Monday, May 16, 2011

The Malcolm Gladwell Innovation Hypothesis Applied to Multi-Stage Evolution of Disease Management

Who Really Invented This?
While the Disease Management Care Blog doesn't subscribe to The New Yorker, it has pieced enough of the National Public Radio and this on-line summary together to understand the "cliff notes" version of Malcolm Gladwell's "innovation" hypothesis. 

He argues that true innovation is really a multi-stage process that not only involves raw creativity but subsequent insights on how that creativity can be changed, adapted and applied.  For example, it was the Soviet military that envisioned remote digital technology, the Americans who made gadget drones and the Israeli military who used them in real warfare.  Another famous example is the Xerox clunky mouse and Apple's historic success in commercializing a far more compact version.

The DMCB suggests the same may be true of "disease management."  According to this seminal Boston Consulting Group paper, DM's early roots can be traced to the advent of self-glucose monitoring and the groundbreaking realization that patients could actively participate in clinical decision making.  The Big Pharma business model of linking this to higher drug sales was ultimately stymied, only to be replaced by a 2nd wave of entrepreneurs who figured one-size-fits-all disease-specific telephonic advice would lower health care costs.  Good idea, but that was ultimately supplanted by today's far more cost-effective approach of risk stratification with tailored DM targeted at patients who are most likely to respond and benefit.

Unfortunately, too many policymakers and regulators remember the early versions of DM.  Good thing they're not calling the shots on the use of drones in Afghanistan or how Windows operate in today's tablets and laptops.  DM's continued evolution is why it's so prevalent among commercial, Medicaid and employer-run insurance plans. Like the Israelis and Steve Jobs, they know a good thing when they see it.


Unknown said...


Do you believe that the consolidation of DM has hampered the introduction of innovative measurement techniques? It seems as if the incentive to keep selling a suspect ROI value has outweighed the incentive to introduce more useful and accurate metrics such as dollars saved. Interested in your thoughts.

Jaan Sidorov said...

Interesting question. My impression is that the DM companies that are rising to the top are the ones with the innovative measurement techniques. It could be argued that the ROI silliness of the 1990s has given way to a more deliberate process, thanks to greater buyer sophistication.