JTMH Journal

Perspective

 What is good medical care? Like everything else today, the answer depends on your perspective.

 Indeed, given everything that is wrapped up in the otherwise innocuous phrase "Good medical care" – health, money, politics, life, love, and more – there is perhaps no other topic that can provoke such a wide range of responses.

Here's my view.

 I don't come at this view lightly. In fact, I try not to come at it from just one perspective. I'm a doctor, businessman, husband, father, taxpayer, patient, and friend. I have seen all of the powerful good and shameful bad that our medical system provides. I’ve seen lives saved and lost. I’ve marveled at the righteous help we can provide to each person as well as huge populations, and I’ve shaken my head in disbelief at wasted time and money that prevent even more individuals from getting the help they need.

 But with so many angles, one has to start someplace. There must be something in the center – an organizing principle – around which all of the other health system concerns rotate.

 The patient and their family is that center.

 Here’s what that looks like:

 Putting the patient at the center is not just a feel-good maneuver – nor is it the end of the challenge. Tough decisions will still need to be made by all parties around cost, quality, frequency and duration of care. But when one puts the patient at the center of the equation, the math becomes much simpler. Tough decisions become more straightforward.

 As a doctor and businessman in the health care sector, I get asked a lot about the topic. What’s amazes me is that I don’t get asked for free medical advice often as you would expect (“You’re a doctor? This has been bothering me… what do you think I have?”).

 Instead, the question I most often get asked is: What is going on with my health care? Do you think I really needed that test? Should I have that surgery? Do these drugs make sense?

 This makes no sense. Why should people ask me about their health care as opposed to their own personal health? For the reason we all know: Health care is broken.

 The breakdown is obvious. To begin, two-thirds of all health spend goes to hospital care, unnecessary waste and administration as well medications, and a phenomenal amount of this spend – $1 trillion – is totally unnecessary. People wonder why things are so expensive and out of control. Instead we should wonder how can we re-prioritize patient care – what incentives need to be in place?

 In fact, health care broken from whichever perspective one takes – a mix of good intentions gone awry and, often, conflicting interests:

·                     Hospitals: When hospitals are fighting each other to secure relationships with physician groups – as well as having to manage bed-occupancy rates in the face of excess capacity increased hospital-owned outpatient services– health care is broken.

·                     Doctors: When doctors spend more time on back office administration than talking with patients and their families and more intimate bedside manner – more effort navigating insurance requirements than on patient concerns – health care is broken.

·                     Pharmaceuticals: When drugs cost upwards of 90 percent more in the U.S. than just over the border in Canada – and pharmaceutical companies have doubled their share of health care dollars while fighting against legislation to ensure VA pricing for everyone – health care is broken.

·                     Payers: When payers are forced to act like banks rather than being able to focus on promoting good care – when they face the understandable frustration of double digit premium increases while spending increasing time addressing potential regulatory change rather than encouraging healthy habits – health care is broken.

·                     Policymakers: When policymakers seem uniquely focused on removing health care from millions rather than enabling excellent care for all and ignoring the psychosocial needs of patients, including addressing the social determinants of health care– health care is broken.

·                     Pundits: When commentators and journalists treat health care like a political game of football – a contest of who’s up and down, rather than as the most important social issue our nation faces – health care is broken.

·                     Patients: When patients avoid seeing doctors for fear of expense or hassle – when becoming healthy carries a greater burden than getting sick – health care is broken.

Now, I’m not naïve; health care costs money. I know that in our market-based system, once pharmaceutical companies release a new drug, they need to recapture their deep investments in R&D. I know that doctors and nurses deserve to make good livings. I know hospitals can’t go broke. Remember: I’m not just a doctor; I’m also a businessman.

But as a businessman, I also can recognize when a marketplace is broken. When incentives are misaligned, and money flows towards perpetuating inefficiencies rather than improving human health, things are broken.

Getting health care right carries another important benefit: It will bring back the joy to the practice of medicine.

I have an old saying: Happy doctors make happy patients. We need true advocacy and real partnership – trust – between patients and their doctors. To be clear, this is about primary care not specialty care.  Specialists are consultants and collaborators. They’re central to good care.

But this is about restoring dignity for both patients and doctors together. It about shifting the model so patients pay for personal interaction, not just tests.  This is about bringing back the joy to medicine for both patients and doctors and achieving the quadruple aim: Higher quality care, lower total cost of care, better patient engagement and higher physician satisfaction.

If we can get health care right, the next time I’m asked, “What’s going on with my health care,” I can provide an answer as straightforward as the question: All interested parties are focused on the same thing – Your wellbeing.

The solutions won’t come easily. But I’m anxious to do my part.

Over the next weeks, agilon will launch an ongoing dialogue with representatives from the key parts of our health care system: Hospitals, doctors, payers, policymakers, pundits, and most importantly, patients.

We will advance a conversation to unwind complicated answers with simple questions:

·                     How can we put the patient at the center of our health care system?

·                     How can we ensure a market-based system that aligns appropriate financial incentives with the human incentive to help other people get and stay healthy?

·                     How can we get health care right?

We will conduct this conversation through blog posts, highlights of smart third-party articles, thoughtful podcast conversations, social media, and more. We will focus on the important components required to make things better, including cost, care, patient engagement, and policy.