By KIM BELLARD
Larry Levitt and Drew Altman have an op-ed in JAMA Community with the can’t-argue-with-that title Complexity in the US Health Care System Is the Enemy of Access and Affordability. It attracts on a June 2023 Kaiser Family Foundation survey about shopper experiences with their medical health insurance. Lengthy tales quick: though – surprisingly – over 80% of insured adults price their medical health insurance as “good” or “glorious,” most admit they’ve problem each understanding and utilizing it. And the folks 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 possibly can choose nearly 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 “conducting by advanced means what seemingly may very well be accomplished merely.”
Boy howdy.
Medical health insurance is many individuals’s favourite villain, one which many wish 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 generally even be well being insurers) to do community administration, claims fee, 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 overview, 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 corporations 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 information; they contracted with corporations like Epic or Cerner. Well being care entities had bother sharing information, so alongside got here H.I.E.s – well being info 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 may well 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, considered 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 purpose, and had accomplished good work, however on this supposed era of interoperability they need to be making an attempt to place themselves out of enterprise.
HIEs recognized a ache level and located a method 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 effectively.
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 aren’t any model factors, no effectivity targets, simply credit score for survival. Positive, generally 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 instantly 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 must be eliminating them.
If we had a magic wand, we may remake our healthcare system into one thing a lot easier, way 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 appear like. We’ve gotten so used to the advanced that we are able to not see the straightforward.
I don’t have a Utopian imaginative and prescient of a healthcare system that may remedy 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 another kind, log into yet another portal, make yet another telephone 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 info that’s going to be shared to assist sufferers or clinicians, please rethink.
- In case your resolution solely focuses on a point-in-time, fairly than serving to an ongoing course of, please rethink.
- In case your resolution is designed to extend income fairly 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 lowering/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, fairly than searching for one of the best take care of the affected person in one of the best place, please rethink.
- In case your resolution provides prices to the healthcare system with out uniquely and particularly lowering 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 assume their concept may 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 normally they’re including to it.
So, yeah, I agree with Mr. Levitt and Dr. Altman that medical health insurance must be much less advanced. Similar to every thing 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.
