Physician-scientist Clay Marsh is one of the indisputable rising stars in the constellation of personalized health care (a term he doesn’t fancy), and a genuine innovator in devising preventative health care as opposed to “sick care,” and in pursuing novel translational research and pilot projects that find new ways to engage patients in the nation’s largest academic health care system.
Among his multifaceted appointments, Marsh currently serves as Executive Director, Center for Personalized Health Care; Vice Dean and Senior Associate Vice President for Research, College of Medicine; Professor of Internal Medicine in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine; and Director, Center for Critical Care and Respiratory Medicine. He is also a member of the National Summit on Personalized Health Care Board of Directors.
MD4 Utah: How would you describe your program’s business model, in particular related to its approach to scientific inquiry?
Clay Marsh: Our scientific approach and business model are tightly connected. We are trying to save money and improve outcomes, based on foundational principles. One of our primary goals is value innovation: less cost, higher quality.
MD4 Utah: How does this approach translate to strategic objectives?
Marsh: Essentially, there are three aspects in the immediate-, mid- and long-range. The most immediate goal is to save money through what we call medical hotspotting: coming up with ways to identify people spending the most on health care, and find solutions for them. The top 1 percent of the CMS patients spent 23 to 30 percent of all of the funds in Medicare/Medicaid, the top 5 percent spend 50 percent and the top 15 percent spend 97 percent of the money, so the bottom half, 50 percent spend about 3 percent of the money. If you want a solution that will save money and improve outcomes in a meaningful way, focus on the people spending all the money because focusing on everybody you will really dilute your ability to bring meaningful solutions to the topline.
We are really interested in trying to predict the topline 5 percent of people using the system, utilizing our own health plan as the paradigm there, and then wanting to understand what are the things we can intervene with to improve their outcomes – whether that’s visiting their homes in person, by computer or telephone, looking at their benefits to see if there are medicines that could cause problems or if the medicines could be substituted with other as-effective but less-costly medicines. What are the top diagnoses of these areas: heart failure or something else, for example? We want to really create critical pathways for these diseases, looking at long-term importance and keeping people at home. We think hot spotting would be one of the easiest ways to reduce costs and improve outcomes.
The critical intermediate focus we have is that healthcare delivery is quite variable, so being able to deliver evidence-based practices is not really effective across our whole health system. We need capabilities and to engineer our delivery systems to automatically deliver the right treatments for the right person at the right time. And this has more to do with workflows and systems engineering of medicine practice, as Clayton Christensen said. We really want to create automatic checklist level systems that bring healthcare down from individual physicians to systems that include nurse practitioners and physicians’ assistants and genetic counselors – but many of these would eventually would be pushed down to electronic medical records. The electronic medical record system may be a personal alarm system for each person.
In the long term, we’re working on something not yet ready for prime time: going from disease-oriented care to health- and wellness-oriented care. First we need to understand what health and wellness is. At the end of the day we want to facilitate driving health and health care, not just sick care. We need people to stay well. This will represent an entire paradigm shift in how we look at health and patient care, and knowledge and measurement need to change dramatically. These three primary goals are connected on multiple levels.
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