There is innovation, then there is ‘INNOVATION’. Much of the innovation happening today is ‘coloring between the lines with different colored crayons’. Incremental change. Trying to improve an existing system that may not be salvageable. Healthcare remains a typically ‘siloed’ enterprise even within a single system. ‘Human nature’ hates change and healthcare exhibits this trait well. Do we have time to tweak the system and try to evolve it? Will it bankrupt us before we can make any meaningful change?
Even the ACA was not significant change regarding what healthcare in the U.S. is and how it works. ACA primarily changed ‘insurance’ – we still have a ‘sick care’ system not a ‘health care’ system. Yes there are a few leading institutions that have embraced value based care, ACOs, and population health, but the majority of healthcare organizations are still just thinking about these changes – with great anxiety. In 2016 , MedScape published the results of a Health Affairs study reporting that 95% of provider visits still used fee for service payments (http://www.medscape.com/viewarticle/860003). Long way to go to change that statistic.
Will the ‘consumerization’ trend in healthcare drive more change? Individuals are shouldering more of the cost of care through high deductible health plans and ever increasing premiums for health insurance. More than once I have asked myself if it is worth having insurance that costs almost $20,000 per year in premiums, plus responsibility for a $6,000+ deductible (each!). Really! The results have been that hospitals and health systems are seeing significant increases in consumer bad debt with little expertise in how to handle this trend. Consumers are not able to be good ‘consumers’ of healthcare because information about price, quality, and performance are not easily available. You can argue that quality and performance data are available – perhaps so much so that it is confusing – but understandable price data is still well hidden in the dark recesses of the chargemaster. And the most helpful information, out of pocket cost estimates for a particular procedure or service, are scarce and are very difficult to provide.
Healthcare still generally treats all patients the same with ‘one size fits all’ messaging and wonders why patients don’t do what they should do regarding compliance with medications, care plans and follow up care. Sorry physicians, recent research on healthcare consumers identifies about 13% of consumers who obediently will follow ‘what the doctor says to do’ – so you are only ‘miscommunicating’ with 87 of your patients!!
Recent articles are promoting the use of all variety of care coaches, care navigators, even family caregivers. Great idea, it works, but what is the cost of inserting care coaches at multiple levels throughout the care continuum? Who will pay for this? Hospitals that are now laying off workers to make ends meet?
So how do we get to the ‘new healthcare’? The more I think about it the more I think we should start from scratch – blank sheet of paper – zero based budgeting – blue field! Okay we cannot change an industry that accounts for about 18% of the U.S. economy overnight. But I think we need some very aggressive programs to try new approaches on a larger scale. Perhaps offer incentives for experimentation by larger populations of patients to try new care models, even beyond current ACOs, incorporating more focus on keeping people healthy from an early age instead of treating them after they become chronically ill. Could some insurers take up the challenge? Perhaps – since their current business model does not seem to be doing so well regarding affordability. Could some leading health organizations who are already integrated and delivering coordinated care step up to the plate – hope so. Could even a state or two be courageous enough to take the plunge – Wow that would be something to watch! I am a fan of experimentation and change to find new ideas and new ways to be better – and now is the time for healthcare to be bold!
Anybody else on board for TRANSFORMATIOINAL CHANGE?!
James DiGiorgio, President, Applied Knowledge, LLC, Tel: 630-219-4118, Email: jdigiorgio@