The robust discussion, which took place at the Fairmont Copley Plaza in Boston on Sept. 19, hit many levels of healthcare and health IT, as wide-ranging questions were posed to a panel of experts with various areas of proficiencies: Dave Levin, M.D., chief medical officer at Minneapolis-based health IT company Sansoro Health (former CMIO at Cleveland Clinic); Gary Gottlieb, M.D., CEO, Boston-based Partners in Health; Nathan Bays, managing director, health systems M&A group at investment bank Cain Brothers; Robert Huckman, Ph.D., professor, Harvard Business School; and moderator James Golden, Ph.D., managing director, healthcare IT for PwC.
The panelists were first asked about what looks like Republican lawmakers' last-ditch effort to repeal Obamacare, via legislation recently released by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana that has until Sept. 30 to pass. There seemed to be a general consensus among the panelists in Boston that there will not be any real "repeal" that will get through in the next 10 days. Gottlieb, who noted that over the past several years, some 20 million people who were without health insurance have gotten coverage, and that efforts to bring providers and payment together to move from an illness care system to a healthcare system have been demonstrated, said that "it's very difficult to move people away from a program that has changed access to care for a large portion of the population." And, he said, "It's even tougher to do that in the next 10 days."
Huckman and Bays also expressed doubt that anything significant would take place before the 30th, with Huckman noting, "I hope that if we do inject more 'market competition,' let's make sure that the product we are producing is actual insurance rather then [creating] competition between companies that call themselves insurers but don't act like them." Added Levin, "The healthcare system is clearly broken, and the concepts of value-based care make a lot of sense and seem to be resonating with key stakeholders." So, when asked about what to do in the meantime, Levin said, "Be better at the traditional things you have done while finding ways to take on risk. There are clearly opportunities to learn how to do value-based care delivery, and to engage patients and others."
This brought up the concept of innovation, and if healthcare organizations should be ramping up their levels of creative ideas and investments or slowing them down due to the current political uncertainty. Levin, who admits he has a horse in the race, working for vendor Sansoro Health, said, "We're in desperate need of third-way solutions. The challenge is innovating smartly," he said, advising to be more thoughtful about investments, carefully pick strategies, and look for ways to be more agile. "Experiment on a small scale, prove the [experiments] out, and then expand them. We tend to favor moonshots in healthcare, and that's a bad way to do things typically. There are lots of great ideas out there right now, but where's the data? We don't know what actually works yet. So measure carefully and establish the outcomes," he said.
Bays pointed out that via the Obamacare agreement, the deal at the time was that hospitals would accept $155 billion in cuts to their Medicaid and Medicare payments over the span of a decade in exchange for millions of patients gaining coverage, which, according to the dealmakers, would lead to the newly-insured patients flooding into hospitals and thus offsetting the cuts. Bays said that regardless of how one feels about that deal, a cut of that magnitude has created continued pressure for greater innovation. "Innovation is the only way to bridge that gap," he said.
Huckman agreed, noting that innovation should be going on all of the time, regardless of policy or industry. "The challenge in healthcare is that we tend to say that we have checked certain boxes around innovation. Such as, do we have an innovation center? Well, really, the [innovation center] should be the entire hospital. Do we have an EHR [electronic health record]? But that's not innovation until it flows down to the frontline of care delivery. We all agree that we can't afford to spend this much on healthcare," he said.
Continuing the thought on innovation, Levin, half-jokingly, said that too often he says the phrase, "All day I work in healthcare and then I go home and live in the 21st century." Referring to how behind healthcare is from other industries when it comes to innovation, Levin said, "We are burning providers out with this bad experience. The first thing is to [change how we talk] about the patient and the consumer; there are patients and there are consumers, with different needs who interact with the world differently, and who use technology in different ways."
Levin continued, "We need to step back and take a hard look at EHRs. We have invested lots of money, disrupted ourselves enormously to deploy these systems, and yes, they did get us to put down our pens and papers, but they are very fancy transactional system, if we're being honest. So we need to unlock those [systems] and get much more value out of them. We have seen it done in other industries," he said.
But it won't be technology alone that gets the job done, the panelists attested. They all noted how new entrants into the sector, "disruptors" some of the experts called them, will have an impact.