The U.S. health care system is in crisis. In America, the health of our citizens not only compares unfavorably to many other nations; annual health care costs account for 18 percent of the gross domestic product (GDP) and drive a large portion of our growing annual budget deficit. There is no other country on the planet where the cost of health care is so disproportionate to the results achieved.
Just as in the United States, around the globe health care is being called upon to be not only more cost-effective, but simply better. We are far beyond the point where small fixes and iterative change will achieve meaningful improvement in the time frame demanded by a too long avoided, and now urgent economic predicament. Riding the same bicycle harder and faster will not get us to the finish line. We need an entirely new kind of vehicle to carry us forward—a new kind of thinking.
That new kind of thinking is surely a commitment to innovation. Innovation begins with creativity, but also requires those participating in the ecosystem to alter perceptions and behaviors in a manner that allows innovation to soar. Turning ideas into products and services at a rapid pace requires a willingness to consider and test new ideas, even those that might prove to be failures. In such an atmosphere, the best ideas can succeed, allowing that nation’s health to leap forward.
While sweeping change in a health care industry as large and complex as ours creates excitement and opportunity, it is also anxiety provoking. At times, it feels like we are attempting to fix an airplane while in mid-flight. Many people working at the front lines of health care, as well as patients experiencing gaps in service delivery, wonder whether we are headed to a better place or simply toward chaos.
Success requires both our optimism and courage. We find ourselves at a point of convergence, where the urgency for innovation is matched by decades of discovery and development in broad areas of computer science and information technology, to fundamental advances in biology and genetics, to the social and process-oriented sciences that consider the means of health care service delivery to patients.
If we are going to leverage these gains, how do we do so to effect change? A first step will almost certainly be humility—a recognition that what we are doing today, while seemingly “good” in a local sphere, does not scale to improve the health of all people and is economically unsustainable. Innovation is born in such an atmosphere, where both procedural and cultural norms can be openly questioned and challenged.
For example, the model where the physician is the sole or even primary point of service, a cornerstone of our health care model in the U.S. for more than a century—whether in an office setting or in an emergency room—no longer scales to the continuous and growing health needs of our aging population. MyHealth Team, a project initiated at Vanderbilt and funded by the Centers for Medicare and Medicaid Healthcare Innovation Awards Program, is implementing a regional, team-based innovation model for ambulatory health management, to find a better and more cost-effective way to manage some of the most costly and debilitating chronic diseases in our society: diabetes, hypertension, and congestive heart failure. In collaboration with other regional hospitals in the Vanderbilt Health Affiliated Network, using enhanced health information technology (HIT) and evidence-based decision support integrated into the clinical workflow, an inter-professional staff including physicians, nurses, and medical assistants are working to improve communication, care planning, and monitoring. The goal is to communicate with patients continuously in a manner that results in improved care with reduced hospital admissions and emergency room visits.
The proverb “necessity is the mother of invention,” ascribed to Plato, was never more real in health care as we witness the development and testing of innovative solutions like MyHealth Team at centers across the country. For sustainable change, measures of cost and quality in these experiments must show clear improvement over the status quo. But even so, transformative gains will not be realized unless we—as providers and patients—can imagine a “new normal” for how people can remain healthy and prosper in an entirely new delivery system.
Jeff Balser, MD, PhD, is Vice Chancellor for Health Affairs (CEO) for Vanderbilt University Medical Center and Dean of the Vanderbilt University School of Medicine. He is a member of the Institute of Medicine of the National Academy of Sciences, American Society of Clinical Investigation and Association of American Physicians, and is past chair of the NIH Director’s Pioneer Awards Committee.
This article was originally published in the Diplomatic Courier's July/August 2014 print edition. This article was also published in the 2014 Global Action Report, co-produced by the Diplomatic Courier and the Global Action Platform.
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The Urgency for an Innovation Roadmap to Transform Health Care

July 25, 2014
The U.S. health care system is in crisis. In America, the health of our citizens not only compares unfavorably to many other nations; annual health care costs account for 18 percent of the gross domestic product (GDP) and drive a large portion of our growing annual budget deficit. There is no other country on the planet where the cost of health care is so disproportionate to the results achieved.
Just as in the United States, around the globe health care is being called upon to be not only more cost-effective, but simply better. We are far beyond the point where small fixes and iterative change will achieve meaningful improvement in the time frame demanded by a too long avoided, and now urgent economic predicament. Riding the same bicycle harder and faster will not get us to the finish line. We need an entirely new kind of vehicle to carry us forward—a new kind of thinking.
That new kind of thinking is surely a commitment to innovation. Innovation begins with creativity, but also requires those participating in the ecosystem to alter perceptions and behaviors in a manner that allows innovation to soar. Turning ideas into products and services at a rapid pace requires a willingness to consider and test new ideas, even those that might prove to be failures. In such an atmosphere, the best ideas can succeed, allowing that nation’s health to leap forward.
While sweeping change in a health care industry as large and complex as ours creates excitement and opportunity, it is also anxiety provoking. At times, it feels like we are attempting to fix an airplane while in mid-flight. Many people working at the front lines of health care, as well as patients experiencing gaps in service delivery, wonder whether we are headed to a better place or simply toward chaos.
Success requires both our optimism and courage. We find ourselves at a point of convergence, where the urgency for innovation is matched by decades of discovery and development in broad areas of computer science and information technology, to fundamental advances in biology and genetics, to the social and process-oriented sciences that consider the means of health care service delivery to patients.
If we are going to leverage these gains, how do we do so to effect change? A first step will almost certainly be humility—a recognition that what we are doing today, while seemingly “good” in a local sphere, does not scale to improve the health of all people and is economically unsustainable. Innovation is born in such an atmosphere, where both procedural and cultural norms can be openly questioned and challenged.
For example, the model where the physician is the sole or even primary point of service, a cornerstone of our health care model in the U.S. for more than a century—whether in an office setting or in an emergency room—no longer scales to the continuous and growing health needs of our aging population. MyHealth Team, a project initiated at Vanderbilt and funded by the Centers for Medicare and Medicaid Healthcare Innovation Awards Program, is implementing a regional, team-based innovation model for ambulatory health management, to find a better and more cost-effective way to manage some of the most costly and debilitating chronic diseases in our society: diabetes, hypertension, and congestive heart failure. In collaboration with other regional hospitals in the Vanderbilt Health Affiliated Network, using enhanced health information technology (HIT) and evidence-based decision support integrated into the clinical workflow, an inter-professional staff including physicians, nurses, and medical assistants are working to improve communication, care planning, and monitoring. The goal is to communicate with patients continuously in a manner that results in improved care with reduced hospital admissions and emergency room visits.
The proverb “necessity is the mother of invention,” ascribed to Plato, was never more real in health care as we witness the development and testing of innovative solutions like MyHealth Team at centers across the country. For sustainable change, measures of cost and quality in these experiments must show clear improvement over the status quo. But even so, transformative gains will not be realized unless we—as providers and patients—can imagine a “new normal” for how people can remain healthy and prosper in an entirely new delivery system.
Jeff Balser, MD, PhD, is Vice Chancellor for Health Affairs (CEO) for Vanderbilt University Medical Center and Dean of the Vanderbilt University School of Medicine. He is a member of the Institute of Medicine of the National Academy of Sciences, American Society of Clinical Investigation and Association of American Physicians, and is past chair of the NIH Director’s Pioneer Awards Committee.
This article was originally published in the Diplomatic Courier's July/August 2014 print edition. This article was also published in the 2014 Global Action Report, co-produced by the Diplomatic Courier and the Global Action Platform.