W After ten years of driving healthcare reform with healthcare systems, medical device OEMs, and thought leaders, I have an opinion on how we can get it done. I posted this on social media recently: “There are 2 parts to driving #healthcarereform of reducing cost and improving outcomes: 1) Who gets care and 2) How care is delivered. Both need a radical overhaul.”
Someone replied, “Can you provide more detail around those points? How do you envision rationing who gets care? How would you go about innovating the delivery [for] that care?”
This article is meant to hit the highlights for each of those three questions. To keep it short, I’m not going to include all of the statistics so you will have to research them yourselves.
Who Gets Care
With the discussion of Obamacare and its repeal, the topic of “medically uninsured” is top of mind for many people. Some argue that healthcare is a right and that inequality and disparity of outcomes is unacceptable. Maybe it is, maybe it isn’t. I will leave that to the politicians and social reform.
There is much we can do regardless of where we stand on that topic. There’s a significant amount of healthcare spend and poor outcomes with births, untreated chronic diseases, and end of life.
Babies and their moms
Our babies need to come healthy into the world. Costs can be driven up for their entire life if someone has a poor start in life. Many infant mortalities and complications can be avoided with simple, prenatal care that is unavailable or unused for or by too many people.
The Chronic Diseased
With 45% of Americans having at least one chronic disease, healthcare reform must address this. We have to care for people with chronic diseases before exacerbations. Ultimately, we would like to drive down the rates of diabetes, hypertension, asthma, and others, but we can make a significant improvement in healthcare by offering easier treatment and education plans that are non-hospital, non-clinic based with minimal physician involvement.
We need to start talking about end-of-life sooner. When a loved one is in the hospital, it’s too late. I have seen far too many instances of family members trying to extend the life of their loved one for weeks days or even hours however possible. Not only is it uncomfortable for the person dying, it’s outrageously expensive and ultimately ends in death anyway. We should move to having 100% of advance directives in place prior to hospitalization. We should also talk about death with dignity in a non-hospital environment.
How Care is Delivered
Any industry is going to protect the status quo and tradition. It’s easier because it doesn’t require the players to change. Healthcare is no exception. Its employees are the most educated in the world. They have significant incomes and tremendous power. They accept change when legally mandated or when it could negatively impact revenue or personal income. Healthcare reform demands a change in how care is delivered.
Last week, two major academic institutions announced hospital projects. Total spend for two facilities is expected to be $8 billion! Both were claiming to advance medicine and offer the absolute highest level of care for patients. They used fancy words like artificial intelligence and precision medicine. With healthcare spend in the U.S. at nearly 20% of GDP, projects like this are fiscally irresponsible.
Hospitals should only be used for the highest acuity issues, academia should conduct research but everything else should be treated somewhere else. The smaller and more distributed treatment places are, the better. The centralized hospital model continues to drive unprecedented levels of inconvenience, cost, and societal impact. They increase traffic, have poor or expensive parking, require long patient commutes, have acquired infections and more. It also puts people in the worst healing environment: a hospital room.
We have overqualified medical professionals treating patients with simple issues. For many health issues, we don’t need to see an actual doctor. A nurse, nurse practitioner or physician’s assistant is more than sufficient. For other issues, our primary care physician isn’t the best and we should talk to a specialist. We can’t overutilize the high-priced experts, though.
We must use specialists, subspecialists, and super subspecialists only when necessary to return a patient’s health to “normal.”
We can’t continue to require a patient to schedule an appointment at a doctor’s office. It’s overkill. A significant number of appointments don’t require “hands-on” presence of a physician and they can be done via phone call, video conference, email or text. We must kill the office visit unless absolutely necessary.
Having open hours when the majority of dual-income families are working is ridiculous. Opening at 9 AM and closing at 4 PM doesn’t work. Non-acute healthcare, especially primary care, needs to be available before normal working hours and after normal working hours. Finally, we can no longer have providers that reject evidence-based medicine and instead rely solely on their own experience. Too many physicians and offices are clogging their schedules with appointments that are medically unnecessary. This includes everything from annual physicals to how often and how early a woman should get a mammogram.
Innovating Care Delivery
We have to innovate our patient care model to achieve healthcare reform. As much as I would like to think that an existing healthcare system can do this, there is little evidence that they can. There are very few systems that even have an innovation center in place and even fewer that focus on the patient care model. Most want to be a tech incubator for new ideas from the surgeons or physicians. While I applaud those efforts, we can have a significantly higher impact by investing equivalent time and resources into care model changes.
This requires a systematic approach with a dedicated team. A hospital or healthcare system must invest in the minimal number of resources required to develop new care models. It is a skill set not possessed, taught or practiced in any healthcare environment yet we must establish and expand this skill set, everywhere.
We can’t expect corporate mega-conglomerates to come up with the best way to care for patients. They are focused on selling technology and solutions at a high-profit margin. They rarely understand the customer, the entire healthcare process or the people delivering it. You must have an immersive, ethnographic process, such as design thinking, coupled with technology development and change management. It must be internal- healthcare systems know their patients and market best.
Create Healthcare Reform
Now, when I say it only takes two things to impact healthcare reform, they are big things. However, I have personally led and experienced organizations that are taking the right steps. There are companies like CVS which are redefining care delivery.
Reform will happen. Time will determine the winners and the losers. It can’t be the patients. Check out my article on Population Health for a deeper dive.