Seven Solutions to Healthcare Reform (Part 1 of 7)

In our last blog, “ObamaCare | Epilogue Part 2” we ended with seven solutions for healthcare reform. There are certainly many more than seven things that we can do to reform healthcare; however, as we mentioned in the last blog, healthcare is extremely complicated and a change in one area has a ripple effect throughout as we’ve seen happen with the Affordable Care Act. We must start with a view of the entire landscape of healthcare, and the seven solutions provide us this high altitude view so that we can then make sense of the details, bring change to the dynamics of healthcare, and bring order out of chaos and confusion.

The end goal is that whatever replaces ObamaCare will have to extend longer than just the next four years; additionally, it will require a clear consensus going in to affirm that once the plan is set, it is not “tweaked” or changed with every ensuing administration. Our position on ObamaCare has been consistent since day one and we have written extensively here, especially over the last 6 months.

Here are the seven solutions we recommend to advance healthcare reform in the United States:

1. Reduce the cost of providing quality care by using more technology to collect, analyze, and make actionable recommendations for patient wellness.

2. Engage and empower the consumer in managing their own wellness, in part, by using more healthcare IT.

3. Reward consumers for improving their own wellness and reporting their own data.

4. Promote higher quality of care by facilitating coordination between providers of care and their patients.

5. Advancing a more efficient and transparent system to all that reduces waste and administration.

6. Adopting a payment model to be more aligned with care, and less to do with visits.

7. Allow “free market” competition into the healthcare process where it makes sense, and the cost of providing healthcare services, goods, and products can bring meaningful cost savings while maintaining quality of care.

Starting with this blog and continuing over the next six blogs, we will do our best to briefly address each of the seven solutions.

First, let’s discuss the better use of technology.

Nearly every industry on earth has been transformed by technology. From our perspective, there are effectively two that remain modestly changed by technology today – education and healthcare. I have a committed interest to both; first, I give a substantial amount of interest to one of the state colleges, as well as a research university, both located in South Florida. Secondly, healthcare has been my professional career for 25 years. During those 25 years, I have been deeply immersed in trying to both understand and improve it.

It is uncontested that the U.S. has the best diagnostic technologies in the world; that is, MRIs, CT scan, EEG, EKG, remote monitoring, etc. Since 2004, we have had mandated electronic health records (EHR), and since 2009, we have spent collectively well over $150 billion (USD) across the industry in software, integration, lost productivity and more than likely, people. The U.S. Government alone has invested over $35 billion (USD) to promote the EHR mandate over the last five years, and yet healthcare practioners are still not connected. We have simply transformed paper silos into digital silos.

Any casual reader of this blog knows that I have a strong passion to read, and when not working or sleeping, you can find a book in my hand nearly the rest of the time. I just picked up a new book by Thomas L. Friedman that has been totally consumed. The title is “Thank You for Being Late: An Optimist’s Guide to Thriving in the Age of Accelerations.” While I’m currently only three chapters in, Mr. Friedman discussed many things that interest me, and two points are relevant to the subject of this blog.

Mr. Friedman mentions how the year 2007 was an inflection point from his perspective. That year we saw the emergence of the iPhone, Twitter, IBM’s Watson, Facebook (to the masses), etc. This amazing collection of computing power, with other data like geolocation features, as well as the ability to provide access to nearly all the knowledge known to man, all through a device that fits in the palm of our hand. Despite the very best technology than anywhere else, all we have is a disjointed functionality and interoperability of EHR and “health” applications that measures our heart rate, how many steps we take in a day and what we entertain in or engages our attention. All this capability and data are in their respective “silos” on your smart phone or in an obscure application in the cloud however, it is NOT connected to the people that provide care of our health.

Mr. Friedman took note that today General Electric (GE) has evolved way beyond an industrial company that “connects” to what it makes. GE connects real time to 150,000 medical devices, 36,000 jet engines, 21,500 locomotives, 23,000 wind turbines, 3,900 gas turbines and 20,700 oil and gas equipment. The sensors installed in these devices, and their connection to the “Internet of things” (IOT) totally changes how GE makes every piece of equipment operate better, be adjusted or serviced.

Humans for the most part have sensors that tell “us” a lot; however, they don’t connect to anything. While the data integration is there, nothing is available real time for those to act on it, such as our care management team. My truck has a sensor that actually allows for actionable decision. More on this below.

We have been a longtime proponent of digitization of the wellness record since we entered healthcare in the early 90s, and we have made material investment in that space ever since. We have seen it work in a clinical environment and projected the possible benefits. We have also questioned why the government has advanced EHRs in the U.S. in such a dysfunctional way that neither providers nor patients are able to see any tangible benefit.

Eventually, the goal should be to integrate medical records, and other “sensors” to both improve quality of care and reduce cost. This is the only way we can reduce the rate of increase in healthcare cost at two (and sometimes three) times the inflation rate. We advocated that the health information industry should be treated by our government as “infrastructure” (please hear this President-Elect Trump), and we should invest in it, as we have done with all long-term infrastructure projects since the Erie Canal circa 1817. We need long-term investments to gain long-term value. We have recently noted that the U.S. interstate system took 35 years and hundreds of billions of dollars in public investment to accomplish.

After a $35-billion-dollar (USD) investment to influence the largest industry in the U.S., we have just barely scratched the surface and have not brought the significant impact to what healthcare technology can bring. If we calculate the investments based on over $20 trillion that we have spent in healthcare over the same period, it would be less than a rounding error and it wouldn’t be noticed.

We believe that it would be very prudent for our government to see an investment at a minimum of let’s say, one third of 1% of our national health expenditures on Health Information Technology (HIT) for the next two decades. That is 0.003 X $3.2 trillion (USD) or @ $9.6 billion (USD) per year. The value to our society will be dramatic and a “moon-shot” commitment with lunar landing value derived – a “giant leap for mankind.”

Another use of technology today is to integrate industries so that the flow of information is more transparent, yet secure. Information flow is more relevant than ever to the consumer of healthcare. Thanks to the internet revolution, consumers’ first line of questioning is the internet. Healthcare questions are always at the top in the top searched categories. This definitely causes some issues in self-diagnosis; however, a well-informed, engaged and empowered consumer should make for a better patient.

Our point goes well beyond the traditional EHR, even once integrated to connect doctors to each other and to the consumer on a real-time basis; it is going to use all the technology we have to improve the standard of life.

What if we connect all we have to the EHR – the smoke detector in our home to measure air quality, our refrigerators to monitor our caloric intake, and the weight in our bathrooms? How about those fancy watches we all wear today that give us information? That all goes somewhere however, not to where it can bring us direct value – to our physicians’ EHR. Even our cars are smart and can offer insight into our wellness. Where we go and what we do, all impact our lives, whether we are awake or sleeping.

My Ford F-150 is connected to the internet, it communicates with Ford regarding how the engine is performing and when it needs service. Even more interesting, my truck connects to both satellites and my cell phone to tell me of traffic issues, weather, and other alerts that are of value and improve safety. We don’t even have to talk about the all the alerts that it has on traction, spacing between cars or alerts when cars are on my blind side. Yes, it can monitor the road and it can adjust to conditions to make my driving safer. We need that technology transformation for our lives and our wellness, not just our homes and our cars.

Imagine a world where everything we do that impacts our lives connects to our wellness record, and our providers! The sad news is, that as much as we think we have invested in health information technology, it pales in comparison with the use and advances in the application of technology in nearly every other field in the U.S. and the world. How the most important component of human life has yet to experience the “inflection point of technology” is disappointing. As an optimist, we remain observant and expect that breakthrough moment at any time.

– Noel J. Guillama, President