In Doctors' Declaration Of Independence, I highlighted a growing movement of doctors who are done with the status quo healthcare system; they want to be independent of an oppressive system that is at odds with why they went into medicine. The Story Behind Epidemic Doctor Burnout And Suicide Statistics details the abuse doctors receive in today's under-performing status quo that leads to the destruction of doctor well-being. It's simply common sense that abusing doctors as well as other clinicians isn't the path to achieving the Quadruple Aim that is evident in the best-performing organizations.
Naturally, a broad-based grassroots movement such as civil rights or unbreaking healthcare has many people playing a critical role to drive societal change. For example, Regina Holliday has been referred to as the health care's Rosa Parks. In The Big Heist film, we are highlighting the leaders of the movement to have health care realize its full potential. There are many clinicians who are leaders and entrepreneurs completely reinventing their field including strong doctor-writers such as Atul Gawande, Marty Makary, Eric Topol, Bob Wachter and others. However, the doctor who has established the voice that is reaching the broadest audience is Dr. Zubin Damania through his alter ego, ZDoggMD. Damania's childhood hero was Weird Al Yankovic and now he's the medical equivalent.
All over the country and across many different sectors, there are organizations applying the principles of the Health Rosetta. The following are a few examples of how living laboratories can be drawn upon for others to replicate and/or improve upon:
My keynote presentation to leaders from most of the largest financial firms on Wall Street got me thinking about the shareholder value being held back by ineffective healthcare purchasing -- the second largest cost after wages for most organizations. Previously, I highlighted the tricks the healthcare industry uses to redistribute profits from companies to their coffers. In this piece, I will outline the antidotes that the most effective benefits leaders use to ensure their organizations maximize shareholder value by avoiding needless overspending on health benefits. As the earlier article pointed out and the table below illustrates, this can have a major impact on shareholder value.
As I've been working as a subject matter expert on The Big Heist film (think of it as The Big Short for healthcare), my talk to Wall Street leaders on how there are opportunities hiding in plain sight seemed apropos. A well-regarded author and business consultant, Ric Merrifield, has also provided advice to the film and had the following to say:
The Big Short, and Moneyball, had one major theme in common - in the face of a mountain of evidence, the evidence was ignored - in the case of baseball for over 20 years until someone got backed into a financial corner and had to take a big chance. Baseball kept ignoring the value of OBP relative to batting averages, stolen bases, and RBI. Wall Street and regulators didn't downgrade the credit ratings of the mortgage backed securities even when the mountain of evidence was presented to them. So why should we expect healthcare to be any different? Healthcare is in the same place at the moment. The healthcare mess in many ways is happening in broad daylight and there is no evidence of major change.
Healthcare incumbents are making the same mistakes that newspapers made when their future was uncertain and a multitude of new competitive threats emerged. They spent too much time looking in the rear-view mirror when they should have been looking through the windshield. Unfortunately, they are doing the equivalent of studying Sears to try to get a handle on the future of retailing.
The number one success factor for my last startup (Avado, acquired by WebMD 2 years ago) before moving to the VC side of the industry was our focus on studying the next generation healthcare payment and delivery models. Sadly, the vast majority of digital health startups are zombies because they followed bad investor advice and focused on getting their technology deployed in 'Sears' when they should have focused on 'Amazon'. It was clear to us that there would be a growing understanding that the catastrophic misalignment of health resources towards a "5-alarm" sick care system created the horribly under-performing status quo. Time proved that we made the right bet on the shift to value-based care model.
Other components of the Health Rosetta outline proven approaches to slaying the healthcare cost beast. This contribution to the Health Rosetta addresses the necessary items to have an ERISA plan that will ensure the Plan Administrator (the fiduciary) fully adheres to the fiduciary duties. Falling short can put the Plan Administrator at personal financial liability. At stake are millions of dollars for a moderate size self-funded plan.
As high deductible plans become mainstream, plan beneficiaries are paying closer attention to medical bills. We have already seen cases against large employers and the health insurance companies that are serving as their third-party administrator (TPA).
Naturally, one should consult with their own ERISA attorney. These should be considered general guidelines. Follow the link below to a leading ERISA law firm that contributed their expertise to this component of the Health Rosetta.
If the current trend continues, it means that the first graders entering the Allegheny County schools in the Pittsburgh area will collectively have $2 billion more available to their community to invest in education and services over the course of their school years. This is in stark contrast to how healthcare’s hyperinflation “tax” has redistributed money from education and middle class incomes to healthcare’s prolificacy. Ideally, the leaders in Allegheny County will follow the lead of the citizen in Orlando that reinvested money that would have otherwise been squandered on healthcare. In the process, he not only improved the health of his company and employees by saving 50% per capita on health benefits, they adopted a nearby neighborhood that was previously crime-ridden.
During today’s 60 Minutes, ‘Aid in Dying’ addresses what advocates call "death with dignity” and opponents call "assisted suicide." Dr. Eric Walsh of Oregon speaks about this controversial practice with CBS News chief medical correspondent Dr. Jon LaPook. CBS also speaks with the husband of Brittany Maynard whose final days received national attention in 2014.
As would be expected, there is controversy about the issue with strong feelings on both sides. Yet, in the five states where assisted suicide is legal, they represent just 0.2% of all deaths. Meanwhile, for the 99.8% of deaths that are “normal”, far too many deaths can only be described as ‘death without dignity’ and there’s little disagreement that our failing system strips humanity away from both patients and doctors. On the subject of dying, our healthcare system is falling far, far, far short of what we should expect.
Concierge customer service addresses a substantial challenge that exists for health consumers today – namely that the benefit and healthcare ecosystems are complex and costly to understand and optimally navigate. Current trends toward high deductible plan design only amplify the time and money that consumers invest as they attempt to make more intelligent decisions. Proliferation of point solutions that address 1-2 discreet consumer needs, such as scheduling, price transparency or provider finders, still leave the individual to synthesize information across disparate sources. Often, the member is attempting to access and understand information from these fragmented point solutions when she has an acute health need and is not at her best. In the moment of need, many health consumers are aren’t able to access the information and support they need, and incur avoidable costs of care as a result.
Concierge service provides a simple solution to the fragmented experience that many...
Earlier I wrote about how benefits advisors could save America. At the same time, I was stunned that a tech entrepreneur/investor who does writing on the side (me) was finding proven solutions to slay the healthcare cost beast that most benefits brokers didn’t know about. A conversation I had with one of the country’s leading consultants to benefits organizations explained the disconnect.
The key word is “broker”. He said those who are/were in the dark are just like stock brokers of old — they primarily care about the transaction happening not whether their client is getting the absolute best return. The following is his stinging commentary:
Employees should be outraged and plan sponsors should feel like Madoff has been managing their money — it is time for change and the incumbents are just not getting the job done.
Healthcare has been the embodiment of the irresistible force paradox, a classic paradox formulated as “What happens when an unstoppable force meets an immovable object?” We know that technology and empowerment of the individual have been the drivers of immense change in virtually every corner of our lives…except healthcare.
There are many efforts ranging from startups to convening thought leaders at events to public and private sector initiatives meant to change this dynamic. It’s clear it will take a broad coalition of these efforts to make the change most desire in the face of immense forces to protect turf. It’s natural that organizations collectively generating trillions of dollars of revenue won’t give up without a fight. In fact, it’s entirely predictable that they’ll use every “FUD” (fear, uncertainty & doubt) tactic in the book…and already have. The key is to create the inoculation against that inevitable poison.
The Boomer parents of Millennials may have complained about their kids leaving messes around the house, however Boomers are leaving an exponentially bigger mess for their kids. Millennials will see their future stolen if the healthcare cost beast that Boomers have largely ignored isn't slayed.
Healthcare’s hyperinflation-driving fortress has been impenetrable to forces trying to disrupt it over the last couple decades. Whether through regulatory capture to protect the status quo or self-inflicted mistakes (e.g., HMO “gatekeeper” and denial of care debacle), healthcare has been remarkably resilient to forces that have driven change in virtually every other sector.
At long last, the gig is up and the fix is in (the good kind of “fix”). It’s coming from the edges and is largely unnoticed by incumbents who haven’t delivered any productivity gains in over 20 years (unless you measure productivity by getting out bigger bills).
In the United States, direct primary care (DPC) is primary care offered directly to the consumer, without insurance administration. It is an umbrella term, incorporating various delivery systems that involve direct financial relationships between patients and healthcare providers outside of the volume-driven insurance-based model. It can be implemented in a range of practice models from solo practitioners to organizations national in scope.
Direct Primary Care (DPC) is primary care model that offers patients, physicians and purchasers an alternate to fee-for-service (FFS) payment arrangements. In traditional arrangements primary care physicians are paid in FFS model, meaning they are reimbursed by the volume of services they provide. DPC offers a meaningful alternative as healthcare purchasing shifts from a volume to a value model.
DPC typically charge a membership fee on a monthly, quarterly or annual basis. This membership fee covers all or most of primary care services including acute and preventive care. The fee is paid for individuals out of their own pocket or via a sponsoring organization such as employers/unions or via health plans managing government programs such as Medicare Advantage. Most commonly, the practice is devoted to the particular sponsoring entity (e.g., a near site clinic for employers/unions or a Medicare Advantage-based clinic devoted to seniors).
DPC should not be confused with concierge primary care. Concierge care often adds a layer of enhanced access and amenities, paid for on a subscription basis, to a base of traditional fee-for-service primary care.
Recently, headlines screamed about UnitedHealth threatening to leave the ACA Exchanges. As Bruce Japsen reported, United is losing hundreds of millions on the public exchanges. Meanwhile, virtually no one has noticed perhaps the smartest move I’ve seen any health insurer make — build a de novo value-based primary care model from the ground up that is optimized for the consumer and small business market that the exchanges target. A proper primary care model is foundational to the Health Rosetta now guiding wise healthcare purchasers.
It should come as no surprise that most health plans aren’t doing very well with consumers. After all, health insurers have the lowest Net Promoter Score (NPS) of any industry. As I’ve pointed out many times, the status quo health benefits couldn’t be worse and there is catastrophic misalignment of resources to have a successful population health program. It’s not uncommon for some health insurers to actually have a negative NPS. Meanwhile, there are startups who have tackled healthcare’s most vexing problem — pricing failure — via Transparent Medical Networks. It can make one wonder what all those health plan and benefits people have been doing while a startup could slay the healthcare cost beast relatively easily. The evidence is crystal clear that health plans have made no dent in making the country healthier, improving the consumer experience or controlling costs and we know how doctors feel about dealing with insurance. This is highlighted in the New Health Plans, New Health Benefits section of the 95 Theses for a New Health Ecosystem...
A Transparent Medical Network offers employers and organizations such as unions a set of fair and fully transparent pricing for medical services/procedures ranging from a specific treatment (i.e., knee replacement) to a specific condition (i.e. diabetes). Providers provide up-front pricing at significantly reduced rates in exchange for increased patient volumes, quick pay, reduced friction and the avoidance of claims/collections problems – all factors that allow for providers to have greatly reduced prices while netting a similar amount to standard insurance billing. Services and procedures are typically bundled, meaning there is just one bill for the all the services rendered across a specific treatment or condition, multiple providers and sometimes multiple settings. Another dimension of transparency is that the network is open to any provider who has sufficiently high quality indicators and is priced fairly...
Let's face it, your health benefits stink. Given the massive amount of money spent by employers on health benefits, it's brutal to look at just how bad the status quo is for health benefits. Great people are operating inside of a horribly designed system as this NY Times doctor/columnist/patient painfully describes. Far more resources have been directed towards administrative overhead designed to optimize revenues than to optimize the Quadruple Aim. Fortunately, smart employers such as a small manufacturer and a small hotel chain have proven how you can spend 30-50% less per capita AND provide great benefits.
The fact is that most payroll increases for companies have gone to pay for healthcare's hyperinflation, rather than wages. Forward-looking organizations recognize that we can expect much more from this large of investment.
The Health Rosetta is the model health benefits package that wildly outperforms the status quo. The positive impact for employees and their community are breathtaking when they are employed. In contrast, we see teacher strikes with health benefits being a core issue of contention. The cost of healthcare's hyperinflation on a typical American family's nest egg has been $1M. Most people haven't made these connections, nor do they know how much better things are when the health benefits are optimized. This is a core reason behind thedocumentary I'm working on -- i.e., to catalyze a movement that is a partnership between increasingly dissatisfied clinicians and individual citizens (aka patients, consumers, people)...
