William Haseltine is chair and president of ACCESS Health International, a nonprofit organization he founded in 2007 that fosters innovative solutions to health care challenges globally. The founder of several successful biotechnology companies, he also founded Human Genome Sciences, where he served as chairman and CEO until 2004. Previously, Haseltine was a professor at Harvard Medical School and Harvard School of Public Health. He spoke in the 2019 Aspen Ideas: Health session Rebuilding the Patient Experience.
The health care system in the United States is inefficient. Our country spends more on health care than any other developed nation. Eighteen percent of GDP goes toward health — more than three trillion dollars each year, with the number expected to double by 2027.
What do we get for all that spending? Very little by international standards. Today, the United States ranks thirty-fifth in health outcomes among the 195 nations of the world. When measuring things like infant mortality, maternal mortality, and death under the age of five, the United States ranks well behind all other countries in the Organisation for Economic Co-operation and Development (OECD) — even below Cuba and Slovenia. All that, despite spending almost twice as much of our GDP on healthcare as other OECD countries.
The real cost of the ineffectiveness of our healthcare system is not borne by our government. It is borne by each of us — the patient — and the impact on our overall health and well-being. We all have a right to better and higher quality care in the United States, at a cost that both we and our country can afford.
There is no doubt that our healthcare system is in need of transformation. The question is how might we restructure it? Based on my years studying the most effective healthcare systems across the globe, there is one solution that may prove to be the answer we need: integrated, patient-centered care. Integrated, patient-centered care means that every element of our health system is working toward improving the quality of care offered to patients. It means care is delivered when and where the patient needs it, whether that be at home, virtually, at a mobile clinic, or at a traditional community clinic or hospital. It means health records and medical information are shared appropriately with every provider who comes in contact with the patient, whether that is an emergency service provider, a primary care doctor, or a specialist at a tertiary care facility. To be truly effective, an integrated, patient-centered healthcare system would be tied together by a seamless information system using the latest and the best technology available to us.
The power of technology lies in its ability to tackle the iron triangle of healthcare — quality, access, and cost — by mitigating the usual trade-offs between the three. Through digital and information technology, it is possible to transform health systems to deliver high quality patient-centered care, all while saving on costs.
I’ve seen how a focus on patient-centered care, coupled with the latest technology, can reduce costs and improve care. Ten years ago, NYU Langone Health was a failing medical institution. The combined losses of its medical school, hospital, and research activities threatened to bankrupt not only the medical center, but the entire New York University system. The quality and safety of patient care ranked in the bottom third of the then 90 academic medical centers. The medical school was ranked fortieth or below. And support for research was declining at a time when external research support for many other institutions was increasing rapidly.
Then came new leadership and a new CEO and Dean, Dr. Robert I. Grossman and his vision of a world class, patient-centered, integrated academic medical center. The words patient-centered were the key to Dr. Grossman’s vision. To Dr. Grossman, patient-centered meant everyone who was a part of the medical center, from the cleaners, the researchers, the IT staff, and the nurses and doctors. All of these people, he thought, understood their role was to improve the patient’s experience and quality of care in whatever way possible.
One of Dr. Grossman’s very first steps was to build a first-rate modern information environment. This meant doctors had readily available, detailed, transparent information about the health of each patient. The information system was designed to be comprehensive and to allow real time, interface free, integrated, and actionable data to be shared horizontally and vertically across the organization.
For the first time, the information technology system gave providers and administrators real-time analysis of the effectiveness and safety of every procedure, measurement of the fixed and variable cost of each treatment, and a quantified understanding of patient satisfaction in real time. The information technology also created the basis for real accountability for everyone within the NYU Langone system.
The information technology system was the critical lever of change that lifted NYU Langone from near bankruptcy to one of the very best medical institutions in the United States. Over the last few years, NYU Langone has been rated in independent surveys as offering the very best in patient care, quality, and safety. Last year NYU Langone was ranked as the number three medical school in the United States, just behind Harvard and Johns Hopkins. It is now ranked as the best biomedical research facility in New York State and has the highest research support per capita in the country. Moreover, the combined enterprise of patient care, education, and research has generated a substantial financial surplus. NYU Langone went from an annual deficit of $150 million a year to a surplus of $240 million.
The information technology system is a win for NYU Langone and for its patients. Prospective patients and their loved ones can search for new doctors and book appointments online. Patients can compare the work of one doctor with that of another. Patients and their loved ones can view medical records and test results at home, often mere minutes after tests have been conducted. Patients can consult with emergency care physicians virtually at any time of day, and decide together whether the patient needs to visit an urgent care clinic in-person. The information technology system at NYU Langone allows patients to be cared for and to review their records when they want and where they want, whether that is at home, in a hospital, or in a clinic.
The incredible turnaround at NYU Langone is a lesson for all of us across the United States and, indeed, the world. The laying of cable fibers and broadband networks, and its potential impact on health systems, is the modern-day equivalent of the laying of pipes that brought water and sanitation to every corner of our country. Water and sanitation dramatically improved life expectancy and became the foundation of our public health system here in the United States. The digital revolution can help us rebuild this foundation and deliver high quality, integrated, patient-centered care to all Americans at a price everyone and our country can afford.
The views and opinions of the author are his own and do not necessarily reflect those of the Aspen Institute.