By KIM BELLARD
Larry Levitt and Drew Altman have an op-ed in JAMA Community with the can’t-argue-with-that title Complexity within the US Well being Care System Is the Enemy of Entry and Affordability. It attracts on a June 2023 Kaiser Household Basis survey about shopper experiences with their medical health insurance. Lengthy tales quick: though – surprisingly – over 80% of insured adults charge their medical health insurance as “good” or “wonderful,” most admit they’ve problem each understanding and utilizing it. And the folks in honest or poor well being, who presumably use well being care extra, have extra issues.
Medical health insurance is the goal on this case, and it’s a honest goal, however I’d argue that you possibly can decide virtually any a part of the healthcare system with comparable outcomes. Our healthcare system is ideal instance of a Rube Goldberg machine, which Merriam Webster defines as “engaging in by advanced means what seemingly could possibly be carried out merely.”
Boy howdy.
Medical health insurance is many individuals’s favourite villain, one which many want to do with out (particularly docs), however let’s not cease there. Healthcare is stuffed with third events/intermediaries/middlemen, which have led to the Rube Goldberg construction.
CMS doesn’t pay any Medicare claims itself; it hires third events – Medicare Administrative Contactors (previously referred to as intermediaries and carriers). So do employers who’re self-insured (which is the overwhelming majority of personal medical health insurance), hiring third get together directors (who could typically even be well being insurers) to do community administration, claims cost, eligibility and billing, and different duties.
Even insurers or third get together directors could subcontract to different third events for issues like supplier credentialing, utilization assessment, or care administration (in its many types). Take, for instance, the universally reviled PBMs (pharmacy profit managers), who’ve carved out a giant area of interest offering companies between payors, pharmacies, and drug firms whereas elevating growing questions on their precise worth.
Doctor practices have lengthy outsourced billing companies. Hospitals and docs didn’t develop their very own digital medical data; they contracted with firms like Epic or Cerner. Well being care entities had hassle sharing information, so alongside got here H.I.E.s – well being data exchanges – to assist transfer a few of that information (and HIEs at the moment are transitioning to QHINs – Certified Well being Info Networks, on account of TEFCA).
And now we’re seeing a veritable Cambrian explosion of digital well being firms, every considering it might probably take some a part of the well being care system, put it on-line, and maybe make some a part of the healthcare expertise rather less dangerous. Or, seen from one other perspective, add much more complexity to the Rube Goldberg machine.
On a latest THCB Gang podcast, we mentioned HIEs. I agreed that HIEs had been developed for purpose, and had carried out good work, however on this supposed period of interoperability they need to be attempting to place themselves out of enterprise.
HIEs recognized a ache level and located a strategy to make it rather less painful. To not repair it, simply to make it much less dangerous. The healthcare system is replete with intermediaries which have workarounds which permit our healthcare system to lumber alongside. However as soon as in place, they keep in place. Healthcare doesn’t do sunsetting properly.
In contrast to a real Rube Goldberg machine, although, there isn’t a actual design for our healthcare system. It’s extra like evolution, the place there are not any fashion factors, no effectivity targets, simply credit score for survival. Positive, typically you get a cat via evolution, however different occasions you get a unadorned mole rat or a hagfish. Healthcare has much more hagfish than cats.
I’m impressed with the creativity of many of those workarounds, however I’m awfully bored with needing them. I’m awfully bored with accepting that complexity is inherent in our healthcare system.
Complexity is dangerous for sufferers, dangerous for the folks immediately giving the care, and solely good for all the opposite folks/entities who make a residing in healthcare as a result of if it. As an alternative of creating ache factors much less painful, we ought to be eliminating them.
If we had a magic wand, we may remake our healthcare system into one thing a lot less complicated, rather more efficient, and far inexpensive. Sadly, we not solely don’t have such a magic wand, we don’t even agree on what that system ought to seem like. We’ve gotten so used to the advanced that we will now not see the straightforward.
I don’t have a Utopian imaginative and prescient of a healthcare system that may clear up all the issues of our system, however I do have some recommendations for all of the innovators in healthcare:
- In case your resolution makes sufferers fill out yet one more kind, log into yet one more portal, make yet one more cellphone name, please rethink.
- In case your resolution takes time with sufferers away from clinicians, making them do different duties as an alternative, please rethink.
- In case your resolution doesn’t create data that’s going to be shared to assist sufferers or clinicians, please rethink.
- In case your resolution solely focuses on a point-in-time, quite than serving to an ongoing course of, please rethink.
- In case your resolution is designed to extend income quite than to enhance well being, please rethink.
- In case your resolution doesn’t acknowledge, acknowledge, report and act on failures/errors/errors, please rethink.
- In case your resolution can’t merely be defined to a layman, please rethink.
- In case your resolution provides to the healthcare system with out decreasing/eliminating the necessity for one thing even greater within the system, please rethink.
- In case your resolution steers care to sure clinicians, in sure locations, quite than in search of the most effective look after the affected person in the most effective place, please rethink.
- In case your resolution provides prices to the healthcare system with out uniquely and particularly decreasing much more prices, please rethink.
- In case your resolution doesn’t have built-in mechanisms (e.g., use of A.I.) to be and keep present on an ongoing foundation, please rethink.
I’m positive all these innovators suppose their concept could be very intelligent, and plenty of are, however bear in mind: simply because an concept is intelligent doesn’t imply it’s not Rube Goldbergian. They should step again and take into consideration in the event that they’re including to healthcare’s Rube Goldberg machine or serving to simplify it. My wager is that often they’re including to it.
So, yeah, I agree with Mr. Levitt and Dr. Altman that medical health insurance ought to be much less advanced. Identical to every part else within the healthcare system. Let’s begin taking the healthcare Rube Goldberg machine aside.
Kim is a former emarketing exec at a serious Blues plan, editor of the late & lamented Tincture.io, and now common THCB contributor.
