I went into healthcare and found there are more sharks there than in all the world's oceans!
Recently, I had the opportunity to interview two individuals whom I greatly respect in the healthcare system and Value-Based Care world, David Muhlestein and Cliff Frank. I have interviewed each of them several times for the class I teach annually on value-based care in the master’s program at the John D. Bower School of Population Health at the University of Mississippi Medical Center. Both individuals have been involved closely with the system for decades and have sought to identify, analyze, and create the changes we all hope to see.
What was fascinating but not surprising was how they both came to the same conclusion. Value-Based Care is not creating what we hoped it would. Its impact has been less than substantial. It was clear from both interviews that the legacy healthcare system is so entrenched, so strong, so dysfunctional that efforts to fix it are like cleaning a single windowpane in a dirty skyscraper. A skyscraper that keeps on growing.
People and politicians have been discussing this issue for decades. It seems every five years or so we have some new solution that’s going to fix the system. Whether it was DRGs back in the day, health maintenance organizations, narrow networks, value-based care, ACOs, population health, LEAD, or the latest and greatest Artificial Intelligence, fundamentally, they are all good ideas. They have incredible potential to fix parts of what ails the American health care system. But, and it's a big BUT, the American health care system does not want to be fixed. It's running perfectly for those mega organizations that are taking our economy and our health to the cleaners. The Megalodons.
Whether it’s the Big 6 Insurance companies (United, CVS Health, Elevance, Centene, Humana and CIGNA, and more), the Big 3 PBMs (Express Scripts, Optum Rx, CVS, and more), the ongoing hospital consolidations, VC or hospital acquisitions of clinician practices or service offerings, and on and on. All say they’re here to fix it, but really, honestly, are you serious…. No surprise, it’s about money. It’s like putting your hand into Fort Knox. The skyscraper keeps on being built.
My words are nothing new, and while healthcare has advanced using all this whiz-bang technology and discoveries over the last 60 years. The business side of healthcare is worse. 42 years ago, I stepped into my first hospital as a wide-eyed administrative resident whose father, a physician and professor of medicine, had advised me to “Take your science background into healthcare administration and make a difference. But you may be too ethical for it.”
Sadly, he was right, and even more sadly, I look back on my career and wonder if I made a difference. Perhaps a little around the edges, maybe I cleaned a minuscule portion of that one windowpane. People are still struggling; healthcare is inconsistent, we spend oodles and oodles, with more spending on the way. Changes come, and changes go, and many get rebirthed every twenty or so years.
We talk a good game; we get excited for the newest ideas and proclaim them loudly from the booths at every trade show. And then we go back to our offices and sling ideas into the void to bounce off the impenetrable walls created by the Megalodons. Perhaps I should have continued studying sharks after my undergraduate degree, but I went into healthcare and found there are more sharks there than in all the world’s oceans.