Where Is the Elon Musk of Healthcare?

I have been following and interested in space and rockets since I was a child. In April, I was honored to give the distinguished lectureship at the University of Mississippi Medical School, School of Population Health, titled SpaceX, Moonshots and Diabetes in Mississippi. The announcement that the U.S. Air Force has contracted with SpaceX for a launch of its Falcon Heavy brought that point home again. The gist of my presentation compared the current efforts to launch rockets into space with our healthcare system. In the space race, there are two major players at this time, United Launch Alliance, composed of Boeing and Lockheed Martin, with decades of experience and strong government relationships, and SpaceX, the Elon Musk company. ULA is like our current healthcare system -- big names, big contracts, major impact on and strong relationships with our federal government -- and the rockets cost a lot of money. In fact, ULA could also be compared to the Cancer Moonshot, which also has big names with strong government relationships and has big bucks. The Cancer Moonshot approach of using big data analytics, biologics and CRISPR to edit out the genetic defect are all needed and are all great ideas. They are also shiny objects, and they will most likely cost a lot of money. See also: 10 Reasons Healthcare Won’t Be Disrupted   As Buckminster Fuller said, "You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete." SpaceX is the upstart that is doing just that. It is based on Elon Musk's original vision to re-energize the public to space exploration by putting a greenhouse on Mars. This initial vision has become the goal of "enabling people to live on other planets." He quickly discovered that he could not do it with the rockets developed because they cost too much. So what did he do? He devised a new system/rocket and removed the waste, the waste of throwing away the rocket, resulting in lower costs and making his dream reasonable. Well, he did that and much more. His launches are considerably cheaper than those of the big guys of ULA. His Falcon Heavy is only the latest example: "The launch contract will cost the U.S. Air Force $130 million, far less than the $350 million average cost of United Launch Alliance’s Delta IV, previously the heaviest lifter in the U.S. arsenal." So what does that have to do with healthcare and diabetes in Mississippi?

• In 2015, Mississippi ranked first in the nation for overall diabetes prevalence, with more than 333,000 adult Mississippians living with the disease; that’s more than 14.7% of the adult population
• Diabetes accounted for more than 1,000 deaths in Mississippi in 2015
• In 2013, direct medical costs (e.g., hospitalizations, medical care, treatment supplies) accounted for about $2.4 billion, of which Medicaid spent almost $1 billion.
• MS has an estimated 30% of adults with pre-diabetes, creating the potential that more than 600,000 Mississippians are on the path to develop type 2 diabetes

Yet we know that perhaps 80% of type 2 diabetes is preventable. We also know that an estimated 30% of healthcare is waste, fraud and abuse. So that's roughly $800 million in waste, etc. that if freed up from the system could be applied to the social determinants of health that are driving this disease. Imagine that, the money to solve the problem is locked up in the system itself. Why not create a grand mission just like Elon Musk's mission to Mars. A mission that people can work toward, as they do the incremental changes needed to create the new system to make it happen. Lifting a quote from President Kennedy, I said: We chose to eradicate every case of lifestyle-related type 2 diabetes and pre-diabetes in the state of Mississippi, for no more than we are spending today on healthcare. We chose to eradicate every case of lifestyle-related diabetes and pre-diabetes, not because they are easy, but because they are hard; because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one we intend to win.  So how do we do this? By creating an Accountable Health Organization, implementing a broad-based population health program, changing the reimbursement to the healthcare system to a value-based approach, perhaps to capitation, and using the savings to fund the social services. It's a heavy lift, no pun intended, and it will take decade(s), but it can be done. It will require new systems, a long-term approach and a lot of small changes to get there. If we created the system to do this with diabetes, we could then apply it to the rest of the preventable issues, for we will have developed solutions for diet, exercise, patient engagement, adherence, appropriate medical care, rural care, urban approaches, personalization and on and on. See also: How to Optimize Healthcare Benefits   In fact, the UMMC School of Population Health and the Jackson Hinds-Comprehensive Health Center FQHCs have begun just such an effort by starting with pre-diabetes. Can you imagine the look on all our faces when we succeed...? You can find the article originally published here on LinkedIn.