100 to 200 large regional systems around the country. The accepted view is "you have to be big, and you have to be integrated," Morrison said, adding the question: "How do you get these behemoths to really innovate?" He later noted, "More of these large behemoth businesses are willing to take the risks. They are getting into the health plans."
- Employers, who have been purchasers of health insurance for their employees, are showing signs of an exit. "Every purchaser has become an activist about wellness – some would say 'Stalinist,'" Morrison said.
As also reported by Health IT News: Morrison argued that there are two competing visions for the U.S. healthcare system: The Berwickinian Nirvana (named for Donald Berwick, former CMS Administrator) of the large ACOs that encourage rationalization of the delivery system and the atomistic view of a consumer armed only with high deductible health plans that will impose market discipline on providers."
"Those two visions need to be reconciled," he said.
There is so much work left to do that requires innovation, Morrison said. He rattled off a few: clinical integration, health IT as platform, learning to live on Medicare, managing business model migration, building a culture of quality and accountability.
"We have the anatomy of an accountable care organization but none of the physiology," he commented.
"When you get in the Triple Aim (improve afforability, improve the patient experience and improve health) work, you have to think in different kinds of innovations," Morrison said. "You have to open your mind. You've got to get serious. I don't think we're going back to the 1970s. The purchasers have had it; they're not going to take it anymore."
One area continually missing from the quality improvement community in discussions around innovation is the lack of discussion around therapeutic innovation. We are not living an extra 10 years because of better organized healthcare. On the contrary we are living longer because life science companies have invested billions in creating innovation that allows us to lead longer and fuller lives. Until that discussion is addressed we are simply focused on moving healthcare workers into larger closed systems which in the end have a hard time innovating.