The Healthcare System's Dirty Secrets | Big Think

the fundamental problem with with Healthcare in the US and and and in many other countries as well by the way is that uh the system is not really organized and structured uh around

delivering value for the patient Michael Porter um professor at Harvard Business School we have a system where in America particularly we don't have everybody

covered by an insurance system and the insurance system that we do have uh is again not uh structured around value um

uh insurance companies have been rewarded for actually excluding sick people um and their modus openda is to bargain down prices with providers um

rather than actually improve the health of their subscribers we we don't even know if insurance compan do a good job of actually assisting their members or their subscribers in in improving their

health conditions and so the insurance Market has been really not rewarding value uh but really rewarding cost shifting pushing cost from one entity to

another passing more cost on to the consumer so uh so the insurance system is is really a key part of the problem but what we I think understand now is the real fundamental problem is the that

we're not delivering healthc care in a way that creates value or the maximum value for the customer and that's fundamentally because the organization of healthc care is

misaligned with really the needs of the patient uh Healthcare is organized around Specialties and interventions uh uh you go to the radiologist you go to

the uh Internal Medicine person you go to rehab these are all separate departments separate people separate uh interventions with separate administrative structures U but but

that's not what creat creates value what creates value is really to integrate all the expertise and Specialties and interventions necessary to address the patient's medical condition whether it's

diabetes or heart problem or uh an arthritic hip um over the full cycle of care of that patient um and and and fundamentally then the organization of the delivery of care is really not

organized around the patient and the value for the patient but it's really organized around the traditional uh divisions and special needs in the field and and what makes it worse is that we don't actually measure the value

delivered we don't even measure Health outcomes at all uh except in very rare cases so it's very hard to drive value in a system where where value really isn't measured and where pricing

actually reinforces uh the fragmentation and lack of coordination in the system today we pay for services basically we pay SE pay

the doctor separate from the hospital we pay the radiologist separately from the surgeon we pay pay the surgeon separately from the anesthesiologist we pay the office visit separately from the rehab and essentially the payment system

then just simply encourages people to do more services rather than to optimize the overall value that they that is delivered uh in terms of the patient outcomes per dollar Spence so we've got

a real mess on our hands because the the structure of the system is really really fundamentally disconnected to to Value electronic medical records are a

very important uh technology that has to be deeply embedded in healthcare delivery because it enables what we fundamentally know we have to do to deliver value uh

electronic Med medical records enable integrated care where all the experts and Specialties and and and and and and folks working with a given patient can

actually be on the same page in terms of sharing information and having the full information about the patient's whole medical condition um rather than have each office each specialty have their

own records and and really not know what anybody else did um we also know that electronic medical records are a platform for measuring results that is measuring the outcomes uh carefully over

the whole cycle of care and and also being able to carefully measure the total cost see we don't really care about the cost of anyone intervention what we care about is the cost of the

whole cycle of care and we need to be optimizing the total cost not trying to minimize the cost of individual interventions in fact what we know in healthcare is that we actually may want

to spend more on some things like say screening um in order to save money later on in the care cycle by uh minimizing uh complications or emergency

room visits or whatever but we don't without electronic medical records that really cut across all the Specialties and services we can't really even start to think about those

issues met medical science is is a very rapidly changing and improving uh set of Technologies and and so when we when we create a healthcare

delivery system we need to have a system that's actually engineered for continuous innovation uh to rapidly embrace the the the newest uh uh uh

protocols the newest drugs the newest devices the newest services that can actually enable the patient to do better uh to get well more quickly to do it do

it more efficiently um so ironically healthc care delivery should be really structured around Innovation the the problem we have today is is that because

of this kind of siloed model and because everybody looks at their little piece of the of the of the patient care uh cycle separately uh we actually uh don't

deploy Innovation very well and often Innovation is perceived as the enemy because we we come up with a new Imaging technique or we come up with a new medical device and then and then the incentives are for the people involved

in that to just do as much as they can and crank up as much revenue as they can rather than think about how can that uh image or that device actually change the

entire care cycle how can we optimize the overall uh process of care so um you know um uh we we believe that um you

know the a lot of the the concerns uh uh about the use of technology and and and the cost of technology in healthcare are not inherent in the technology itself but they really reflected in in the

nature of the way technology is actually deployed in the delivery system and how we pay measurement in health care is is is happily uh something that is now

Gathering some steam uh but uh unfortunately the approach to measurement in healthc care has been to measure processes of care not outcomes uh

processes of care are things like did the did the doctor prescribe the given drug at the right time uh was there uh

an appropriate test given um you know uh so so basically the process approach to measurement says let's kind of second guess how doctors practice medicine or

how teams practice medicine and let's take guidelines that we've learned from clinical studies and let's make sure that the doctor is doing the right thing the problem with Process Measurement is that it never

fundamentally captures even a small part of the complexity of actual caring for a patient uh even for a relatively simple disease there there are there's a lot of judgmental factors that are necessary

guidelines don't cover everything the trouble with guidelines is they also freeze the status quo they're really anti- Innovation they the guidelines are always several years behind the best

practices and so if you force do doctors to follow the guidelines rather than figure out how to do it even better you you kind of slow down Innovation so what we need to move from is the process

approach which is the approach that we're using now to really the outcome measurement approach process is still need to be measured but that needs that can be left to the providers that can be

left to the organizations themselves like we leave that to businesses you know we don't compare process measures across companies in in in in public rankings you know we we compare out

measures of of companies and now now outcome measurement is the health outcomes how well the patient did uh did they survive uh how close to recovery

did they get uh how how fast did that recovery occur uh how much complexity and complications were there in the treatment process were there relapses how often how soon how serious those are

the kind of things we need to be measuring but by and large this process is just beginning to take hold in

America and uh uh uh and and this is in my view the single biggest leverage point to drive he Improvement in the healthare system is to measure outcomes

and to measure it for every provider for every medical condition uh we we know we can do this we've proven it works we've proven that when we measure outcomes we

can get dramatic improvements in value uh but we simply have lacked the will um and the conviction that this is really on the top of the list for really driving improvement in healthcare