Working in healthcare, one notices quickly that the industry is dangerously siloed. Physicians live in a service world wherein if they do less, they make less. Hospitals need to keep beds full in order to keep revenue flowing. Rewards in this system are based on what and how much you do, not on the positive outcomes you achieve. In other words, the system is designed to be counterproductive to real value – the value of improved outcomes for individuals and families who demand the best from the system.
Perhaps it is healers who are best tasked to heal the healthcare system. We can see the problems standing in the way of healthcare’s most important mission: providing everyone with the care needed to treat the illness that they face – no more and no less. We are also in a position to provide the leadership needed to transform care.
In my discipline of cancer care, there are two fundamental forces: one that drives change for good, and the other, which we strive to avoid. On the positive side, we are unravelling the mysteries that occur within a cell that lead to cancer and take a patient’s life. More and more, we understand the phenomenon of what’s embodied in the cell, and we are developing an array of therapies that will fight a multitude of cancers.
On the negative side, the completely unsustainable increase in the cost of cancer care is inhibiting our ability to bring scientific progress to patients. So, while we are driving toward precision medicine, we are not approaching precision payment. Cost would be less of a concern if we were consistent about applying best practice to match patient tumor type to best therapy and best possible outcome. But that’s not the case. We must match precision payment and medicine, allowing us to align the business of healthcare with the direction of the science.
Sometimes, it may seem as though we need to take a wrecking ball to the business side of healthcare. Right now, the healthcare industry accounts for an impressive 18% of the American economy, but one third of every dollar spent, a staggering $1 trillion each year, is lost to administrative and clinical waste. That means tests, treatments, operations or other procedures from which patients won’t benefit, but which are ordered and undertaken anyway and – of equal problem – underutilization of necessary care. Waste and inefficiency, or lack of necessary care, may cause additional impacts when they expose patients to further risks, and potentially, further procedures that, in turn, cost more money.
The system that stresses paying for treatments and procedures – rather than their effectiveness – is one that must be retired. It should be broken apart, replaced with a new, more efficient and more demonstrably results-oriented mindset centered on evidence-based medicine – an approach that identifies which tests and treatments lead directly to outcomes, and which don’t. What’s needed is an approach that unites specialty physicians who see treating patients as their operational pathway, their mission and their calling.
In this formula for the healthcare system of the future, technology plays a critical role at the point of care. Data, enabled by AI and machine learning, shows doctors the right path forward for each patient to achieve the best outcome. In this way, we reduce unnecessary variation of care that often takes away from getting the treatment that patients need for the disease that they have, cutting unnecessary costs and increasing effectiveness and efficiency.
As an inventor, scientist and businessman, I know what needs to be done. I’m also still a practicing doctor, so I still see the waste and unaffordability of our current paradigm firsthand. It’s frustrating when you see misplaced emphasis blunting efforts to heal and be efficient. I look at third parties, who are taking money out of the system and not improving clinical outcomes or reducing cost. They don’t share a passion for getting the necessary care to every patient and reducing total cost of care.
Securing the best outcomes for our patients should be our first concern and should be the value that resonates with everyone who has pledged their best efforts to heal. To ensure that we cut waste, helping to make physicians more effective and improving patient outcomes, we need to change the way we pay. Harnessing AI and machine learning, we need to identify only the procedures and therapies that will work best for each patient. Outcomes are what we providers should be rewarded for, not how many times we turn the wheel.
To get to that point, what’s needed is leadership. Leaders who live by and stress the values that unite us. Leaders who come from within the healthcare system and who are focused on healing. Stepping forward, healthcare’s new leaders need to break open the siloes and let the light in, establishing lines of communication that enable a collaborative approach to healthcare delivery, based on value-focused partnerships. These leaders need to convene payers, providers, life science companies (pharma), and hospitals and set up a new model founded on outcome-based reimbursement, predicated on the shared value of the patient’s right to the care they need – no more, and no less.
Written by Dr. Andrew Pecora.
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