If you know someone or have personal experience being in a healthcare treatment ecosystem you have most likely experienced the confusing, helpless feeling of being shifted between offices, trying to schedule appointments, understand your diagnosis or diagnostic discovery process, making treatment decisions and then understanding what you were charged for all of this.
I know this first hand as I lost my mother to cancer when I was 13 years old. I watched her be run through the healthcare mill for 4 years prior to her passing. After this experience, even as a naïve observer of the process, it was obvious that something seemed off. Most recently I experienced my mother-in-law passing of cancer after an almost 4-year battle. Even after working in the healthcare industry for many years at that point it was clear that, even with all of my knowledge and understanding of how things worked, I was still unable to help my family avoid several blunders by her care teams and the billing departments involved.
None of the previously mentioned even touches on the lack of bedside manner and simple human and communication ineptitude displayed by many of her physicians and ancillary care providers. Impersonal and cold are understatements.
Unlike any other industry on the planet, the American healthcare system has evolved into a massive, confusing and maddening institution that, for the most part, treats those it serves as if they are privileged to be a patient vs. seeing itself as a servant to its patients and rarely admits its part in broken processes or poor treatment.
Now, I have worked within the healthcare industry, primarily on the provider side for over 16 years now. I have worked with physicians, patients, health systems, carriers, government and support companies serving different aspects of healthcare. I have met some really caring people who are truly changing the paradigm I described above. I am not throwing the baby out with the bathwater. However, what I witness now more than ever is that healthcare is struggling to get beyond its own bad habits, lack of patient-centered systems and data interoperability and regulatory and reimbursement issues. Patient care, transparency, and outcomes are unfortunately not topping the list of healthcare executives’ focus.
For example: In 2000, Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health, wrote an article that was published in the Journal of the American Medical Association (JAMA). Based on her article, a headline was created that has reverberated through the web ever since: Doctors Are The Third Leading Cause of Death in the US. Dr. Starfield's research documented how 225,000 Americans die per year from iatrogenic causes, i.e. their death is caused by a physician's activity, manner, or therapy. The numbers since this article have only continued to climb.
In addition to this, over a decade ago, Professor Bruce Pomerance of the University of Toronto concluded that properly prescribed and correctly taken pharmaceutical drugs were the fourth leading cause of death in the U.S.
In 2010, a then-new analysis published in the New England Journal of Medicine (2) found that, despite efforts to improve patient safety, the health care system hasn't changed much. In looking over records that spanned from 1976 to 2006 (the most recent year available at the time) they found almost a quarter-million deaths annually were coded as having occurred in a hospital setting due to medication errors. In all, there were over 25 injuries per 100 hospital admissions—yes, that is 1 out of every 4 people.
Adverse Drug Reactions- 106,000
Medical Error- 98000
Unnecessary Procedures- 37000
There are significant costs associated with all these errors as well. For example, the cost of adverse drug reactions (3) alone is more than $136 billion annually -- greater than the total cost of cardiovascular or diabetic care.
What is contributing to these problems?
Lack of Physicians = Less Per Patient Care and Support.
An analysis of the projected supply and demand for physicians, conducted by the Health Resources and Services Administration in 2008, foretells of a total shortage across the entire workforce. Particularly evident is the deficit projected in non-primary care subspecialties, with a shortage of 35,000 surgeons and 27,000 medical specialists by 2024.
Physician demand is only increasing today. Roughly 30 million new healthcare consumers are projected to increase the use of all physicians by 5% or more by 2020.
For reference, due to our ever-increasing demand for healthcare services, this means that 30,000,000 new consumers x 2 additional physician visits per year, divided by 4,000 avg. number of patients seen per year by each primary care physician.
Equals = 15,000 additional primary care physicians needed to simply keep up with the demand that exists today.
The Association of American Medical Colleges estimates the United States will be short of 45,000 primary-care doctors in 2020 when 268,000 are projected to be practicing.
That compares to a shortfall of 9,000 in 2010, with 254,800 practicing.
At least one in 20 adults is misdiagnosed in outpatient clinics in the US every year, amounting to 12 million people nationwide, and posing a “substantial patient safety risk,” finds research published online in BMJ Quality & Safety 5.
The state of medicine today makes it necessary for those of us that are responsible for the healthcare for the employees and families in our company to understand this pressure on healthcare and act accordingly. Healthcare budgets and risk pool asset allocation must focus on tools that will help to support medicine in its struggles and ensure that our employees and plan dependents are properly diagnosed, receiving the right care, given support to navigate the healthcare system and provided with assistance when trying to make sense of what they owe.
I know that most of you never intended to be in a position where you had to become an expert on healthcare but employers brought healthcare into the benefits mix decades ago and now we are forced to manage it. I call this an “Employer-based Accountable Care Organization.” This structure of care management and treatment oversight utilizes consumption tracking and data to identify gaps in care and risk mitigation opportunities based on claims and data incoming through clinical pre-cert, prior authorization, medical/utilization review, etc. This allows the health plan to drive real-time, relevant resources down to the member and physician level where they are needed the most.
Healthcare literacy is one of the greatest tools to combat the issues referenced above. The more patients know about the healthcare system and their own bodies, the better they can self-navigate and make better treatment choices.
What healthcare needs and tools that allow for more precise treatment and diagnosis. Precision Medicine and genomics offer this with incredible efficiency and accuracy. Patients can know everything they need to know about their body and their physicians can utilize this information to ensure that treatments are going to be effective for every patient without the normal trial and error diagnosis. Precision Medicine and genomics offer this with incredible efficiency and accuracy. Patients can know everything they need to about their body and their physicians can utilize this information to ensure that treatments are going to be effective for every patient without the normal trial and error.
This isn’t the future—it is here now and we must begin to drive the care of our high-risk members with this type of guided therapy. This will optimize treatment effectiveness and dramatically improve the quality of life for employees and their families in treatment. This includes cancer treatments being customized for the exact type of tumor and the chemotherapy that the patient’s body will best respond to. This means patients can stay on lower cost drugs by maximizing dosages based on genes to get desired clinical outcomes. The possibilities are endless and the time is now.
About The Author
We believe the next big advancement in medicine is already here. Precision Medicine is the cornerstone of the next generation of medical care. Precision medicine is treatment plans informed by an individual’s health data. Patients want to have a Precision Medicine treatment plan as standard clinical guidelines fail many patients who would otherwise experience successful treatment with Precision Medicine.
We are passionate about applying Precision Medicine to medical treatment and helping people receive the most appropriate, effective and individualized treatments possible.
1) Medical Group Management Assn. 2012: Physician Compensation and Production Survey
4) U.S. Department of Health and Human Services, Health Resources and Services Administration; Exhibit 51, Baseline FTE Supply Projects of Active Physicians, and Exhibit 52, Baseline Physician Requirements Projections, December 2008.
5) BMJ Quality & Safety, April 18, 2014