Those who follow my musings know about my deep conviction that our broken healthcare system is the result of a leadership crisis in American healthcare. We are saddled with inauthenticity, poor execution and incomplete consideration of the tradeoffs required to build and run systems that rein in costs while improving patient outcomes.
One of the problems with healthcare leadership is that, too often, it fails to wrestle with ethical challenges. Financial success and virtue come into opposition; too often the former comes out the winner.
Lately I’ve been fantasizing about fixing these problems by building an academy to train the current next generation of principled healthcare leaders. In those fantasies, I’ve purchased some land in Westchester County, New York. It’s hard to spot from the air, and you’d never notice it if you walked by. But peer behind the trees and rugged landscape and inside you’ll find what I call, with apologies to Marvel, The Xavier School for Healthcare Leaders.
Here’s a look at some of the course offerings designed to produce industry leaders capable of producing a humane, affordable, accessible and equitable healthcare system where financial incentives are in balance with patient needs.
Patient Care 200: The Lived Experience
“If you’re going to change something, you should know something,” a colleague of mine used to say. SCAN, the diversified healthcare organization that I lead, used to have a program called Trading Ages; via high-tech headsets, people could gain a first-hand appreciation of the aging process. Similarly, this course will rely on low-tech solutions to create empathy for those facing common illnesses. Students will wear glasses smeared with vaseline to get an idea of what it’s like to have cataracts, and noise-canceling headphones to better understand what hearing loss feels like. During a field trip, participants will shop for groceries using a walker and try to access public transportation while confined to a wheelchair. During the final exam, participants will eat five super-sized fast food meals in 30 minutes and ride a roller coaster so they can get a sense of what polypharmacy often feels like.
Engineering 300: Navigating the Healthcare System
In this hands-on course, students will work as care navigators inside a real health plan. They’ll take calls from members during a weeklong shift and help them access care, refill prescriptions, schedule appointments with specialists, arrange transportation to and from appointments, get the results of their labs faxed to various provider offices, and understand their care regimens. Students wishing to pursue advanced studies in the subject will have to demonstrate an ability to explain deductibles and co-pays in plain language.
Healthcare Economics 200: The Freedom to Capitate
Too many physician groups and healthcare systems are reluctant to assume risk for their patients’ health outcomes by accepting global capitation arrangements. But in this course, we’ll learn that, as my mentor Leeba Lessin used to say, “capitation is freedom.” Often provider organizations complain that payers have them hamstrung by relentlessly focusing on costs. But by entering into capitated care agreements, providers can find the footing to dictate the path of care while focusing more fervently on outcomes. Designed for the skeptic, this course will provide participants with many examples of providers who have built successful and lucrative practices while achieving patient outcomes that put their peers to shame.
Healthcare Economics 310—aka “Follow the Money”
No one can effectively change—much less simply maintain—our healthcare system’s status quo without a rudimentary understanding of its economics. In this class, we will follow healthcare financing and learn how money flows between private and public payers, providers, pharmaceutical companies and the myriad other participants in the healthcare system. Coursework will focus on misaligned incentives, in which individuals and corporations are paid handsomely for producing consistently inferior outcomes.
Patient Care 330: Medication Adherence
Almost everyone entering a healthcare profession comes in thinking the easiest way to treat a patient is to prescribe a medication for them. Little do they know that patients only take their prescription medications half the time. In fact, non-adherence likely causes 125,000 deaths and a quarter of all hospitalizations in the United States. In this course, students will learn the causes of non-adherence, with an emphasis on those that are financial and cultural. To pass the class, students must demonstrate proficiency raising adherence rates, which takes time, money, hard work, cultural sensitivity and, most of all, patience. Note, it is likely that many students will come into this class thinking it’s an “easy A,” fail, and be asked to retake the course again and again. Just like clinicians do every day.
Executive Management 420: The Role of Risk
Not to be confused with Healthcare Economics 310 above, this course focuses on the value of risk in management. The premise underlying the class is that too many healthcare leaders are risk-averse. They believe in sluggish incrementalism, running endless pilots and studies, and seeking out elusive consensus before enacting common-sense solutions. In this class, we’ll learn how to quickly implement change and inject innovation into systems before resistance to it takes form. Special emphasis will be placed on learning from mistakes and making iterative improvements to bold programs and initiatives.
Being Human 101
Required for all degree candidates. No matter what you may hear, the future of healthcare—like the future of most industries—will depend on artificial intelligence. AI systems will scan medical records, read images, make diagnoses, create treatment recommendations, discover the most effective treatments, and so much more. Which means that the future’s best healthcare practitioners will bring a human touch to patient care that computers just can’t. In this class, we’ll learn how to talk in plain language, ask questions sympathetically, and demonstrate a genuine sense of caring. Successful candidates will learn that, in healthcare, human connections do what computers, diagnostics and treatment plans cannot.
Admissions Criteria for all Courses
A professed desire to improve healthcare for patients. Applicants excessively focused on profits or policy-making and procedural tinkering for their own sake are strongly discouraged from applying.
All of this is tongue in cheek – or is it? What would our industry look like if we did have an academy – and everyone who wanted to drive change—management, politicians, board members, investors—had to demonstrate these basic proficiencies. I suspect we would be much farther along the way to the healthcare system we want and need.
