Imagine you’ve been chosen as “Leader of American Healthcare.”
You are to devise a plan to fix the $3.5 trillion American healthcare industry, which lags its global counterparts in nearly all quality-outcome measures, including life expectancy and childhood mortality. You must also improve physician satisfaction, rein in the system’s runaway costs, and counter the rising death toll caused by medical errors and variations in clinical practice.
Over the past six months, we at the Fixing Healthcare podcast have interviewed a half-dozen candidates for this fictitious role. Their ideas and recommendations have sparked a national dialogue about where American medicine is today, where it ought to be and how best to get there.
Now it’s your turn. For background and inspiration, here are six of the boldest ideas we heard during Season One of Fixing Healthcare, each followed by my thoughts on how their implementation, if successful, would impact the hospital industry.
After you’ve read them, please check out the Fixing Healthcare Survey and vote for the solutions you believe will be most effective.
Idea 1: Right-size the ratio of primary care physicians to specialists (Zubin Damania)
The show’s first guest, a Stanford-trained hospitalist turned satirist who goes by the name ZDoggMD, called for a wholesale reduction in specialists and major investments in both primary care physicians and “health coaches.”
Zubin believes effective primary care can help patients get the preventive services they need, avoid complications from chronic disease and embrace necessary lifestyle changes. This, in turn, would reduce the need for hospitalizations and high-cost specialty care. If he’s right, his approach would reduce hospital revenues and eventually lead to hospital closures.
Idea 2: Remove “administrative complexity and regulatory burden” (Halee Fischer-Wright)
As the head of the nation’s largest medical group association (MGMA), Halee has seen the system’s inefficiency take a toll on doctors and their patients. Her solutions include (a) cutting in half the $471 billion direct-cost of managing medical billing and claims, and (b) simplifying the prior authorization process.
Of course, anyone capable of solving this “administrative complexity” would become an instant hero. But remember, insurance companies don’t implement these requirements to torment physicians. They’re trying to curb redundant and unnecessary care.
It’s estimated that 25% of all U.S. healthcare spending is wasted on expensive, ineffective services. Drastically reducing documentation may lead to higher utilization, which might leave insurers with no choice but to rollback what they pay for inpatient services and procedures.
Idea 3: Close the majority of hospitals and repurpose physicians (David Feinberg)
Currently a Google executive, David joined the Fixing Healthcare podcast while serving as CEO of Geisinger Health. At the time, he told us his job was to close as many hospitals as possible.
Why? Because only 20% of health outcomes are determined by what doctors and hospitals do, he said. A far greater percentage depends on people’s access to nutritious foods, clean water, transportation, good schools, well-paying jobs and a dependable social network. David believes these “social determinants of health” could be effectively addressed with sizable investments in outpatient services, community-health initiatives and home-based healthcare.
To accomplish this task, today’s hospital staff would need to undergo a massive retraining effort. If and when the health of communities improved, hospitals themselves would close their doors. It’s a radical solution that, if successful, would forever shift how we think about and deliver healthcare in America.
Idea 4: Use machine learning, AI and remote monitoring to reduce hospitalizations (Eric Topol)
Known as health-tech guru and genomics expert, Eric focused on how technology can improve clinical accuracy and physician satisfaction.
“There are more than 12 million serious medical errors in the United States every year and that number is not going down, but rather is increasing as the rate of burnout increases. We need to make life better for clinicians. The way we can do that is giving the gift of time, which can be achieved by using analytics.”
By “analytics,” Eric means using artificial intelligence, machine learning, data analysis and remote monitoring to improve physician workflow. I agree these technologies can lower costs and improve the effectiveness of healthcare. At the same time, doctors and nurses are likely to resist the implementation of any technology that could render human jobs obsolete.
Idea 5: Align all health systems and care providers behind the “Triple Aim” (Don Berwick)
As the former head of CMS and creator of healthcare’s “Triple Aim,” Don argues that transformation cannot occur unless all leaders unite behind these three goals: better care for individuals, better health for communities and lower costs.
Achieving them would require major investments in prevention and expanded outpatient programs. Implicit in a plan designed to make care more affordable is a reduction in the dollars paid to specialists and hospitals. Without this shift in expenditures, we as a nation would fail to achieve Don’s essential third aim.
Idea 6: Expand physician leadership in healthcare (Ian Morrison)
As a futurist and global leader, Ian has observed healthcare systems around the world. Based on his experience, he concludes that physicians and other clinicians are best equipped to lead the change process.
Asking doctors to alter how they practice is difficult. Many are afraid of giving up what has worked in the past. However, it’s easier for them to embrace change when a clinician they know and respect is leading the way. In most hospitals, the CEO is an administrator with a business degree. If Ian’s plan were adopted, it would require that a fundamentally alteration in how we train doctors and select future leaders.
Make Your Choice As “Leader Of American Healthcare”
There they are: Six bold suggestions from six of healthcare’s most respected leaders. Each idea is designed to move us from a “sick care” system that rewards heroic intervention to a healthcare system that emphasizes prevention, innovation and efficiency. The exact outcomes of these plans are far from clear, but one thing is certain.
Regardless of the solution, the consequences for hospitals and their leaders would be massive.
Now that you’ve reviewed and considered these recommendations, please visit the Fixing Healthcare Survey and vote on the top ideas from Season One. There, you’ll also be asked what changes you’d make as “Leader of American Healthcare.” We’ll read the best suggestions over the coming months.
A Quick Preview Of Season 2, Episode 1 Of Fixing Healthcare
Starting February 2019, Season Two of the Fixing Healthcare podcast begins with a totally different format. Our first guest will be the cardiac surgeon, entrepreneur and healthcare disruptor, Dr. Devi Shetty. He is chairman and founder of Narayana Health, a chain of 21 medical centers in India.
Physicians in his facilities perform cardiac surgery for $1,800 a case with results that match the best in the United States. Shetty recently opened a large hospital in the Cayman Islands, just a one-hour flight from Miami. Will his high-quality, low-cost model of care become a potential threat to the American healthcare status quo? Time will tell. In the interim, you may not like what this talented physician leader has to say, but you certainly won’t want to miss it.
Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via iTunes or wherever you find podcasts. Join the conversation by following the show on Twitter @fixingHCpodcast, liking the show on Facebook or visiting the LinkedIn page.