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The healthcare headlines of 2018 were a sorry sight: The opioid crisis lowered life expectancy for a third consecutive year. Skyrocketing drug prices deprived more Americans of life-essential medications. Some of the most decorated institutions were riddled with research scandals and ethics violations while hospital mega-mergers put profits ahead of patients.
America’s political and medical leaders have promised fixes for decades. Nothing has worked so far. Healthcare has grown increasingly less affordable and avoidable deaths continue to wipe out hundreds of thousands of U.S. patients each year. The time has come for serious change.
Incremental improvements, local pilot programs and shiny new machines simply won’t cut it. We need a solution – something robust, brave and disruptive with approaches capable of transforming the system for good.
With that aim in mind, I launched the Fixing Healthcare podcast in August 2018. The format for season one, which wrapped this week, was simple: Invite innovative and articulate healthcare leaders to apply for the prestigious (and totally fictitious) role of “Leader of American Healthcare.” To earn it, each guest would have 10 minutes to present a bold yet pragmatic plan to solve healthcare’s five biggest problems (see image).
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As co-host, my duty has been to probe each plan for weaknesses and pose the kinds of questions that helped the show become “the toughest job interview in healthcare.”
In season one, all six of the guests I invited accepted the challenge and offered their best solutions. Now it’s your turn to decide which ideas stand apart.
You’re Invited To Vote For The Best Ideas To Fix Healthcare
I’ve boiled down the best and boldest recommendations from season one: three per guest. As you’ll see, their recommendations differ greatly. Please vote for the ones you think have the great potential to fix healthcare and feel free to share your own ideas on our polling page. We’ll read the best listener comments during season two, which begins February 2019.
Click here to view the ‘Fixing Healthcare’ poll
Dr. Zubin Damania (aka ZDoggMD) is the voice of the Health 3.0 movement. As a former hospitalist turned clinical leader (turned healthcare satirist), he sees solutions in non-traditional primary care tactics. In his words, “There’s this distinction between how to pay for healthcare, which is what we talk about all the time, and what you’re actually paying for. First, we have to fix what you’re actually paying for.” To do that, ZDoggMD suggests:
1. Reduce number of specialists and hospitals nationwide. Hire more primary care doctors who focus on preventive medicine and utilize “health coaches” to spur positive lifestyle changes.
2. Replace healthcare’s fee-for-service reimbursement system (which pays doctors for each visit, test and procedure) with a capitated (or “bundled”) payment model so docs focus on the quality, not quantity, of clinical services.
3. “Go where patients need us,” using telehealth, phone visits, secure email and Skype to improve convenience and satisfaction.
Listen to episode 1 with ZDoggMD | Vote for ZDoggMD’s ideas
Dr. Halee Fischer-Wright, a 19-year pediatrician, is now CEO of Medical Group Management Association (MGMA), a membership group that represents roughly 50% of all healthcare delivered throughout the United States. In her words, the industry’s two biggest problems are “administrative complexity and regulatory burden.” Here are three of Dr. Halee’s boldest recommendations:
4. Use improved technologies and commonsense solutions to halve the cost of medical billing and claims, which currently sits at around $ 471 billion per year.
5. Simplify the prior authorization process for doctors to free up nearly 15 hours a week, thereby creating time for physicians to focus on patients rather than documentation.
6. Create “empowered partnerships,” placing trust and accountability in the hands of all healthcare players, from physicians and their patients to insurance companies, policy makers and drug companies.
Listen to episode 2 with Dr. Halee Fischer-Wright | Vote for Halee’s ideas
Dr. David Feinberg, a psychiatrist by training and former CEO of Geisinger Health, is now at Google in a leadership role. He surprised me with his plan, which focused primarily on addressing the “social determinants of health,” not the shortcomings of U.S. care delivery. In his words, only “20% of whether we live or die is based on doctors and hospitals.” His plan to fix healthcare would therefore address “the stuff that really matters: your genetic code, your zip code, your social environment, your access to clean food and transportation.” Here are Dr. Feinberg’s three disruptive ideas:
7. Close the majority of hospitals and reassign doctors to community- and home-based healthcare roles that help people get or stay healthy.
8. Offer free, nutritious foods to all Americans living with (a) type-two diabetes and (b) food insecurity, a practice that can improve health and reduce per-patient medical costs by 80%.
9. Provide free transportation to anyone who needs it because “getting someone to the doctor is a lot cheaper than having the ambulance come two days later” for a medical emergency.
Listen to episode 3 with Dr. David Feinberg | Vote for David’s ideas
Dr. Eric Topol wears many healthcare hats: He’s a health-tech expert, one of the top 10 most-cited researchers in medicine, a professor of molecular medicine, the EVP of Scripps Research and an author of two bestselling books on the future of medicine. He too surprised me with his foremost healthcare recommendation:
10. Guarantee universal coverage and “provide healthcare equitably among all U.S. citizens. That’s step number one.”
11. Use AI, machine algorithms and remote/home monitoring systems to reduce the need for staffing and utilization in hospitals, which account for $ 1.2 trillion annually.
12. Eliminate incentives for doctors to perform wasteful or unnecessary “in-person” tests and procedures. Do so by paying all physicians a salary and reducing the influence of medical specialty societies, which advocate for status-quo payment models.
Listen to episode 4 with Dr. Eric Topol | Vote for Eric’s ideas
Dr. Donald Berwick was the founder of the Institute for Healthcare Improvement (IHI), leader of the 100,000 Lives Campaign and head of the Centers for Medicare and Medicaid Services (CMS). He offered a provocative prescription for American healthcare.
13. Eliminate fragmented, ineffective healthcare by forming a consortium of leaders who all share this trio of goals: better care, better health and lower costs (aka, the “Triple Aim”).
14. Put American healthcare on a “measurement diet,” reducing the number of performance metrics by 75% within 5 years (so docs can focus on patients, not on hitting arbitrary numerical targets).
15. Move healthcare reimbursement from fee-for-service to “global budgeting” (budgeting for the totality of patient care at the regional level), giving community leaders the power to allocate healthcare dollars where they’re most needed, locally.
Listen to episode 5 with Dr. Don Berwick | Vote for Don’s ideas
Ian Morrison, a world-renowned futurist and the final guest of season one, has worked with more than 100 Fortune 500 companies. He specializes in national polling and forecasting healthcare changes. Here are three of his recommendations for fixing American healthcare:
16. Provide “Medicare Advantage for all,” with managed-care plans privately run insurers that receive funding from the government (as opposed to “traditional” fee-for-service Medicare).
17. Limit spending on new medications and medical devices that fail to deliver major improvements in patient outcomes.
18. Tie the rate of healthcare inflation under Medicare Advantage to the annual rise in U.S. GDP. Today, the former greatly outpaces the latter, resulting in dramatically high prices for American healthcare compared to other countries.
Listen to episode 6 with Ian Morrison | Vote for Ian’s ideas
Based on the superb and innovative ideas presented in season one, two conclusions are evident. First, effective solutions do exist for American healthcare. Second, no one person’s ideas will be sufficient. It will take many people and a combination of breakthrough ideas to radically improve our system of care. That’s why your feedback is so important.
Vote now on the top 3 ideas for “Fixing Healthcare”
Six of healthcare’s most significant voices shared their plans for fixing a broken system.FixingHealthcarePodcast.com
James Surowiecki, in his book The Wisdom of Crowds, demonstrated convincingly that the feedback of many knowledgeable individuals is superior to the judgement of a handful of experts. I’m optimistic that you, the Forbes’ reader, can and will elucidate the best of these ideas. In addition, please offer your own recommendations on how to fix the current healthcare system on the polling website. We’ll share the best suggestions with our listeners during season two. Together, we can once again make American healthcare the best in the world.