1. Genetics and Health Care Reform The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf)

3. Disruptive Innovations Over Time u Computers: Abacus; IBM/DEC main frame; HP calculator; PC/Mac; massively parallel processors u Communication: Smoke signals; pony express; telegraph; wired telephone; cellular telephone; Internet u Education: Tutor; University; Community College; On-line Access by wealthy to access by all

4. Disruptive Innovations: Elements 1. Technology enabler 2. Business model 3. Valued network

5. Disruptive Innovations 1 Technology Enabler Intuitive medicineWhat’s the diagnosis? u Past: Infectious disease; Future: All diseases Empirical medicineWhat to do? How to fix? u Past: Trial-and-error; Future: Mechanism based Precision medicineExact diagnosis and therapy u Past: Strep throat; Future: Genetic diagnosis and Rx

6. Disruptive Innovations 2 Business model Solution Shop Hospital/clinicMayo/Cleveland u Fee-for-service; complex; no guarantee Value-added process Hospital/clinicHeart Hospital Eye Institute MinuteClinic u Fix it; fee-for-output; simple; guaranteed

7. Disruptive Innovations 2 Business model Solution Shop Hospital/clinic*Mayo/Cleveland u Fee for service; complex; no guarantee Value-added process Hospital/clinic*Heart Hospital Eye Institute MinuteClinic u Fix it; fee-for-output *But, Crossing the Quality Chasm; To Err is Human; cost

8. Disruptive Innovations 3 Value Network InsuranceMutual helpHealth Club; WebMD u Membership fee u Profit for wellness

9. Disruptive Innovations Business model Solution Shop Hospital/clinic*Mayo/Cleveland u Fee for service; complex; no guarantee Value-added process Hospital/clinic*Heart Hospital Eye Institute MinuteClinic u Fix it; fee for output Gene Diagnostics Gene therapy, pharmacogenomics

12. Disruptive Innovations Value Network InsuranceMutual helpHealth Club; WebMD u Membership fee u Profit for wellness Anticipatory guidance; EMR; Genetic Alliance; Social networking

18. Other thoughts* Forced productivity gains Cadillac coverage Simplified forms Electronic medical records Reform of delivery system Independent commission Managed competition A public plan/option Comparing treatments Negotiating drug prices Malpractice reform *New York Times November 15, 2009 Editorial, p 9

19. Other thoughts* Forced productivity gains Cadillac coverage Simplified forms Electronic medical records Reform of delivery system Independent commission Managed competition A public plan/option Comparing treatments Negotiating drug prices Malpractice reform *New York Times November 15, 2009 Editorial, p 9

20. Questions? Comments?