What Do I Want to Change in Healthcare? How About Everything?

March 28, 2021
Healthcare Business Today

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Originally published on Healthcare Business Today as a contributor article: https://www.healthcarebusinesstoday.com/what-do-i-want-to-change-in-healthcare-how-about-everything/

The current healthcare system isn’t working.

It rewards a small group while methodically finding opportunities to take advantage of an opaque system that prioritizes profits over patients. Too many players in the industry are focused on the bottom line and if patients get cared for, that’s an added benefit.

But to be fair, that is not true for everyone. I’ve met leaders who truly want to put patients first and prioritize care over costs.  Like them, I want to improve our healthcare system for American families so they can understand their care options and have a simple way to find the right care for their loved ones.​

To narrow it down further, I want to help patients afford quality healthcare. To do that, we need to decrease costs by creating a system that provides a simplified and understandable health experience that increases proactive patient education and provides incentives that encourage people to engage in their healthcare decision-making.

Currently, most people don’t know how much care costs and they have no way of managing all their healthcare-related activities in one place. Patients are paying the price for higher profits for facilities and insurers. As Niall Brennan, President and CEO of the Health Care Cost Institute, said in a recent podcast interview, “American healthcare consumers want a healthcare system that doesn’t screw them at every turn… we need a seamless, frictionless experience. And we’re not, anywhere near there. ”

Marshall Allen shared a Houston patient’s “drive-thru” COVID-19 test experience in ProPublica recently and revealed that the emergency center billed for an “emergency department visit, level 3 (99283 25)” with a facility fee of $1,784 and a physician fee of $486. In the end, the patient was charged $2,479 for a $175 COVID-19 test. Some might argue that the patient wasn’t actually charged that amount, but the insurance company was.  That is a short-sighted view completely ignoring the fact that the outrageous charges our insurance companies pay are what lead to ever-increasing insurance premiums in the first place.

What makes this story particularly upsetting is that this was a non-emergency situation. The person could have shopped for care and identified a facility that charged a fair price. The problem is, there isn’t an easy way to comparison shop.

An Expert Opinion

One of the experts quoted in the ProPublica article was the aforementioned, Niall Brennan, who was also the first Chief Data Officer at the Centers for Medicare and Medicaid Services (CMS). He knows a thing or two about health costs. When asked, Brennan called the charges for this drive-thru COVID-19 test “one of the most egregious examples of giving the fox the keys to the henhouse I’ve ever seen and yet another example of the absurdity of U.S. healthcare pricing. Imagine a vendor in any other walk of life being allowed to bill a third party for whatever amount they wanted.”

We need a universally available platform that will give consumers the price and outcomes information they need to actively shop for care. At a minimum, this platform needs to help patients find affordable, quality healthcare, and allow providers to focus on caring for patients (not administrative headaches.)

This will not address all of the clinical, process, payment model, and care delivery issues present in our system, but it would be a step in the right direction.

Why Platforms Can Help

Why don’t we have a platform in healthcare like this? Well, the list of reasons is quite long: opaque healthcare costs, very limited quality or outcomes data, a fragmented healthcare system, perverse financial incentives, the principal-agent problem in healthcare (the users of healthcare are rarely the people actually paying for it) and more.

Despite all of the reasons we haven’t seen a platform emerge, there is reason for hope. The COVID pandemic is shining a light on how flawed our system is, digital health companies are proliferating and price transparency is expanding.

One of the biggest issues with healthcare is the “us vs them” mentality we see between stakeholders, particularly providers, patients, and payers. Due to regulations and economic incentives, these groups are often at odds with each other even though they have the same end goal: caring for patient’s needs.

A well-formulated platform that creates value by connecting patients to high-quality doctors would benefit all three parties. Take AirBnB for example. Their hosts and guests work together to meet mutual goals. Guests get fair-priced accommodations and hosts make money on a property that would otherwise be vacant. The platform just facilitates the transaction and ensures quality. If this same concept were applied to healthcare, enabling providers, patients, and payers to partner there would certainly be positive value created for all parties.  

Platform technology could streamline patient experiences, simplify care options,  display upfront pricing, consolidate reporting, scheduling, and even payment processing in one intuitive platform. It even has the potential to be a user-friendly application for patients to directly communicate with their provider and payer.

We have started to see some developments in healthcare platforms and digital tools to streamline patient experiences, but work must be done to ensure they talk to each other and don’t lead to a digital platform version of our fragmented system. Newer standards like FHIR (Fast Healthcare Interoperability Resources) are being implemented that enable platforms to exchange health information securely so systems will talk to each other.

The platform itself is just the beginning. The effect on incentives could be significant. If the platform is implemented thoughtfully it can alter the relationship between the payer and patient to increase incentives to shop for care, ultimately leading to the best facilities/providers receiving the most demand and forcing others to rise to their level or lower their costs.

Real progress has been made via technology in the industries that choose to embrace it. Just as the hospitality industry was forever changed by AirBnB and transportation was changed by Uber, healthcare will be changed by platform technology too. Platform technology is one way to create a healthcare experience that doesn’t completely suck.

Will healthcare ever be fun? No, probably not, because the reason people seek healthcare is generally for a health problem that needs a remedy. However, your biggest problem in healthcare should be the issue you went to the doctor for, not the experience you go through to find and pay for that care.


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Download the Patient Advocacy 2.0 White Paper

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