(Note: In keeping with our 2 Minute Drill mantra, we’ve broken this into two parts. Today in Part 1 we’ll highlight Gawande’s view of the three big systemic problems with healthcare. Tomorrow in Part 2 we’ll summarize his vision for the ABJ-HCE.)
Last week Amazon/Berkshire/JP Morgan Chase announced the appointment of renowned author, surgeon, and researcher Atul Gawande to head up their ambitious new “Amazon/Berkshire/JP Morgan Chase healthcare endeavor” (still unnamed, we’ll refer to it as ABJ-HCE for now). In a long form interview at the Aspen Ideas Festival Gawande expounded on his view of the problem facing the U.S. healthcare system and his thoughts on what the ABJ-HCE can do to make the whole system work better.
Here are few of Gawande’s thoughts that struck me as I watched the interview:
- While healthcare comprises 18% of the U.S. economy, 30% of those expenditures are of no benefit to the patient.
- The three biggest sources of waste are:
- Very high administrative costs. He said there are a lot of “middlemen” in the system some of which must be taken out of the system to simplify the equation.
- Pricing (I think he’s referencing the price of healthcare services and the method of paying providers for the services)
- Mis-utilization of treatment. This is identified as by far the biggest of the three buckets. He defined mis-utilization as the wrong care, delivered at the wrong time, and in the wrong way.
- On the reality of our healthcare system:
- It was built in the 1940’s and 1950’s when there were only a handful of treatments.
- Then: A system where the clinician could be expected to do it all – administer the right medicine and treatment. Add in some staff and a place for the patient to recover otherwise leave the clinician alone to do it all.
- Now: We’ve discovered in the last century that the number of illnesses we can have and the number of ways the human body can fail exceeds 70,000 (covering 13 organ systems).
- And, in the last fifty years we’ve generated 4,000 new surgical procedures and 6,000 new drugs.
- Yet, we’re still deploying all these new discoveries and capabilities on a 40’s and 50’s system where the clinician will take care of it.
Gwande points to a broken system. Healthcare is now so complex “that everybody involved feels it’s out of their control – payors, patients, and providers — with no real influence over the end results. “Obamacare is on life support” and “even though I’m going to work for a bunch of employers, employer-based care is broken”.
Tomorrow in Part 2, Gawande on what’s needed, what ABJ-HCE brings to the table, and achieving his goal for the endeavor: “Scalable solutions for better healthcare delivery everywhere”.
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- Tom Barrett
- June 26, 2018
- ACA, confusion, cost, costs, coverage, employees, employers, health plans, healthcare, healthcare reform, hospitals, insurance, medical, medicare, Obamacare, physicians, prescription, trends
- 0 Comments
Great friend, colleague, and highly respected industry consultant Joe Paduda writes today in his widely read Manage Care Matters column about the possible cost and claim shifting implications of uninsured and underinsured workers. In it he makes specific reference to HDHP’s. Among the points Joe makes about ‘High’ deductible health plans are the following:
“44% of working-age adults were covered by high-deductible plans – but more than half of them don’t have health savings accounts needed to fund those high deductibles.”
“ ‘High’ deductible health plans aren’t much different than no insurance at all if the patient can’t afford the deductible – and over half can’t. So, more incentive to cost- and claim-shift.”
I have great respect for Joe and his point of view. He’s as smart as they come, his points are always thoughtful, well-supported by research, and totally authentic (well maybe except for April 1 every year).
However, when it comes to high deductible plans I’d like to remind Joe and others — let’s not throw the baby out with the bath water. There are some innovative and practical uses of HDHP’s to lower costs and deliver better coverage that are most times overlooked by the national stats, commentators and think tanks.
As famed radio commentator the late Paul Harvey used to always say “And now for the rest of the story”.
The “rest of the story” is this: HDHP plans can be and are often used, at least in our little slice of the healthcare world, by savvy and practical employers to lower costs while still providing strong benefits. There’s a core of strong employers out there — many that we are very grateful to count as clients — that are utilizing high deductible plans in combination with reimbursement plans like our own SharedFunding to reduce costs AND provide better coverage to their employees.
Comments like these from a recent conversation among a group of CEO’s speaking to a fellow CEO about SharedFunding are not unusual:
“Helped us tremendously with health costs.”
“We have had zero increases in premiums in the last 4 years.”
“We hired them last year (our year 1) to replicate the comprehensive plan most of our employees had……….. They did it – even using same insurer.”
“Here’s the key – they contract a very high deductible plan (like $11,000 for a family), and then manage all claims & reimbursements. All the paperwork flows through them. Our employees have much lower deductibles and copays they have to meet….”
Have a great Memorial Day Weekend.
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- Tom Barrett
- May 25, 2018
- affordable, confusion, cost, costs, coverage, employees, employers, HDHP, health plans, healthcare, high deductible, HRA, insurance, SharedFunding, trends
- 0 Comments
In a CMS press release the Trump Administration announced yesterday, as expected, that beginning in 2019 individual states will have more control and greater flexibility in regulating the individual health insurance market and the Obamacare Marketplace (aka the Exchange). In a summary of the “final 2019 Payment Notice Rule” CMS highlighted provisions that were intended to increase flexibility, improve affordability, and decrease administrative burdens.
It’s likely that changes made at the individual state level will ultimately have some impact either directly or indirectly on employer sponsored health coverage, particularly the small group market. We will be monitoring this very closely for our clients and will report back, especially as we get closer to 2019 and more information becomes available.
In the meantime, here’s a sampling of the headlines and links to the respective articles following yesterday’s announcement by CMS:
Here’s a link to the CMS press release:
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- Tom Barrett
- April 10, 2018
- ACA, affordable care act, cost, costs, coverage, employees, employers, exchange, federal, health plans, healthcare, healthcare reform, insurance, mandate, medical, Obamacare, states
- 0 Comments
A month and change has now passed since the great splash of January’s big Amazon/Berkshire/Chase health venture announcement. It certainly was successful in disrupting the news cycle. The initially sky-high healthcare “Richter Scale” readings are returning to normal. And, it’s pretty safe to say that any substantive changes, major disruption, and any new normal that may be triggered by this venture on big healthcare (20% of the economy), other employers – big, small and in between, and everybody else are not on the immediate horizon.
Like the CVS/Aetna venture announced last December, real change is likely to be More Tortoise Than Hare.
A sampling of Warren Buffett’s comments in some of his recent interviews with Bloomberg, CNBC, and KHN may provide you with a little more insight and a glimpse of some of his expectations.
Here are a few sound bytes from recent Buffett interviews:
He said that the goal of the business is “better care, lower costs,”and, that it will “take time.”
“This is not easy. If it was easy, it would have been done.”
“It would be very easy I think to go in and shave off 3 or 4 percent just by negotiating power. We’re looking for something much bigger than that.”
He spoke of health-care spending taking up an increasing proportion of the U.S. economy, and a indicated that the goal of the venture is to “at least” halt that ascendant trend.
Buffett also stated that he hopes “we could find a way where perhaps better care could be delivered even at somewhat lesser cost.”
To read more go to Bloomberg: Buffett-Dimon Health Venture To Go Beyond Just Squeezing The Middlemen