MoneyBall Medicine, Thriving in the New Data-Driven Healthcare Market by Harry Glorikian and Malorye Allison Branca
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Have you heard about medical tourists who travel globally for affordable surgeries? Have you wondered how tech tycoons develop new ways to use data and make millions of dollars? Do you stay up late worrying why medical costs are high? Harry Glorikian and Malorye Allison Branca have answers. The authors diagnose the ailments and inefficiencies that hobble health care. With case studies and personal stories, they build a portrait of the health care system in this must-read for business leaders, health care professionals and consumers who want to follow the digital trail of money and medicine.
Take-Aways
- High-tech entrepreneurs are targeting opportunities in health care.
- Auto, sports and retail industries provide digital playbooks for health care delivery.
- Health care faces unique barriers against data efficiency.
- Tech titans are boosting clinical trials.
- Researchers are using big data to help patients with rare illnesses.
- Budget-hunting patients become medical tourists.
MoneyBall Medicine Book Summary
High-tech entrepreneurs are targeting opportunities in health care.
A family health crisis led to a career detour for Nat Turner, a technology tycoon.He watched a close relative struggle with the bureaucracies surrounding leukemia treatments for a child. Turner saw the child’s father carry volumes of paper medical files and DVDs around the country because the family’s team of cancer specialists could not easily share those files. It was a familiar story for Turner and his business associate Zach Weinberg, who had seen other family members struggle with cancer treatments, medical records and doctor-to-doctor data exchanges. Weinberg and Turner realized they could apply their past successes in high-tech to the health care industry.
The two men had sold an analytics-driven advertising company to Google for $81 million in 2010. They believed that same data-driven processes was ideal for tracking cancer treatments and changing the medical records industry. The high-tech entrepreneurs launched Flatiron Health in 2012 after conducting extensive interviews with nurses, oncologists, researchers and hospital leaders. Weinberg and Turner sought to learn more about the clinical workflow in the oncology sector, while analyzing industry successes and failures. They processed the feedback and measured the expert testimony against their own family experiences with cancer patients. The verdict? The medical industry was outmatched by the large volumes of patient data.
“Why can’t health care be more like financial services? Or retail? Or the automotive industry? Or…baseball? All of these fields use data and advanced analytics to help make better decisions and increase profits.” ”
Turner and Weinberg took their talents to the electronic health records (EHR) sector, also known as electronic medical records (EMR). The two businessmen concluded that physicians felt ill-served by current EHR processes, because data collection software often amplified rather than reduced their workload. Industry surveys confirmed their suspicions. Only 30% of physicians surveyed expressed satisfaction with EHR technology, according to industry data. To move into the EHR/EMR sector, Flatiron purchased an OncoEMR, a developer of EHR, from Altos Solutions. Flatiron also identified business opportunities in other medical segments, including patient portals, billing systems, analytics and the management of clinical trials.
The Flatiron team and other business experts argue that innovative data-driven processes could lead to smarter decisions and cost containment in health care. Consider the numbers: In the United States, the health care sector is vast with an estimated value of $3.2 trillion in 2015.That tremendous sum translates into approximately 18% of US GDP or almost $10,000 annually per person. America and its citizens can no longer afford to pay escalating medical costs, and that reality pushes the need for data-driven strategies to contain health care costs. Rising medical costs encroach into society’s capacity to pay for other basic expenses, including education and transportation. Other countries are studying the effectiveness of data-driven medical strategies in the United States. This global spotlight is shining on the industry’s practices as analytical tools become increasingly mature and standardized.
Auto, sports and retail industries provide digital playbooks for health care delivery.
Technology entrepreneurs believe the health care industry should learn from the sports, automotive, financial and retail sectors. In those industries, profits and decisions rely on analytical strategies and data. One baseball team, for example, used analytics and data-driven strategies to move from the lowest competitive position to the highest position in league charts. But in the health care industry, anecdotal information from a lone physician and constricted databases shape decisions in the health care industry.
“Security of health care data remains a challenge for companies and health care providers, especially when data sharing would be useful.”
The medical sector can use analytics and the digital playbook lessons from professional sports to improve safety records, operating efficiencies and medial outcomes. Entrepreneurs and professionals from other fields ask the following about the health care industry:
- If a credit card company has easy access to my credit report, why is it so difficult for my physician to get access to my health records at another hospital?
- Other industries and services provide cost estimates? Why is it so difficult to get a price estimate for medical treatments or hospitalizations?
- Why can’t my primary care doctor compare his advice to me against the type of recommendations made by other physicians?
Health care faces unique barriers against data efficiency.
The health care industry faces several unique barriers that block access to efficient use of the information highway. Those barriers include:
- Regulatory landscape – The health care/medical sector is one of the most regulated industries. Developing a new drug, for example, costs about $2.8 billion, and the journey through the U.S. regulatory process can take one to two decades, according to industry data. The approval process for medical devices is also lengthy and rigorous. What’s more, regulations designed to protect patient privacy — the Health Insurance Portability and Accountability Act (HIPAA) — have also been misinterpreted to block patients seeking to share their medical information with other health care institutions or providers.
- Patient privacy concerns: Medical privacy is a major concern for patients in the U.S. Individuals are concerned that their medical data could be a future source of personal embarrassment or used as a tool to deny medical benefits, life insurance or employment. Privacy policies impede research and development by making it problematic for investigators to exchange clinical information related to patients.
- Consumer behavior: In general, healthy individuals have been reluctant to manage or maintain personal online medical health records. Once individuals become ill, the task of managing online records becomes daunting. Consumers shop around for cars but are not eager to shop around for a cardiac specialist. Many patients believe that an expensive specialist might offer better care than an affordable option.
- Institutional resistance: Health care institutions have found it expensive — in time and money — to exchange data. Providers also worry that sharing data will make it easier to lose patients to industry competitors. This reluctance to share data has created silos of information in the health care sector with fewer interactions and comparisons.
Tech titans are boosting clinical trials.
The clinical trials industry has attracted capital from tech entrepreneurs, who seek to create new processes and software to enhance the development of new drugs, devices and treatments for cancer and other rare diseases. The Flatiron team, for example, sought to increase the number of patients participating in clinical trials. Industry studies show that innovative cancer studies only attract about 3% of cancer patients. Low participation rates impair the development of new treatments because access to a small patient population limits the collection and sharing of useful data about new treatments.
“Instead of patients trekking around the country from doctor to doctor, could an oncologist use just a few clicks of a mouse to identify the right trial for the patient?”
To improve patient recruitment, Turner and Weinberg of Flatiron, developed OncoTrials, an electronic health record system designed to help researchers and cancer specialists determine which patients might be suitable for different clinical trials. The clinical trials process is lengthy and expensive.Therefore, the Flatiron team argued that EHR systems and related databases could be used by doctors to collect “real-world evidence” about the effectiveness of different cancer treatments and drugs—thereby speeding up the research process. Ultimately, Flatiron collaborated with different oncologists to create a specialized database. From that initiative, Flatiron Health has built a robust software business for cancer specialists, researchers and drug companies. Flatiron’s network includes more than 265 cancer clinics, several academic research organizations and nearly a dozen of the top global pharmaceutical companies that specialize in cancer research. What’s more, global finance giants have invested heavily in Flatiron, with Google Ventures leading a $130 million investment round during 2014, and Roche at the helm of a $175 million infusion in 2016.
Researchers are using big data to help patients with rare illnesses.
Health professional define rare diseases as conditions and illnesses with patient populations of up to 200,000. Experts have identified 7,000 types of rare diseases that affect more than 350 million patients around the world. In the U.S., the Orphan Drug Act and data-based strategies have streamlined the process for developing drugs and treatments for rare diseases. As a result, the rare disease market represents a potentially lucrative opportunity for biotechnology and pharmaceutical companies. Big data strategies — typically employed to address wide-scale health problems such as diabetes and cardiac disease — are useful to address treatments for rare disease.
““At the patient level, Big Data, analytics and related technologies are having big impact.””
The universe of patients with rare illnesses is small, but the price tags are large for rare drugs and life-saving treatments. Insurance companies are willing to pay for rare treatments. Nonprofit organizations centered around specific diseases, patient advocacy groups and academic research institutions are also driving financial growth in the rare drug sector.
From innovative uses of social media to data analytics, technology is offering tools and hopes to patients, their families and pharma companies seeking to develop treatments for rare diseases. Social media became a valuable tool in the hands of Deb McGarry, a patient from the Chicago Metropolitan area. McGarry has been diagnosed with SCAD, which stands for “spontaneous coronary artery dissection,” and she used social media to connect with other SCAD patients. The online community provided insights and hope her medical providers could not offer. That community ultimately developed clout in the medical community. Mayo Clinic is now working with McGarry and other SCAD online community members on a major research project.
Budget-hunting patients become medical tourists.
Michael Shopenn, a professional photographer, became a medical tourist when he tried to find a new hip joint online. His insurance company declined to pay for the surgery after ruling that Shopenn suffered from a preexisting condition. Therefore, the photographer began searching for an affordable option, and he needed several pieces of information: the cost of an artificial joint, the surgeon’s fee and the price of an operating room.
“Health care pricing has long been highly secretive about everything from convenience to quality and pricing. But the pressure is on to make the industry more transparent and is driven primarily by government initiatives.”
By searching online, he discovered that his hip replacement surgery would cost $80,000 in the U.S., excluding the surgeon’s fee. In contrast, the same procedure would cost only $13,660 in Belgium, and that amount would include all fees, related costs and airline tickets. His experience is not unique.
Examples of medical tourism appear in the 2009 book: The Healing of America: A Global Guest for Better, Cheaper, and Fairer Healthcare by T.R. Reid. In that book, Reid documents his global search for treatment of his shoulder injury. The hunt for affordable medical care inspired Jeff Rice, an entrepreneur, to develop a website and a company to help consumers search for affordable medical treatments.
About the Authors
With more than 30 years of experience as a successful entrepreneur, Harry Glorikian has launched business ventures around the globe. He is an expert in life sciences, information technology and healthcare. Maloyre Allison Branca is an award-winning writer, specializing in medical science and healthcare.
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