The enactment of the Affordable Care Act will bring tens of millions of U.S. citizens into the private health-insurance market for the first time, while also expanding Medicaid, the government-run insurance program for the needy. Among other things, this change raises questions about how our medical system will cope with a huge inflow of patients: Can good health care be made available to more people? Can that happen at a reasonable cost?
This trinity of goals — simultaneously expanding care, maintaining quality, and reining in costs — was the focus of the 2013 MIT Innovations in Health Care Conference, held Tuesday and Wednesday at MIT. More than 35 professors, industry executives, and government leaders spoke on new approaches to primary care, community-based medicine, and data analysis that may help achieve progress.
“We must find ways to utilize these advances within the framework of a sustainable cost model,” Maria Zuber, MIT’s vice president for research, said in opening remarks, noting that health-care costs represent about 17 percent of the nation’s GDP.
While the event, co-hosted by MIT’s Industrial Liaison Program and the MIT Sloan School of Management, showcased new technical devices and lab research, the general emphasis was on innovations in management and improving analytics.
To the extent that better health care may derive from better logistics, “The good news is, sometimes we can do something about that,” said Retsef Levi, the J. Spencer Standish Professor of Operations Management at MIT Sloan, who helped organize the conference. Levi has worked extensively with Massachusetts General Hospital to optimize its surgical schedules, which are among the most complex in the country, covering 56 operating rooms and 35,000 patients annually.
Surgeon general: We need innovation in prevention
Many of the speakers addressed the possibility of “a reconceptualization in primary care,” in the words of Robert J. Master, CEO of the Commonwealth Care Alliance, a nonprofit Massachusetts-based system that cares for Medicaid recipients. Many such community-based groups are trying to move away from a model of health care based on intermittent visits and fees for service, and toward one based on more regular contact and predetermined costs.
Whatever the structure of medical groups, a variety of industry leaders observed that a huge portion of health-care expenses come from repeated hospital visits for the fairly small part of the population with serious chronic conditions. Keeping this population from having to make so many hospital visits, perhaps by encouraging better preventive-health practices, could have a big impact.
“We need to think about people before they are acutely ill,” said Kevin Tabb, president and CEO of Beth Israel Deaconess Medical Center in Boston.
Encouraging preventive medicine was also the theme of an address by acting U.S. Surgeon General Boris Lushniak.
“We need innovation in the concept of health and wellness as well,” Lushniak said, adding that good health was “not merely the absence of illness or infirmity,” but included sustainable physical and mental health practices. In the U.S., he added, “We do really, really well at sick care [but] we’ve not done a very good job in prevention of illness.”
That lack of prevention, Lushniak noted, has a high cost. Every case of HIV costs an average of $355,000 to treat, he said, while every $1 invested in preventive health measures by a company saves it $3.27, according to research.
Bridging the divide in care
As tempting as it may be to complain about the health-care system as a whole, an underlying theme that emerged from the conference was the difficulty of generalizing about medical provision — either in the U.S. or across the world. Some portions of the population have ready access to technologically advanced care, while others do not.
Amy Glasmeier, an MIT professor of geography and regional planning and an expert in the economic geography of the U.S., presented slides showing that the uneven state-by-state adoption of the Affordable Care Act is following a distinct pattern: Places with a larger percentage of citizens in need of access to care are the ones not fully adopting the legislation.
“How will we, as a nation, bridge this divide that is really quite substantial?” Glasmeier asked.
Similarly, Tabb declared, “There is no health-care system in this country. … We have a bunch of disparate, siloed, fragmented pieces. We do not act as a system, we don’t coordinate, there is nothing that is cohesive about the provision of health care in this country.”
On the other hand, Tabb noted, the disparities in care allow analysts the opportunity to examine the results achieved by different medical systems: “We are all testing whether [new approaches] will work in different environments.”
Many economists are already taking advantage of regional differences in care to conduct innovative research. Amy Finkelstein, the Ford Professor of Economics at MIT, presented results from a study she co-authored about the use of Medicaid in Oregon, where the state conducted a lottery to admit some applicants. That random nature of admission allowed Finkelstein and her colleagues to show that, among similar populations, access to Medicaid leads to greater use of health care, fewer financial shocks, and declines in depression — although the long-run physical effects of these outcomes are unclear.
As Finkelstein noted, that study has been subject of much political spin, but she added, “We’re not arguing about what the facts are” — which, by itself, represents an advance in knowledge about medical care.
While the conference focused largely on operations and data, there was an “Innovator’s Showcase” for new technologies and research discoveries involving MIT students. The first-place award, accepted by MIT postdoc Marzyeh Ghassemi on behalf of a larger team, was for a low-cost device, called Sana AudioPulse, to test infants’ hearing in the developing world. The device will soon undergo tests at a branch of Children’s Hospital, and at multiple clinics in Brazil.