Q&A with Dr. James Mandell, CEO of Boston Children’s Hospital
Q: What do you see are the potential opportunities for teaching hospitals and innovation the new healthcare reform law is implemented over the next several years? Do you see potential challenges that teaching hospitals and innovators face?
A: Providers face a very challenging health care environment. Federal and state health care reform is only one of the shifting tectonic plates. There are intense pressures to improve quality and reduce the growth of health care costs as they consume an ever greater proportion of government, business and household budgets. The shift toward a new global payments model is compelling us to rethink how we deliver care. With a greater emphasis on evidence-based medicine, there are pressures to demonstrate that care is effective and cost efficient.
But these challenges present great opportunities. At Children’s Hospital, we are working at multiple levels through out the institution to improve care delivery, enhance the flow of information and reduce unit costs, while simultaneously improving the patient experience. We are testing a variety of innovative strategies, programs and technologies oriented towards generating greater health care value. There are very few pediatric quality measures and benchmarks, but these metrics are essential for decreasing unnecessary and unproven utilization.
The entire health care system needs to be reoriented towards health and wellness and early intervention in order to prevent health care problems from emerging. Children’s Community Asthma Initiative is an excellent example of an approach that combines high quality clinical care with patient and family education and home-based interventions that address the environmental triggers of asthma. This program has reduced hospitalizations by 81%, emergency department visits by 65% and missed school days by 41%. Over just a two-year period it has realized a return on investment of $1.50 in savings for every $1 invested.
There is a staggering amount of activity and innovation occurring in informatics and IT, electronic health records, genetics, stem cell research and the movement toward more personalized medicine, which is occurring through out the health care system. Bringing these innovative programs, processes and technologies to scale, and changing the health care delivery and payment models at a system level is highly complicated. But the system’s capacity to improve access and the quality and effectiveness of care requires greater alignment with cost and payment.
Q: The MassBio 2015 Report highlighted Massachusetts' position as a world-leading biotech cluster, but also pointed out that other states and countries are positioning themselves as viable life sciences leaders. What can we do better or differently to maintain our position in an increasingly competitive global environment?
A: We need to recognize that our position as the global leader in biotechnology, life science and healthcare is due to the extraordinary concentration of talent that we have here in Massachusetts. The researchers and clinicians in our cluster of academic institutions, teaching hospitals, and biotech and life sciences companies are bringing in the research funding, attracting investment and driving innovation in health care.
Look at the numbers. Massachusetts ranks second overall in NIH funding and Boston is home to the country’s top five NIH-funded research hospitals. More than 4,000 clinical trials are underway. There are 30 major venture capital firms investing more than $900 million in Massachusetts biotech companies - 20 percent of the national total. We lead the country in life science PhDs and there are 67 colleges and universities offering life science degrees. There are more than 400 biotechnology and 300 medical device firms located here.
It is no wonder that other cities, states and countries are looking to emulate what we have here. From Pittsburgh to North Carolina to Singapore, our competitors are adopting highly aggressive public strategies, involving mixes of public-private partnerships, tax incentives, expedited permitting, incubators for start-up companies and other subsidies to lure talent and businesses.
I don’t think we need to match our competitors tit-for-tat with public spending. But we do need to continue to cultivate our strategic advantages, especially our people. We need to continue to invest and promote early-stage innovation. The state needs to do more to promote our people - researchers and clinicians – and the cutting edge programs we have as strategic assets to lure investment and new business to Massachusetts. We need to continue to foster a culture that values innovation, encourages risk taking and tolerates failure as an inherent part of the creative process. The Commonwealth must commit to investment in science, technology, engineering and math education from K-16. We must advocate collectively for a strong federal commitment to medical research, with real and predictable growth in National Institutes of Health funding, which is the lifeblood of medical research and clinical innovation.
Q: Children's has a longstanding commitment to funding vital early stage research. How can we ameliorate the process by which technologies come out of academic or hospital settings and move toward commercialization and get these great ideas from the bench to the bedside in a more efficient and speedy manner?
A: Children’s is the leading pediatric research center in the world, with $225 million in research funding. Our Translational Research program, Technology Development Fund, and our new Clinical Innovation Fund are increasing investment, providing the infrastructure and fostering the collaboration that helps speed the translation of basic research into commercially viable clinical applications.
The system of medical research and innovation depends entirely on collaboration. Increasing the rate of success and speed in translating basic research into actual drugs and therapies will require deepening and expanding relationships between research/teaching hospitals, biopharmaceutical companies and other sectors of the life sciences cluster.
We need to find ways to collaborate at the earliest stages of basic research and then continue to work together through testing and clinical trials all the way to bringing new products to market. The model we have now of academic medical centers conducting research and then patenting and licensing their findings to industry is not the most efficient mechanism for moving ideas from bench to bedside.
In the pediatric research field, because the universe of sick children is thankfully relatively small, only a handful of pediatric hospitals like Boston Children’s have research enterprises of sufficient breadth and depth to fully exploit emerging opportunities in genomic and proteomic research. We have been supportive of establishing regional networks of scientists and institutions conducting pediatric research.
The economies of scale realized by establishing common protocols, sharing insights and knowledge and pooling patients for clinical trials will accelerate basic research and speed the translation of treatment from bench to bedside.