'Disruptive Innovation,' Health Equity Key to Future of Innovation in Health Care

Cheryl Pegus, MD, MPH, FACC

Cheryl Pegus, MD, MPH, FACC, has a long history of promoting innovation in health care. She has held leadership positions at several organizations, where she developed solutions to improve access to affordable, equitable health care and support programs focused on wellness, women's health, health equity, value-based care and predictive analytics. She co-founded A New Beat, an organization that supports career development for women and underrepresented minorities in cardiology, so they can improve access to care for underserved populations. Pegus is currently the executive vice president of health and wellness at Walmart, where she leads efforts to reduce cost and improve access to health care services for communities Walmart serves.

Pegus will kickoff ACC Quality Summit on Thursday, Sept. 30, with an opening plenary on the current and future role of innovation in health care. She recently spoke with Cardiology magazine about the role of innovation in health care.

How would you define innovation in health care?

I use the term 'disruptive innovation,' which was coined by Clayton Christensen, who was a professor at Harvard Business School. Disruptive innovation is a process by which a new product or service starts out being less expensive or more accessible and moves upmarket, eventually displacing established competitors. When I shorten that definition, I sometimes say it's making something less expensive and available to many more people. That has huge meaning in health care today.

What can cardiovascular teams do to adopt innovation at their hospitals or health systems?

Disruptive innovation occurs within, when the people in an organization feel comfortable and confident enough to share new solutions to areas with gaps. Sometimes it's not that the most expensive treatment is needed, but someone may recognize a problem with patients signing in or remembering to come back for appointments and suggest a technology innovation to help people using their smart phones. People who have challenges getting to appointments and understanding health information can benefit from these offerings. The person who comes up with the appointment reminder and trains the front office staff and the person who scales that system have caused disruptive innovation because they are increasing the number of people who can receive access to care. The best disruption comes from team-based innovation. There is a huge opportunity for health care teams to look at whether we're taking those one-offs, those independent innovations, and scaling them and standardizing care.

How can nurses and people working in the quality space drive innovation?

If you ask any patient who they trust, physicians aren't at the top of the list; it's nurses and pharmacists. They're hearing the needs and concerns of patients and addressing them in a personalized manner. For nurses driving innovation, finding their voice within the institution, and communicating what they hear to their innovation leaders is important. Nurses deserve a seat at the table when discussions occur on how to improve care, access and quality. If we allow that to happen within our institutions, we will move a lot faster in patient satisfaction and, I believe, in quality and outcomes.

How does the role of innovation change as the health care landscape continuously changes?

Innovation doesn't happen only in the scientific lab; good, quality, health care has other components beyond providing safe and efficacious treatments. Health care is also about the patient journey. It starts with the patient's awareness and knowledge and what resources exist in their community for them to receive care, delivered in an omnichannel manner. Then we need to listen and ask, "How would you like to receive care?" so we personalize delivery of care to individuals.

A lot of the innovation is occurring outside health systems and hospitals. Think of recent innovations: Telehealth, in-home labs, remote monitoring, hospital-at-home models. Look at where those innovations started. Health care experts have been involved, but a lot of these haven't happened within a medical institution. This is an opportunity for us to stop and think about what's needed for innovation and how to ensure health care companies and people steeped in best-in-class health care are members of innovation teams and companies. This must become part of the fabric and strategy of health care institutions.

How can innovation help address health equity?

For innovation to occur, we must look at where there is a need. At Walmart, we have more than 5,100 stores, open seven days a week, in the evenings and at times when people need help and care. We're providing care to communities that are quite vulnerable – more than 4,000 of our stores are in Health Resources and Services Administration-designated medically underserved areas. We address health equity in innovation by partnering with communities in a culturally sensitive and health-literate manner, so people seek affordable care, on their schedules. For example, increased flu activity is associated with increased heart failure hospitalizations, particularly in underserved and rural communities. Promoting and educating about flu vaccines, making it affordable and accessible by having pharmacists injecting the shots, has significant positive implications.

One of the reasons for high health care costs is that we need to address health equity. This isn't something physicians, including cardiologists, have been trained to do. But if we don't address this and talk to patients about where to get affordable medications or address food insecurity and self-management of health behaviors, we will find more patients needing high-cost, invasive procedures at a time when the health care ecosystem must utilize earlier and less costly care models. I think addressing health equity and social determinants of health is at the core of lowering health care costs and should be part of training of new physicians, including cardiologists, and it is why we are focused on it at Walmart.

What will we see on the health care innovation front in the next few years?

Social determinants of health account for 40% of health outcomes, and health behaviors make up another 30%. Only 20% of outcomes is based on clinical care. I believe we'll see a greater focus on social determinants and health behaviors, because of our shift toward value-based care where the goal is to care for the entire individual, including providing them with easy access to care. At Walmart, we will do that by utilizing teams that include community health workers, pharmacists and access in the local community with digital health tools. I don't even think I'm innovating in saying that; we're already on the road to execution.

Clinical Topics: Cardiovascular Care Team

Keywords: ACC Publications, Cardiology Magazine, Quality Improvement, Quality Summit, National Cardiovascular Data Registries, Healthcare Disparities, Drug Prescriptions, Innovation, Organizational Innovation, Patient Advocacy

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