Aspen Ideas Festival 2012
Discover the big ideas being explored at this seminal event through the voices of Booz Allen leaders.
Booz Allen Senior Vice President Kevin Vigilante, MD, shares his observations about the Aspen Ideas Festival panel discussion titled “Healthcare and the US Economy.” The panel was moderated by Booz Allen Executive Vice President Jimmy Henry, and panelists included Peter Orszag, vice chairman of global banking at Citigroup; Elizabeth Nabel, president of Brigham and Women’s Hospital and professor of medicine at Harvard; and Martin Gaynor, the E.J. Barone Professor of Economics and Health Policy at the Heinz College of Carnegie Mellon University.
What was the most important point to come out of the conversation?
This panel was able to describe some of the bottom-line items we need to pay attention to in order to constrain costs while maintaining the quality of care. That ultimately drives us to the core question: How do we promote value? That is the crux of the issue.
I would resist the axiom that healthcare quality is compromised every time we reduce costs. A large body of evidence indicates that an enormous amount of care delivered in this country is unnecessary, wasteful and redundant, poorly coordinated, or inefficient. If we can extract that waste, it will both reduce costs and improve the quality of care. The idea that it is somehow a zero-sum game simply isn’t true.
How is Booz Allen engaging with its clients to tackle healthcare costs?
Through our E3 campaign—Enterprise Effectiveness and Efficiency—we deliver both results. Often this involves identifying variations in care. At the first level of cost analysis, we work with clients to understand where the outliers in a given healthcare system are located. That helps our clients zero in on and understand processes that are not being optimized. Cost issues are often a systems engineering problem.
Can you share an example of how Booz Allen is helping clients simultaneously lower healthcare costs and improve quality?
Booz Allen is currently working with Mercy, a large hospital system, to understand the earliest signs of sepsis, look for ways to detect it earlier, and identify instances where staff is not taking the proper measures to prevent it. Sepsis is a severe, often fatal blood stream infection that occurs in hospitals. We took more than 25,000 electronic health records, and through a natural language processing technique that came out of Booz Allen’s intelligence work, we were able to extract significant data relevant to the issue. By using data analytics to understand what was happening throughout our client’s system, we were able to help them develop a roadmap to improve the quality of care, reduce patient morbidity and mortality, and save many millions of dollars.
It sounds like there’s a real opportunity to draw insights from healthcare data to improve value.
As we think about tools that are available in healthcare to optimize quality and minimize costs, we have the benefit of something we’ve never had before—vast quantities of data that come from enormously diverse sources. We have genetic data now that we can sequence the genome; we have clinical data that comes from electronic health records; we have multiple sources of data that we never had before to correlate and use to answer questions, or even to pose questions around how better to treat patients so that we’re giving the right care to the right people at the right time and we’re avoiding treatments for other people that now we know don’t work.
The problem is the amount of data we have is quickly outrunning our ability to analyze it. We have to bring different methodologies to analyzing data, and we think there’s a great opportunity here to use capabilities from the intelligence community, which very often deals with very large amounts of data, known as big data. Because decision-velocity is very important in the intelligence community, analyzing that data has to happen fast, and it often comes from different sources and lacks sufficient context. This is analogous to the healthcare environment. We believe by taking our very robust intelligence analytics capability and bringing that into the healthcare space, we’ll be able to make strong contributions to analyzing big data better and faster and to putting a different lens on the data.
How else is Booz Allen helping its healthcare clients reduce costs?
For instance, we work with clients on developing better information technology services throughout an organization. Often that means right-sizing the IT infrastructure. This is an area that is not controversial to staff or patients, and it saves the client considerable amounts of money on the back end. We also help with strategic sourcing and supply chain management. Costs are driven up when an institution has 15 orthopedists each using different bone graph material or several cardiologists using different cardiac stents. When our clients reduce these variations and use volume purchasing to negotiate better prices, they save a lot of money. Booz Allen brings these kinds of industry best practices to help increase efficiency for our clients.
Talk for a minute about the innovations occurring throughout the healthcare system that are driving down costs and improving care.
We are never going to emerge through our current conundrum by brute force or working harder—it’s going to be through innovation. The question is this: How do we introduce incentives so that physicians and hospitals, payers and patients are all incented and rewarded for optimizing health and positive outcomes? We’re seeing this in parts of the Affordable Care Act, with accountable care organizations, bundled payments, and health savings accounts. These are all innovations that create those incentives, and they are starting to ripple through the system.
How is innovation at the systemic level going to reflect in the personal care that patients experience?
There are already such innovations in how we deliver and monitor care, how we use mobile applications and personal monitoring devices to collect data. But we need to keep in mind that our whole system of care is based on a 19th century model—the visit. You go to see a doctor who takes care of you, and then you go home. That is not the right paradigm. We need to move toward what the Institute of Medicine calls a “continuous healing relationship” through which the healthcare system is available to the patient 24/7. It’s a team-based model of healthcare where you can share information with providers through a variety of modalities, whether its texting, e-mail, mobile apps, or wearable monitors. It is model for coordinated care and chronic disease management that is vastly different than we’ve used in the past. Until we make this shift, we will not control the costs that were driven by chronic disease and optimize the quality that all these patients deserve.Read more and comment
Booz Allen Vice Chairman Mike McConnell (right) and Lt. Gen. Mary Legere
James Steinberg (left) and Peter Singer
The Technology of War: What Does the War of the Future Look Like?
Booz Allen Vice Chairman Mike McConnell participated in a panel titled “The Technology of War: What Does the War of the Future Look Like” at the Aspen Institute’s Aspen Ideas Festival on July 1, 2012. The panel was moderated by Steve Inskeep, National Public Radio Morning Edition co-host. In addition to McConnell, the panel included Lieutenant General Mary A. Legere, the senior Army intelligence officer in the Pentagon; Peter Singer, a senior fellow in foreign policy at the Brookings Institutions; and James Steinberg, dean of the Maxwell School of Syracuse University. McConnell, who leads the firm’s cyber business, shares his observations from the discussion below.
So where did this conversation begin, with war or with technology?
Before we started talking about technology, we addressed the question of what war in the future is going to look like. The answer is that in the future, war will look radically different than it has in the past. In fact, it already looks quite different. Recall, the United States has not declared war since World War II. That’s an act of Congress that under the Constitution is reserved to that body. Instead the United States has engaged in conflicts with other nations and with non-state actors without the sort of long lead industrial build up we saw in World War II. That’s another point—there are hostile groups using cyber technology in an attempt to do enormous harm to the United States. Whether those groups are state-sponsored or not, we need to respond appropriately, but those engagements are not war in any traditional sense.
How are cyber attacks and cyber warfare changing the way we prepare to defend the country?
As Lt. Gen. Mary Legere said, there have been significant changes in the operational environment. The threat has expanded from nation states to now include transnational actors and borderless states that seek a different world order. And those enemies have achieved levels of cyber sophistication that threaten our financial, telecommunications, energy, and security infrastructure. With a very small investment, such groups could attack the soft underbelly of the United States. To pick one example: The globe cannot function without a banking system. From a remote location anywhere in the world, an enemy combatant can attack the systems that process and reconcile the transfer of money on the order of seven to eight trillion dollars per day. If the process is sufficiently contaminated or disrupted, business stops—everything stops—because the flow of money is disrupted, confidence is lost, and nobody can be paid.
You’ve mentioned non-state actors. How are other nation states threatening our security?
As the world around us becomes more dependent on the cyber-domain, we need to consider what constitutes warfare inside that environment, and how to secure it. In the past we spent most of our time thinking parameter defense—that is about ways to keep bad guys out. Now we need to consider both outside and inside threats. The Chinese are draining terabits of data out of our industrial complex, particularly research and development, source code, and future business thinking. We are not in a war with them in any traditional sense, so we need to view them as an insider threat seeking to gain competitive advantage without having to invest time and money into their own intellectual insight. What separates the United States from the rest of the world is our innovation, our research and development, new ideas and new thinking. If nation states with cheap labor can steal it at will, they will have our innovation and their cheap labor to out produce us.
What’s being done to mitigate that threat to the civilian institutions you cite?
Certainly a great deal by business and government, but in fact not enough to mitigate the threat. The question we need to answer is this: How do you raise the cybersecurity bar so that it is too difficult for criminals or a nation state to in fact extract information or to gain competitive advantage at our expense? There are a number of bills in Congress now that would address the threats we’re talking about. Unfortunately, none of them appear likely to make it to the president. I believe it will take a catastrophic event—a severe disruption to our basic services—to galvanize the government and the public to require higher cybersecurity standards to protect the nation.
What in the meantime is Booz Allen doing to support its clients’ cybersecurity needs?
We provide cybersecurity support for our commercial clients just as strongly as we do with our government clients, including the military and intelligence sectors. One of the things we’ve done in the last six months is connect our cybersecurity business and with our cloud computing and analytics business—cloud-based services. We help clients manage data in a manner that is informed by the best practices of cloud computing and protected by best practices of cybersecurity. This strategy allows Booz Allen clients to have the necessary security protocols at the same time they are upgrading or developing systems for managing their information. That’s easier to do at the front end of a project than after the fact.
From your point of view, what are three important changes that need to happen to improve American security in this age of technological warfare?
First, the acquisition systems that support our military and intelligence services need to continue modernizing so we can respond to existing and future threats. Military contracting was originally designed to do a certain thing very well—acquire a few big items to exacting standards, like aircraft carriers, fighter jets, or armored vehicles. The wars of the present and future will increasingly require equipment that is remotely operated or unmanned altogether and small in size, and they will be required in large numbers. Our adversaries operate on a short cycle with technologies that are cutting edge. We’ll always be behind unless we make changes to the system.
Second, whatever you think of the future, it’s going to be awash in information. We’ve got an enormous amount of information available to us right now, and most of it is not being used. In the future, we can’t afford not to use it. So the intelligence community is going to be doing a lot more with what’s called big data and advanced analytics to inform decisions around national security in a fast-moving and dynamic future security environment.
Finally, we need to bring all levers of national power to bear in order to understand the complex challenges we are facing and options for dealing with them. A future security threat may, for instance, involve the subject matter expertise of the Department of Commerce and the Department of Treasury because it has an economic dimension. We need to have other agencies understand the ways they can contribute.
How is Booz Allen positioned to make that happen?
We work with agencies across the federal government and help them understand where the touch points are. There is enormous pressure on budgets within the federal government right now, but this is the best time to look at a whole of government approach because it speaks to efficient operations and optimized performance. Booz Allen’s investments in areas such as Megacommunity™ thinking, Mission Integration, cloud computing, cybersecurity, and Smart Power are all examples of how we can accomplish this today. These are actionable engagement strategies that can bring different parts of the government together to work on a shared problem. Because in the future we’re going to have to do things differently and with better integration in government and the private sector. Much stronger forms of public-private partnership are in our future to address the challenges we will face.Read more and comment
Booz Allen Senior Vice President Angie Messer spoke with genConnect at the 2012 Aspen Ideas Festival about how bringing together people with diverse backgrounds, experiences, and ideas results in the best solutions for clients.
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