The late Roy Porter was a professor in the social history of medicine at University College, London. I’ve been perusing his fascinating 2002 book, Blood and Guts: A Short History of Medicine. That books provides a very easy-to-read look at how human medicine emerged from natural medications derived from plants, and from witchcraft- and folk-based attempts to help to heal and cure maladies, to what eventually came to be what we in the 21st century would recognize as modern medicine—a phenomenon that is surprisingly recent, with most of what patients are able to access now in contemporary hospitals and clinics dating back only a century and a quarter, really.
“Emerging in a disease-riddled environment, civilization sought forms of propitiation and relief,” Porter writes, of the emergence of the first forms of healing. “People have always tried to protect themselves and their families—that is integral to self-preservation and parenting. But from early times, healing also became the craft of diviners and witch-doctors, fighting off the disorders raining down from above and offering remedies. Ancient cave paintings, some 17,000 years old, depict men masked in animal heads, performing ritual dances; these may be our oldest images of medicine-men. With the evolution of more complex settled societies, herbalists, birth-attendants, bone-setters and healer-priests followed.”
Porter goes on to note that “[T]he first appearance in the West of an essentially secular medicine came with the Hippocratic doctors who emerged in the Greek-speaking world in the fifth century B.C. Decrying traditional and religious healers, they developed an elitist ideal of professional identity,” and set civilization on the path towards science-based medical treatment. And while Hippocrates (c. 460-377 BC) can be considered the first physician in any modern sense of the term, it took until the late nineteen century for most of the medicines on which we rely, to begin to emerge; even aspirin, a foundational medication, was not introduced until 1896, he notes.
In a rather different context, the emergence of value-based healthcare delivery and financing has been a gradual one in the U.S. healthcare system, too. Though early forms of managed care in the 1980s and 1990s introduced some key concepts, true value-based care delivery and contracting only began to emerge fully blown in the U.S. healthcare system about 10 to 15 years ago, under pressure by the purchasers and payers of healthcare to gain greater value for their outlays, as well as improved outcomes. Yet every day now, new approaches are emerging, like green shoots across a new-spring landscape.
Here at Healthcare Innovation, one of our core missions is to showcase innovation across U.S. healthcare. For 12 years now, we’ve focused our Innovator Awards on teams of innovators from hospitals, medical groups, health systems, health plans, public health departments, and other organizations, showcasing their important initiatives. And once again, with this issue, we are proud to share four winning teams and six semi-finalist teams, and their pioneering work. Working in a wide variety of areas, these teams have pioneered advanced approaches to addressing patients’ housing needs; identifying patients with incidental imaging findings; alerting oncologists to the risk of deadly infections in chemotherapy patients; and developing in-depth care management for at-risk cancer patients.
So, while experimentation and research have been important to all these efforts and many more, the good news is that it will not be taking thousands of years for these initiatives to be widely adopted. The U.S. healthcare system is rather quickly shifting towards becoming a learning healthcare system. And we’re thrilled to play our part in bringing to everyone’s attention some of the worthiest innovations out there. We hope these case studies will be useful to everyone; they certainly merit everyone’s attention. Read on and enjoy!