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 insurance. Lengthy tales brief: though – surprisingly – over 80% of insured adults price their medical insurance as “good” or “wonderful,” most admit they’ve issue each understanding and utilizing it. And the individuals in truthful 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 truthful goal, however I’d argue that you may choose 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 “carrying out by advanced means what seemingly could possibly be accomplished 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 filled 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 generally known as intermediaries and carriers). So do employers who’re self-insured (which is the overwhelming majority of personal medical insurance), hiring third social gathering directors (who could generally even be well being insurers) to do community administration, claims cost, eligibility and billing, and different duties.
Even insurers or third social gathering directors could subcontract to different third events for issues like supplier credentialing, utilization overview, or care administration (in its many kinds). Take, for instance, the universally reviled PBMs (pharmacy profit managers), who’ve carved out an enormous area of interest offering companies between payors, pharmacies, and drug corporations whereas elevating rising questions on their precise worth.
Doctor practices have lengthy outsourced billing companies. Hospitals and docs didn’t develop their very own digital medical information; they contracted with corporations 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 are actually transitioning to QHINs – Certified Well being Info Networks, resulting from TEFCA).
And now we’re seeing a veritable Cambrian explosion of digital well being corporations, every pondering it could 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 unhealthy. Or, seen from one other perspective, add much more complexity to the Rube Goldberg machine.
On a current THCB Gang podcast, we mentioned HIEs. I agreed that HIEs had been developed for a great motive, and had accomplished 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 technique to make it rather less painful. To not repair it, simply to make it much less unhealthy. 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 nicely.
In contrast to a real Rube Goldberg machine, although, there isn’t any actual design for our healthcare system. It’s extra like evolution, the place there are not any model factors, no effectivity targets, simply credit score for survival. Certain, generally you get a cat by means of 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 uninterested in needing them. I’m awfully uninterested in accepting that complexity is inherent in our healthcare system.
Complexity is unhealthy for sufferers, unhealthy for the individuals straight giving the care, and solely good for all the opposite individuals/entities who make a residing in healthcare as a result of if it. As an alternative of constructing ache factors much less painful, we ought to be eliminating them.
If we had a magic wand, we might remake our healthcare system into one thing a lot less complicated, rather more efficient, and far cheaper. Sadly, we not solely don’t have such a magic wand, we don’t even agree on what that system ought to appear to be. We’ve gotten so used to the advanced that we are able to now not see the straightforward.
I don’t have a Utopian imaginative and prescient of a healthcare system that will 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 looking for 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 certain all these innovators suppose their concept may be very intelligent, and lots of are, however keep 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 guess is that often they’re including to it.
So, yeah, I agree with Mr. Levitt and Dr. Altman that medical insurance ought to be much less advanced. Similar to all the pieces else within the healthcare system. Let’s begin taking the healthcare Rube Goldberg machine aside.
Kim is a former emarketing exec at a significant Blues plan, editor of the late & lamented Tincture.io, and now common THCB contributor.
