As I began learning more about the healthcare industry in the US, I was amazed at how little progress this industry has made relative to other industries in the US and relative to the World. Here we are leading the World in the manufacturing of electric vehicles, but when it comes to healthcare we are barely coming off paper records. At my first healthcare conference I listened to Former US President Bill Clinton outline the challenges we face very simply and concisely. As a percentage of GDP we spend more money on healthcare than any other country on the planet and yet we experience worse medical outcomes than many of our peers. We are 34th on the list of countries with the lowest infant mortality rate right behind Cuba! Not only do we pay more, we pay much more. As Clinton stated in his speech, while we are spending close to 18% of our GDP on healthcare the next country after us doesn’t even break 12%. That means we are overspending close to 1 trillion dollars per year on healthcare. Over 10 years that’s close to 10 trillion dollars, and that’s assuming we don’t continue to spiral out of control with healthcare costs. And we wonder why healthcare has become such a big deal for Americans. One can argue that with this kind of spend, healthcare has become so important it is now a matter of national security.
As I’ve been speaking with providers and payers, government officials and health information technology (HIT) vendors the picture gets worse. Speaking to the head of the Special Investigations Unit (SIU) at one payer he admitted to me that the insurance provider had simply written of medical fraud, waste, and abuse as a cost of doing business for many years. Of course this cost of doing business simply got passed on to the consumer. So long as the consumers are paying why bring up uncomfortable topics like fraud? Better to just ignore it and just raise the premiums. And on the HIT side the incentives are skewed there too. Rather than promote working together incentives have caused healthcare IT fiefdoms to arise. After all, if you can get more money for providing a certain feature or function what is the incentive to open this up to other vendors? If you can bundle an inferior product but it still satisfies the minimum requirement and you get paid, then why wouldn’t a company do this? So who is to blame? To borrow and paraphrase some lyrics from a certain Robert Allen Zimmerman, better known to most as Bob Dylan:
But they can’t be blamed. They’re only a pawn in the game.
None of these organizations, be they HIT vendors, or payer, or providers are doing anything that is not encouraged by the system within which they operate. Whether for profit or non-profit, much of the incentives for this industry are established by our government and by the government’s policies and laws. How can any of us blame organizations for maximizing themselves along these incentives? Yes, work has been done to try and modernize healthcare, as we have moved from much of it being paper to electronic form but this has come at a great cost and will not have the impact or promise desired if the incentives in healthcare do not change. This brings to mind another great story teller, Antoine Saint-Exupery, the author of the Petit Prince and many other great pieces of literature. In one of his pieces he writes,
If you want to build a ship, don’t drum up the men to gather wood, divide the work and give orders. Instead, teach them to yearn for the vast and endless sea.
If we want fundamental change in healthcare we must not nip at the margins of the system. We must move to the very heart of the system and make the change there. Align incentives with patient care and you change the US in an incalculable way. Change the US and you can change the World. America is still the most enterprising and innovative country on Earth. Create a system that rewards organizations and people for delivering the highest quality patient care in the most effective way possible and watch what happens. We will all respond. Companies like Recommind, who have made a name for themselves in other industries, are ready to take their innovations and intelligent teams and apply themselves to improving health outcomes. We just need to have a system that rewards for this. A system that rewards efficiency, that rewards quality, that penalizes waste and aggressively roots out fraud and abuse.
Here at Recommind we are very excited about the possibilities around analyzing healthcare data, much of it in the form of unstructured clinical notes, and using this analysis to helps doctors make better decisions. The move to data driven decisions is possible, with the right incentives and system to work in. Today, as we work with payers and providers and other health information technology vendors we see the endless possibilities. However, if the current broken system of paying for procedures rather than outcomes and true patient care, is not reformed we will all suffer in the process with both inferior healthcare and a bigger bill to pay to boot. America has a huge problem when it comes to healthcare however the beauty in all of this is it may just be America’s biggest opportunity to shine. Reform the system in a meaningful way and you unlock the innovation and possibilities for us to once again lead by example and show the World how great healthcare really can be. We must yearn to be that example. We can be great.