TED@Merck KGaA, Darmstadt, Germany
Matthias Müllenbeck: What if we paid doctors to keep people healthy?
Filmed:
Readability: 6.1
1,479,013 views
What if we incentivized doctors to keep us healthy instead of paying them only when we're already sick? Matthias Müllenbeck explains how this radical shift from a sick care system to a true health care system could save us from unnecessary costs and risky procedures -- and keep us healthier for longer.
Matthias Müllenbeck - Business developer
As the Biopharma director for licensing and business development at Merck KGaA, Darmstadt, Germany, Matthias Müllenbeck is responsible for leading strategic partnering initiatives in the field of oncology and immuno-oncology. Full bio
As the Biopharma director for licensing and business development at Merck KGaA, Darmstadt, Germany, Matthias Müllenbeck is responsible for leading strategic partnering initiatives in the field of oncology and immuno-oncology. Full bio
Double-click the English transcript below to play the video.
00:12
It's 4am in the morning.
0
936
2007
00:16
I'm waking up in a Boston hotel room
1
4159
2420
00:18
and can only think of one thing:
2
6603
1898
00:21
tooth pain.
3
9992
1150
00:24
One of my ceramic inlays
fell off the evening before.
fell off the evening before.
4
12061
2546
00:27
Five hours later,
I'm sitting in a dentist's chair.
I'm sitting in a dentist's chair.
5
15592
4103
00:31
But instead of having a repair of my inlay
so that I can get rid of my pain,
so that I can get rid of my pain,
6
19719
4620
00:36
the dentist pitches me on the advantages
of a titanium implant surgery.
of a titanium implant surgery.
7
24363
4916
00:42
Ever heard of that?
8
30647
1244
00:43
(Laughter)
9
31915
1361
00:45
It essentially means to replace
a damaged tooth
a damaged tooth
10
33300
3721
00:49
by an artificial one,
11
37045
1711
00:50
that is screwed into your jaw.
12
38780
1889
00:53
Estimated costs for the implant surgery
may add up to 10,000 US dollars.
may add up to 10,000 US dollars.
13
41934
4682
00:59
Replacing the ceramic inlay I had before
14
47513
2580
01:02
would come in at 100 US dollars.
15
50117
1933
01:06
Was it my health or the money
that could be earned with me
that could be earned with me
16
54200
3817
01:10
that was the biggest concern
for my dentist?
for my dentist?
17
58041
2726
01:13
As it turned out, my experience
wasn't an isolated case.
wasn't an isolated case.
18
61966
3437
01:18
A study by a US national newspaper
estimated that in the United States,
estimated that in the United States,
19
66419
5792
01:24
up to 30 percent of all
surgical procedures --
surgical procedures --
20
72235
3302
01:27
including stent
and pacemaker implantations,
and pacemaker implantations,
21
75561
3556
01:31
hip replacements and uterus removals --
22
79141
3336
01:34
were conducted
23
82501
1151
01:35
although other nonsurgical treatment
options had not been fully exploited
options had not been fully exploited
24
83676
4173
01:39
by the physician in charge.
25
87873
1570
01:43
Isn't that figure shocking?
26
91320
1538
01:45
Numbers may be slightly different
in other countries,
in other countries,
27
93914
2521
01:48
but what it means is that
if you go to a doctor in the US,
if you go to a doctor in the US,
28
96459
3809
01:52
you have a not-insignificant chance
to be subjected to a surgical intervention
to be subjected to a surgical intervention
29
100292
4872
01:57
without there being
an immediate need for it.
an immediate need for it.
30
105188
2333
02:00
Why is this?
31
108632
1150
02:02
Why are some practitioners incentivized
to run such unnecessary procedures?
to run such unnecessary procedures?
32
110831
4210
02:09
Well, perhaps it is because
health care systems themselves
health care systems themselves
33
117243
5271
02:14
incentivize in a nonideal way
34
122538
2595
02:17
towards applying or not applying
certain procedures or treatments.
certain procedures or treatments.
35
125157
3820
02:21
As most health care systems
reimburse practitioners
reimburse practitioners
36
129721
2841
02:24
in a fee-for-service-based fashion
37
132586
2492
02:27
on the number and kind
of treatments performed,
of treatments performed,
38
135102
3674
02:30
it may be this economic incentive
that tempts some practitioners
that tempts some practitioners
39
138800
3640
02:34
to rather perform high-profit
surgical treatments
surgical treatments
40
142464
2563
02:37
instead of exploring
other treatment options.
other treatment options.
41
145051
2698
02:40
Although certain countries
started to implement
started to implement
42
148903
2260
02:43
performance-based reimbursement,
43
151187
2025
02:45
anchored on a quality and efficacy matrix,
44
153236
2866
02:48
overall, there's very little in today's
health care systems' architecture
health care systems' architecture
45
156855
3969
02:52
to incentivize practitioners broadly
46
160848
2084
02:54
to actively prevent the appearance
of a disease in the first place
of a disease in the first place
47
162956
3592
02:58
and to limit the procedures
applied to a patient
applied to a patient
48
166572
2562
03:01
to the most effective options.
49
169158
2000
03:03
So how do we fix this?
50
171993
1466
03:07
What it may take is a fundamental redesign
51
175452
2757
03:10
of our health care
system's architecture --
system's architecture --
52
178233
2172
03:12
a complete rethinking
of the incentive structure.
of the incentive structure.
53
180429
2873
03:16
What we may need is a health care system
54
184490
1968
03:18
that reimburses practitioners
for keeping their customers healthy
for keeping their customers healthy
55
186482
4063
03:22
instead of almost only paying for services
once people are already sick.
once people are already sick.
56
190569
4449
03:28
What we may need is a transformation
57
196284
2207
03:31
from today's system
that largely cares for the sick,
that largely cares for the sick,
58
199261
2934
03:34
to a system that cares for the healthy.
59
202903
2600
03:38
To change our current "sick care" approach
60
206545
2881
03:41
into a true "health care" approach.
61
209450
2292
03:44
It is a paradigm shift from treating
people once they have become sick
people once they have become sick
62
212784
4603
03:49
to preserving the health of the healthy
before they get sick.
before they get sick.
63
217411
3587
03:53
This shift may move the focus
of all those involved --
of all those involved --
64
221831
3333
03:57
from doctors, to hospitals,
to pharmaceutical and medical companies --
to pharmaceutical and medical companies --
65
225546
4857
04:02
on the product that this industry
ultimately sells:
ultimately sells:
66
230427
3377
04:07
health.
67
235006
1150
04:09
Imagine the following.
68
237887
1259
04:12
What if we redesign our health care system
69
240139
2991
04:15
into one that does not
reimburse practitioners
reimburse practitioners
70
243154
2858
04:18
for the actual procedures
performed on a patient
performed on a patient
71
246036
2801
04:20
but rather reimburses doctors, hospitals,
72
248861
3026
04:23
pharmaceutical and medical companies
73
251911
2158
04:26
for every day a single
individual is kept healthy
individual is kept healthy
74
254093
2993
04:29
and doesn't develop a disease?
75
257110
1660
04:31
In practical terms, we could, for example,
76
259560
2628
04:34
use public money to pay a health fee
to an insurance company
to an insurance company
77
262212
4317
04:38
for every day a single individual
is kept healthy
is kept healthy
78
266553
2503
04:41
and doesn't develop a disease
79
269080
1472
04:42
or doesn't require any other form
of acute medical intervention.
of acute medical intervention.
80
270576
3762
04:47
If the individual becomes sick,
81
275188
2111
04:49
the insurance company will not receive
any further monetary compensation
any further monetary compensation
82
277323
4714
04:54
for the medical interventions required
to treat the disease of that individual,
to treat the disease of that individual,
83
282061
4119
04:58
but they would be obliged to pay
for every evidence-based treatment option
for every evidence-based treatment option
84
286204
4048
05:02
to return the customer back to health.
85
290276
2364
05:05
Once the customer's healthy again,
86
293825
2128
05:07
the health fee for that individual
will be paid again.
will be paid again.
87
295977
3079
05:11
In effect, all players in the system
88
299707
2521
05:14
are now responsible for keeping
their customers healthy,
their customers healthy,
89
302252
3500
05:17
and they're incentivized to avoid
any unnecessary medical interventions
any unnecessary medical interventions
90
305776
4373
05:22
by simply reducing the number of people
that eventually become sick.
that eventually become sick.
91
310173
4756
05:28
The more healthy people there are,
92
316743
2182
05:31
the less the cost
to treat the sick will be,
to treat the sick will be,
93
319927
2710
05:35
and the higher the economic benefit
for all parties being involved
for all parties being involved
94
323315
3984
05:39
in keeping these individuals healthy is.
95
327323
2666
05:43
This change of the incentive
structure shifts, now,
structure shifts, now,
96
331323
2620
05:45
the attention of the complete
health care system
health care system
97
333967
2261
05:48
away from providing isolated
and singular treatment options,
and singular treatment options,
98
336252
4254
05:52
towards a holistic view of what is useful
99
340530
3246
05:55
for an individual
to stay healthy and live long.
to stay healthy and live long.
100
343800
3266
06:00
Now, to effectively preserve health,
101
348545
3881
06:04
people will need to be willing
to share their health data
to share their health data
102
352450
3143
06:07
on a constant basis,
103
355617
1508
06:09
so that the health care system
understands early enough
understands early enough
104
357149
3087
06:12
if any assistance with regard
to their health is needed.
to their health is needed.
105
360260
3014
06:16
Physical examination,
106
364458
1841
06:18
monitoring of lifetime health data
107
366323
2333
06:20
as well as genetic sequencing,
cardiometabolic profiling
cardiometabolic profiling
108
368680
4302
06:25
and imaging-based technologies
109
373006
2000
06:27
will allow customers to make,
110
375030
1594
06:28
together with health coaches
and general practitioners,
and general practitioners,
111
376648
3381
06:32
optimal and science-guided decisions --
112
380053
2770
06:34
for their diet, their medication
and their physical activity --
and their physical activity --
113
382847
4214
06:39
to diminish their unique probability
114
387085
2584
06:41
to fall sick of an identified,
individual high-risk disease.
individual high-risk disease.
115
389693
4037
06:47
Artificial intelligence-based
data analysis
data analysis
116
395283
2255
06:49
and the miniaturization
of sensor technologies
of sensor technologies
117
397562
2150
06:51
are already starting to make monitoring
of the individual health status possible.
of the individual health status possible.
118
399736
4129
06:57
Measuring cardiometabolic parameters
by devices like this
by devices like this
119
405118
3236
07:01
or the detection of circulating
tumor DNA in your bloodstream
tumor DNA in your bloodstream
120
409076
3573
07:04
early on after cancer disease onset
121
412673
2325
07:07
are only two examples
for such monitoring technologies.
for such monitoring technologies.
122
415022
2996
07:11
Take cancer.
123
419084
1150
07:13
One of the biggest problems
in certain oncological diseases
in certain oncological diseases
124
421108
3380
07:16
is that a large number of patients
is diagnosed too late
is diagnosed too late
125
424512
4303
07:20
to allow them to be cured,
126
428839
1627
07:22
although the drugs and treatments
that could potentially have cured them
that could potentially have cured them
127
430490
3389
07:25
are already existing today,
128
433903
1817
07:27
if the disease had only
been detected earlier.
been detected earlier.
129
435744
2488
07:31
New technologies allow now,
based on a few milliliters of blood,
based on a few milliliters of blood,
130
439109
3976
07:35
to detect the presence
of circulating tumor DNA
of circulating tumor DNA
131
443109
2790
07:37
and thus, the presence of cancer,
132
445923
1718
07:39
early on in a really convenient manner.
133
447665
2367
07:42
The impact that this early-stage
detection can have
detection can have
134
450736
2897
07:46
may be dramatic.
135
454300
1150
07:48
The five-year survival rate
for non-small cell lung cancer
for non-small cell lung cancer
136
456893
3653
07:52
when diagnosed at stage one,
which is early, is 49 percent.
which is early, is 49 percent.
137
460570
4918
07:58
The same, when diagnosed
at stage four, which is late,
at stage four, which is late,
138
466792
3825
08:03
is below one percent.
139
471206
1499
08:06
Being potentially able
to prevent a large number of deaths
to prevent a large number of deaths
140
474093
4103
08:10
by something as simple as a blood test
for circulating tumor DNA
for circulating tumor DNA
141
478220
5440
08:15
could make certain cancer types
a manageable disease,
a manageable disease,
142
483684
2853
08:18
as disease onset can be detected earlier
143
486561
2818
08:21
and positive treatment outcomes
can likely be increased.
can likely be increased.
144
489403
3277
08:27
In 2012,
145
495593
1380
08:30
50 percent of all Americans
had a single chronic disease,
had a single chronic disease,
146
498124
4636
08:34
resulting in 86 percent
of the $3 trillion US health care budget
of the $3 trillion US health care budget
147
502784
5388
08:40
being spent for treating
such chronic diseases.
such chronic diseases.
148
508196
2362
08:44
Eighty-six percent.
149
512030
2351
08:48
If new technologies allow now
to reduce this 86 percent,
to reduce this 86 percent,
150
516919
4447
08:53
why have health care systems
not reacted and changed already?
not reacted and changed already?
151
521390
3075
08:58
Well, a redesign of what today
is a sick care system
is a sick care system
152
526159
5575
09:03
into a true health care system
that focuses on prevention
that focuses on prevention
153
531758
3938
09:07
and behavioral changes
154
535720
1166
09:08
requires every actor
in the system to change.
in the system to change.
155
536910
2830
09:12
It requires the political willingness
to shift budgets and policies
to shift budgets and policies
156
540521
3551
09:16
towards prevention and health education
157
544096
2298
09:18
to design a new set of financial
and non-financial incentives.
and non-financial incentives.
158
546418
3526
09:22
It requires creating
a regulatory framework
a regulatory framework
159
550902
2652
09:25
for the gathering, using and sharing
of personal health data
of personal health data
160
553578
4420
09:30
that's at the same time
stringent and sensible.
stringent and sensible.
161
558022
2480
09:33
It needs doctors, hospitals, insurers,
pharmaceutical and medical companies
pharmaceutical and medical companies
162
561157
4793
09:37
to reframe their approach
and, most important,
and, most important,
163
565974
3921
09:41
it can't happen without
the willingness and motivation
the willingness and motivation
164
569919
3110
09:45
of individuals to change their lifestyle
in a sustained way,
in a sustained way,
165
573053
4504
09:49
to prioritize staying healthy,
166
577581
2143
09:51
in addition to opening up for sharing
the health data on a constant basis.
the health data on a constant basis.
167
579748
4106
09:56
This change may not come overnight.
168
584668
2123
09:58
But by refocusing the incentives
within the health care industry today
within the health care industry today
169
586815
4580
10:03
to actively keep people healthy,
170
591419
2539
10:05
we may not only be able to prevent
more diseases in the first place
more diseases in the first place
171
593982
3881
10:09
but we may also be able to detect
the onset of certain preventable diseases
the onset of certain preventable diseases
172
597887
3621
10:13
earlier than we do today,
173
601532
1744
10:15
which will lead to longer
and healthier lives for more people.
and healthier lives for more people.
174
603300
3438
10:20
Most of the technologies
that we need to initiate that change
that we need to initiate that change
175
608136
2870
10:23
are already existing today.
176
611030
1650
10:25
But this is not a technology question.
177
613327
2004
10:27
It is primarily a question of vision
178
615736
2674
10:31
and will.
179
619156
1150
10:33
Thanks a lot.
180
621500
1151
10:34
(Applause)
181
622675
4515
ABOUT THE SPEAKER
Matthias Müllenbeck - Business developerAs the Biopharma director for licensing and business development at Merck KGaA, Darmstadt, Germany, Matthias Müllenbeck is responsible for leading strategic partnering initiatives in the field of oncology and immuno-oncology.
Why you should listen
Throughout his career in various roles at Merck KGaA, Darmstadt, Germany, Matthias Müllenbeck worked on strategic asset, technology and diagnostic-licensing deals and on bringing to market innovative chemical products. He holds a PhD in immunology from the Humboldt University in Berlin and has worked at the Max-Planck Institute for infection biology in Berlin, at Bayer, and at the Albert-Schweizer Hospital in Lambarané, Gabon.
Matthias Müllenbeck | Speaker | TED.com