Washington, DC - October 29, 2009
Thank you, Dr. Sanders, for that very kind introduction. Dr. Sanders has had a long and distinguished career in medicine. He’s worked with pharmaceutical companies, hospitals, non-profits, and universities. And now as Chairman of the NIH Foundation, he brings them all together to work with government to keep Americans healthy. Thank you, Dr. Sanders.
I also want to acknowledge Amy Porter, the Executive Director of NIH Foundation. She always does a great job. But I especially want to thank her for her hard work on the flu summit we held here in July. This was a huge event – President Obama phoned in from Italy, we had 3 Cabinet secretaries, we had delegations from 54 states, tribes and territories, we had a great meeting. And we couldn’t have done it without the NIH Foundation. So thank you, Amy.
We have a couple other members of our HHS team here today, two terrific agency leaders – our CDC Director Dr. Tom Frieden and our NIH Director Dr. Francis Collins. You’re actually going to hear from Dr. Collins in just a few minutes. I’m just his warm-up act today. And I also want to acknowledge one person who’s not here: our National Coordinator for Health IT Dr. David Blumenthal whom many of you know is at another conference in California. But Dr. Blumenthal and I have been working closely together and I know he’ll be working closely with all of you in the months to come.
It’s great to be here today. This is good timing for a conference about improving the quality and reach of health care. As you may have heard, we’re right in the middle of a major effort to reform our health care system. We’ve already gotten five bills through committee. That’s never happened before. And we should have final bills from the House and Senate soon.
So we’re making good progress. Don’t get me wrong – there are still details to work out. There are still a lot of lobbyists running around. There are still negative ads flooding the airwaves. But the American people have seen this playbook before. They know what happens when we stick with the status quo. They’re tired of it. And they’re ready for change.
So I’m confident we’re going to achieve reform this year. But that’s not what I want to focus on today. What I want to talk about is what comes after reform: the health care system of the future. I’m talking about a 21st century, American health care system that’s better for patients, better for doctors, and better for our bottom line. The kind of system that journalists profile when they write stories about the best health care systems in the world.
So what will this transformed health care system look like? It starts with fixing our insurance system. Every American should be able to get quality, affordable, health insurance. And once you have coverage, no insurance company should be allowed to take it away.
But even if we fixed our insurance system, we’d still have another problem: we don’t get enough bang for our health care buck. We pay way more than any other country in the world. But we get mediocre results. Or worse.
Let me give you just one example. Last year the journal Health Affairs rated nineteen industrialized countries on how many avoidable deaths they had before age 75. These are deaths from conditions like bacterial infections, diabetes, and treatable cancers that are common, but preventable. Out of those 19 countries, the US wasn’t just below average. We were dead last.
So this is our challenge: how do we go from high costs and uneven results to the high-performing health care system of the future?
The good news is we already have a lot of good ideas for how to do health care better. I’ll give you two examples from the Recovery Act and the reform bills moving through Congress.
First, we need to rely more on evidence. One of the most shocking statistics I’ve heard is that hospital-associated infections – not what brings you to the hospital, but what happens once you’re there – are one of the ten-leading causes of death in America. More people die from hospital-acquired infections than from homicides and car accidents combined.
But some states have dramatically reduced these unnecessary deaths just by using a simple checklist that reminds providers to use good hygiene like washing their hands and cleaning wounds. If we could get the same improvements across our health care system and across the country, it would be a huge step towards the health care system of the future.
We also know we need to focus more on health and wellness. Obesity costs our health care system almost $150 billion a year, 50 percent more than every cancer combined. Remember the term “adult-onset” diabetes. We don’t use it anymore because so many of our kids are getting it.
But we know we can reduce this health risk. By eliminating co-pays for preventive care and investing in proven strategies like providing healthier school lunches and bringing supermarkets to inner city neighborhoods, we can help Americans live healthier lifestyles and longer lives.
These fundamental shifts in the way we provide health care can make a big difference. Congress can push them by passing health insurance reform. My department is pushing them by investing hundreds of millions in Recovery Act money. Hospitals can push them by practicing evidence-based care. Communities can push them by applying for prevention and wellness grants.
But it will be hard for any of these changes to have their full impact unless Americans are empowered to become equal partners in staying healthy.
For example, it’s great for a hospital to try to reduce infections. But we know what will really drive improvement is if patients start going to the hospital on the other side of town because it gets better results. The problem now is that consumers don’t have enough information. If you’re trying to buy a new toaster, you can compare hundreds of models and read thousands of reviews on Amazon.com. But if you’re trying to decide which hospital to go to for your back surgery, there’s no good way of finding out who does it best.
We have the same problem when it comes to health and wellness. A lot of Americans would like to do a better job managing their chronic conditions, but they don’t have the information they need to do that. If you ask us how much money is in our savings account, most of us can find out with a few clicks. If you ask us what our cholesterol is, we have no idea.
When it comes to our health, we don’t know much. We care about our health. We want to take better care of ourselves. But the information we need is often sitting in a chart in a doctor’s office or buried in a medical textbook or else it doesn’t even exist.
That’s where mobile health technologies come in. As a way of communicating mobile phones have a few big advantages. First, almost everyone has one. According to one estimate, it’s 90 percent of Americans. And as we learned during the campaign, mobile phones are an especially good way to reach many of the Americans who are most vulnerable. There are some people who won’t go to a website, won’t read a newspaper, and won’t even watch TV. But you can reach them on their mobile phone.
The other advantage of mobile technologies is that we always have them with us. Some studies have found that we keep our mobile phones within arm’s reach for an average of 19 hours a day. If someone asks us, “what’s the best way to get in touch with you?” Most of us will answer: “Call or text my cell phone.” And as anyone who has kids will tell you, mobile phones are only going to become a bigger part of our world.
Mobile phones are the most direct, convenient, and dependable form of communication we have. That’s why President Obama and I believe that mobile phones have so much potential to empower consumers and propel us towards the health care system of the future.
In some parts of the country, it’s already happening. In Florida, one hospital system recently created a service where patients can send a text message to get the location of the nearest emergency room and the estimated waiting time. Other health care providers are using mobile phones to send appointment reminders to cut down on wasted time. Researchers are experimenting with using mobile phones to send patients exercise plans.
The technology is still in its early stages, but we can already begin to imagine how mobile phones will fit into a 21st century health care system. We can imagine a future where Americans can use their mobile phones to take pictures or video of their symptoms and send it to their provider from anywhere in the world. A future where you get an automatic reminder on your mobile phone that it’s time for your next mammogram, you text back to confirm your appointment, and the test is scheduled without any doctor or office staff lifting a finger.
In this health system of the future, Americans would have much more information about their own health. You could get your lab results sent directly to your mobile phone. You could even use your mobile phone to check your electronic health record. Americans would be able to manage their chronic conditions by tracking health metrics and then using custom software to know what changes to make. They’d have information about the best treatments, the best doctors, and the best hospitals at their fingertips.
Many of you in this room are pushing us towards this future. At HHS, we’re trying to do our part too. At our Agency for Health Care Quality and Research, we’re funding some of these mobile health pilot programs. Because tools like mobile applications can sound good on paper only to be ignored in practice, we also recently conducted a broad research survey of health tools like mobile applications. The results were clear: personalized health information tools can improve care.
So we’re pushing forward. The biggest step we’ve taken is the historic, multi-billion dollar investment in electronic health records we made as part of the Recovery Act. These record systems will not only be a platform that allows doctors and hospitals to send automated alerts and messages. They’ll also give patients unprecedented control their own health information.
Mobile health will have great benefits for individuals. But at my department, we’re also excited about how mobile technologies can help us improve the health of all Americans. One of the challenges in public health is: how do you get critical information to people who need it? You can put a PSA on television or put out a press release and get a story in the newspaper or make an announcement on your website, but whatever way you get the news out, you’re going to miss a bunch of people.
Mobile technologies can help us broaden our reach. For example, the CDC, AIDS.gov, and the Kaiser Family Foundation have developed a tool called KnowIt that helps people get tested for HIV. All you have to do is text your zip code to a certain number and you’ll get a reply back telling you where the nearest testing centers are. Another trial program lets you sign up to get updates on the H1N1 flu.
We’re also working on a major mobile health initiative that will provide important guidance for pregnant women and new moms. We know we have one of the highest infant mortality rates in the industrialized world – about 28,000 American children die each year before their first birthday. We also know that text messages are a very effective way to reach young women in the communities where mortality rates are highest.
Putting these two pieces of information together, an unprecedented partnership that includes the Administration, the National Healthy Mothers, Healthy Babies Coalition, Voxiva, the CTIA Wireless Foundation, Johnson & Johnson and many others is coming together to create a new mobile program that will provide key information to new moms and moms-to-be. The wireless industry has agreed to waive the cost of the messages, and you’ll be hearing more details when the service launches this January.
In some areas of our health care system, we’ve made incredible progress in the last 50 years. We have amazing new drugs. We have unbelievable new surgical techniques and diagnostic tools. The care we get when we’re in hospitals or doctors’ offices – the medicines we take and the treatments we receive – has never been more advanced.
But in other areas, our progress is stalled. Costs are too high. The quality of care is too uneven. Most consumers are still passive. Even though Americans will say that there’s nothing more important than our health and the health of our families, many of us aren’t actively involved in their health except for the 30 minutes every twelve months they spend answering questions at the doctor’s office.
We know we can do better. We can pass health insurance reform so that every American has access to quality, affordable insurance. We can reform our payment and delivery systems so that we start paying for care that works and stop paying for care that doesn’t. We can invest in prevention and wellness, so that we can move from a sick care system to a health care system.
With your help, we can use technologies like mobile phones to empower Americans to take care of themselves and their families. You understand the benefits of these applications. But not everyone does. You need to be evangelists for the benefits of mobile technology and new media. You need to reach out to health care providers, to the public health community, and to the vulnerable populations that have the most to gain. There are nearly 300 million mobile phones in this country. I see them as 300 million health tools ready to be put to work.
Today, it’s hard for many of us to imagine how we ever lived without our cell phones. If we’re successful, twenty years from now, we may look back and say the same thing about mobile health.