control, avoiding or reversing burnout, and creating professional autonomy and meaningful work.
I have been a student of change in the healthcare delivery
system for many years. In 2011, I was privileged to be a founding participant in the Oliver Wyman Health Innovation Center
(OWHIC). Beginning as a group of eight healthcare innovators
around a conference table at the HudsonAlpha Institute for
Biotechnology in Huntsville, Alabama, OWHIC has grown to an
annual conference involving hundreds of leaders from across
the healthcare industry who are focused on the redesign of
the healthcare service industry.
Waves of Change
Much of the group’s work is built on concepts we first flushed
out in 2011 in Huntsville, where we discussed the three waves
of change that would come crashing down on the healthcare
delivery system from 2010 to 2025.
We envisioned the first wave as “Patient-centered Care.”
From 2010 to 2016, health care would transition from
physician-centered to patient-focused, from isolated transactional to care-team managed medicine. Sick care would
broaden to include health and well-being, and access would
become convenient 24/7. We talked about patient turnover/
volume being replaced by patient-health value and unwarranted variation being replaced by evidence-based standards.
We described wave two as “Consumer Engagement,”
believing it would occur from 2014 to 2020. Health care
would become more informed, with physician opinions being
replaced by shared decision-making, bricks and mortar
transactions and fixed office hours replaced by virtual,
mobile, anytime services.
We called wave three the “Science of Prevention” and
predicted it would develop and crest from 2018 to 2025. Basic
health management would be replaced by genome-linked life
plans. The medical focus on symptom management would
broaden to include monitoring and prevention, more accurate
diagnostics and biomarkers, and tailored gene and microbiome therapies. One-size-fits-all medicine would be replaced
by personalized therapies.
Although the eight of us sitting around the table in Huntsville in 2011 didn’t get all the variables right, it is remarkable
in looking back at our work how much of it has come to pass
as we predicted. Certainly by 2016, our wave-one predictions on patient-centered care, care teams, health and
wellness, convenience care, evidence-based medicine, and
value-over-volume have become accepted as mainstream
goals throughout the healthcare delivery system.
By our guideposts, we are in the midst of wave two, and
patient/consumer engagement, shared decision-making, and
virtual care now have the attention of every health system
CEO as they develop their strategic plans.
Here we are in 2018, the advent of wave three, where
the upcoming revolution in health care is accelerating
as insights from whole-genome sequencing, epigenetics,
artificial intelligence, and big data, as well as applications from proteomic and microbiome research completely
transform the healthcare landscape. Already, there are
75,000 genomic tests available in the U.S. healthcare market,
but only 200 Current Procedural Terminology (CPT) codes
available in which to code their use. Tailored gene therapies
are curing heretofore untreatable lethal diseases such as
adenosine deaminase deficiency (the “bubble boy disease”),
X Physician-centered care becomes
X Isolated transactional medicine
becomes care-team managed
X Increase in shared decision-making
X Increase in virtual/mobile services
Science of Prevention
X Advent of genome-linked life plans
Catch a Wave
The author participated in the inaugural meeting of the Oliver Wyman Health Innovation Center in 2011, where healthcare
innovators identified the three waves of change that would overtake the industry between 2010 and 2015: