Ask The Thought Leaders: How To Fix Health Care?

posted by AHIP

on May 8, 2018

It’s time for some big ideas. We asked these industry leaders what they would do to improve U.S. health care if they had a magic wand. Here are their responses:

Dr. Leana Wen, emergency physician, author of “When Doctors Don’t Listen,” TED speaker:

  1. Ensure access. Universal access to health care must be a right, not a privilege. Remember that the narrative of choice is wrong—choice is predicated on privilege.
  2. Focus on health, not just health care. What determines how long and how well you live depends on where you live, work, and play—not only on the type of medical care you receive.
  3. Go back to the basics. Eighty percent of diagnoses can be made just based on your story. Tests and technology are a means to an end, not an end in themselves.

Jo Ann Jenkins, CEO of AARP:

  1. Drug Costs:  Find a solution to out-of-control prescription drug costs. As just one measure, between 2012 and 2017, costs for 12 of the 20 most prescribed brand-name drugs increased by more than 50 percent and six of the 20 most prescribed drugs more than doubled in cost.
  2. Medicare & Medicaid: Strengthen (not cut) Medicare and Medicaid, and pivot from current focus on institutional care toward home- and community-based care, where you can serve three people for the cost of one in an environment (their home) where they’d rather be.
  3. Dementia: The ongoing massive growth of the 65+ population (projected to double over the next generation) and the incidence of dementia in older people is a troubling combination. As a society, we need to direct more resources to finding new ways to treat (and someday cure) dementia.

Dr. David Agus, Professor of Medicine at the University of Southern California:

  1. Define what “value” means in health care
  2. Put emphasis on data collection and analysis
  3. Focus on responsibility of the individual

Dr. Judith Feld, Vice President of Behavioral Health at MVP Health Care:

  1. Incorporate behavioral health and social determinants of health into all medical care. Understanding and working with the major determinants of morbidity and mortality is one of the most robust ways to achieve success with the Triple Aim. These areas should be taught in all medical/health care professional education and should be incorporated into our public school curricula. We should empower our citizens through health literacy and support public health initiatives that promote accountability for healthy living.
  2. Revamp current technology to support person-centered care with standardized data systems for health care providers and access to personal medical records and transparency to meaningful reporting of cost and quality for health care consumers.
  3. Align care delivery with person-centered need, replacing fee for volume with value-based payment structures. Financial incentives should be aimed at team-based care, incorporating “top of license” multidisciplinary approaches integrated across the care continuum as the foundation for all health care delivery with a stronger focus on prevention, wellness, and optimizing outcomes in chronic conditions. Restructure care delivery to support ease of access and availability through technology as well as hub-and-spoke models.

Tom Meier, Vice President of Market Solutions at Health Care Service Corporation (HCSC):

  1. One thing we’re consistently doing to address the underlying health needs of the population, is to give consumers the tools they need to have a high-quality of life and help people with chronic diseases take better care of themselves. We are tackling health determinants using a variety of tactics including a remote monitoring technology platform, which provides members with effective diabetes management through one-on-one coaching by Certified Diabetes Educators and a cellular glucose meter that allows members to easily track and share their blood glucose levels with their doctor and/or family to better manage their condition.
  2. One change we’re always shifting toward as an industry is a transition from a fee-for-service model to a fee-for-value model. As insurance providers, we’re stewards of our members’ health care dollars, and value-based care provides consumers with controlled costs, increased access, and accountability of care. But defining and implementing quality standards can be easier than it sounds. HCSC is working to accelerate this transition in part through the Blue Cross Blue Shield Association’s Blue Distinction® Total Care program, which and recognize doctors who provide preventative services and wellness coaching and who work with patients with chronic conditions to meet their unique needs.
  3. However, a fee-for-value system will only be as strong as the level of customer engagement. We need to encourage consumers to take control of their health care decision-making. We leverage design-thinking to embed ourselves in the mindset of our members and develop tools that help them make more informed, effective choices. The health care system can be very complex to navigate, so our Health Advocacy Solutions provides members with a personal concierge program that addresses health care issues, answers questions, and empowers members to become advocates for their own health. To help reduce members’ health care costs, we offer a program that rewards members for choosing a cost-effective, quality provider. We also actively collaborate with our employer groups to take a holistic approach to employees’ health and well-being to ultimately increase productivity and engagement.

These areas will continue to be top-of-mind as we work to keep health care costs affordable and help improve our members’ quality of life.

Dr. Robert Pearl, former CEO of The Permanente Medical Group, Forbes Health Care contributor, and bestselling author:

  1. Shift toward primary care. For every 100,000 U.S. patients, there are 66 specialists and 46 primary care physicians. This imbalance is staggering considering that disease prevention and chronic-illness management (two fundamental features of primary care) account for 80 percent of the superior clinical outcomes in health care today. If we want to improve healt hcare performance, we must rebalance the workforce.
  2. Alter the financial rewards. Americans appreciate the doctor who can rescue them from a catastrophic event. But all patients would prefer not to suffer from cancer, stroke, or a heart attack in the first place. Unfortunately, that’s not how the current reimbursement system is designed. Fee-for-service medicine rewards volume, not superior quality outcomes. Capitated payments, however, create incentives for providers to focus on preventing disease, avoiding medical errors, and reducing complications from chronic disease.
  3. Reduce the number of hospitals. To most people, the thought of losing their local hospital is a scary proposition. But as patients, we should welcome it. When hospitals consolidate, patient volumes increase in the ones that remain. As a result, these institutions and their physicians will be able to further specialize, which improves overall quality. And with added expertise, specialists become more efficient, reducing the total number required.

Together these three changes can dramatically improve quality while lowering cost.

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