Shifting the focus of healthcare — a roundtable with five health leaders

December 21, 2020
Josie Rasberry

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A British MD with a background as a tech CMO, a healthcare data wizard, a health cost sharing executive with a BUCAH past, a former hospital CEO turned health policy director, and a med school dean/neurologist epidemiologist all join a Zoom.

No, it’s not the start to a bad 2020 joke, but it was the start to an incredibly insightful hour-long conversation among these vastly different healthcare leaders.

You could look at this group and only see their differences, but in fact, Point Health’s Roundtable participants were mostly aligned on what’s ailing healthcare and where we can make an impact. Texas Public Policy Foundation Right on Healthcare Director, David Balat, agreed with Incremental Healthcare founder and former Dell Chief Medical Officer Nick van Terheyden, MD that employers need to get out of health insurance. Dell Med School Dean Clay Johnston echoed Vice President, Public Affairs and Strategy at Sedera Jenny Aghamalian’s sentiment for incentives to be present for patients and providers when it comes to price transparency and reform. The whole group nodded in agreement to HealthQuant founder & former Humana Consumer Innovation Director Greg Matthews’ take on the pitfalls of consolidation in care.

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The main topic of discussion though, was the highly debated (and by many, highly anticipated) hospital price transparency rules that go into effect on January 1, 2021. As we sat in our offices and homes, we discussed what obstacles have prevented patients from being engaged healthcare consumers and how price transparency will make a difference. Below are key highlights and edited excerpts from the discussion.

Price transparency has been a huge topic, and despite the change in administration, it looks as though the rules are still going to happen. Do you think price transparency will truly empower patients? How big of a difference will price transparency make?

The group all agreed that price transparency is a great start but we need more incentives for patients and providers. Hospitals being required to show prices will help patients, but everyone at the roundtable expressed excitement for when payers will have to follow price transparency too.

Jenny Aghamalian (Sedera): “I’m super excited to see how this finally plays out and if the information, the price transparency information, that becomes available publicly is actually going to be actionable for patients. I think when insurers have to start providing transparency about what true out-of-pocket costs will be, that will be helpful also. Then once we get that information and we’re able to use our most innovative minds to synthesize that information and make it actionable for patients, we’ll start to see real change.”

Clay Johnston (Dell Med): “I don’t think we’re gonna get a better system if we don’t have price and quality transparency…It’s giving incentives for people to act on. And currently that doesn’t exist, but the incentives have to also exist on the provider side….If we want providers to innovate and improve value, improve the outcomes, and reduce the waste, then we actually have to reward them. That’s what we do in every other industry, and transparency is not going to be enough to do that.”

Nick van Terheyden (Incremental Healthcare): “You get what you incent.”

Greg Matthews (HealthQuant): “You know, the other thing that I think is interesting when you think about the healthcare professionals angle in this, there’s been so much consolidation of medical practices, either into larger practices or into hospitals or health systems, or even into payer systems. The healthcare professionals are even more distanced from pricing than they ever were when they were independent practitioners…The doctor doesn’t even necessarily have a voice in, ‘what does this service cost and how does my patient get billed for this?’”

What are some of the policy levers that can be pulled to encourage patients to be engaged healthcare consumers?

Healthcare should be patient-provider centered, not insurance centered. David Balat brought up that a huge issue in healthcare is the focus on insurers. As he pointed out, they absolutely have their place in healthcare but they shouldn’t be in total control of all the parts.

David Balat (TPPF): “Even price transparency, as wonderful as it is, is as good a first step as it’s going to be if it’s still within that framework of insurance being the center of how we function in our healthcare industry. What I’m proposing, or what I like to talk about on a regular basis, is the fact that we need to think about that in a different way, and that the focus needs to be on the doctor patient relationship.”

Dr. Nick also chimed in with how difficult it will be to create this change, because several companies and organizations have invested so much into these insurers.

Nick van Terheyden (Incremental Healthcare): “Medicine is being run by nonmedical folks, and that just seems entirely wrong. I know I’m totally biased as a physician, but I’m also biased as a patient. I don’t want somebody that doesn’t know anything about medicine and my health to be making decisions on the best choices.”

What data have you seen or would like to see that shows how we can help empower patients? What data barriers exist that make healthcare consumerism difficult to implement?

Data is available but it’s either: manipulated and being used for self serving companies, or it’s too difficult to find and understand for patients. Greg Matthews pointed out that healthcare companies that have useful data are not interested in making it easily available to patients.

Greg Matthews (HealthQuant): “The fact that we’re still talking about interoperability in 2020 is ludicrous. I think that there is too much self interest right now in terms of ownership of data to enable a platform like the one you’re describing to be truly effective.”

David Balat (TPPF): “We’ve created this environment where hospitals and doctors are doing what they can to maximize and optimize the billing. So, we don’t really have a healthcare system. We have a sick-care system because everything is based on a diagnosis and, ‘this is what I’m going to do for you, and these are the CPT codes.’ So it’s really a system that has been designed and is working really well for a lot of the middlemen, but it’s broken for the doctor patient relationship.”

Greg also pointed out there is public data available for patients, but it’s very difficult for them to find it. If they do find it, the next challenge is understanding how to use it.

Greg Matthews (HealthQuant): “So I think one of the things that we’re seeing for successful digital health engagement, is companies that have been a little bit more patient focused in terms of the way that they’re aggregating data sources and leveraging that to help facilitate better choices from consumers. So I think that’s something we’ll want to see more of.”

Do employers really have a place in a modern healthcare system?

This was one of the most interesting questions posed in our discussion, and received several impassioned responses.

Nick van Terheyden (Incremental Healthcare): “If I have one other vote: get the employers out of this business. Get them out of the healthcare business, now! Say it was because of COVID we’re taking them out.

David Balat (TPPF): “Dr. Nick, I’m not a physician and I agree with you.”

Jenny Aghamalian (Sedera): “COVID has cast a bright light on the danger of tying people’s access to healthcare to their employment status. A lot of people have lost their job and that left them uninsured in the midst of a global pandemic. I mean, that is just a horrible policy outcome. And I think that we are on the cusp of, hopefully, a workforce revolution that decouples your healthcare decision making from your choice of employer… I think that the system is long overdue for some disruption and disruption doesn’t have to be aggressive. It doesn’t have to be combative. It can simply propose a new way of thinking about things that I think coupled with the movement to direct primary care, coupled with price transparency, coupled with a lot of the tools that are existing out there to make people feel empowered, to make decisions, will hopefully create some real systemic change.”

Clay Johnston (Dell Med): “For us, the employers are useful because they’re aggregating interests and they’re more useful if they really are representing the interests of their employees, which they aren’t always. I would worry that if individuals don’t have the aggregated power they’re not going to have access to pricing that the businesses get in part through contracting with insurers. We have had discussions with a large retailer who is presuming that people don’t have insurance. They’re looking at the people who shop in their stores and the key is to increase value, to drive down the price point, and to make it super convenient. That’s been really useful thinking to us as, ‘what do people really want? What will they pay for?’ There’s some disconnect because people don’t pay for things that benefit them long-term. They don’t pay for colonoscopies or even a mammography, and this is a problem. They will pay to have symptoms relieved, but I’d worry a little bit about the preventive care that we know is good for people in the long term.”

Final thoughts.

Our participants enjoyed discussing how to encourage patient empowerment, pointing out the big issues in healthcare today, and sharing how we can change our current healthcare system with other health leaders.

At the end of the discussion, we all agreed that patient focused care is a main key in fixing the many problems in healthcare. To wrap it up in David’s words, “As long as patients are in control of how the dollar is delivered, you’re going to have more affordable care. And in a lot of cases, you’re going to have better quality care.”

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