“We have to stop treating healthcare as any other business. It doesn’t function the same way.”
—Sumita Yadav, MBBS, MHA, system vice president for operations & cardiovascular service line for Catholic Health
Sumita Yadav, who is a physician as well as a healthcare system administrator, summed up the conundrum when we’re trying to transform an industry like healthcare.
Healthcare is an industry like no other.
“Healthcarre is about lives,” said Dr. Yadav[KP1] . “In other businesses, you can say you get one [product] for this amount; if you don’t have it, go away. We can’t just turn people away because they might not have the money. Healthcare functions very differently. We are giving people their health, their wellness, so they can live the best life and they can contribute to the community the best that they’ve got.”
This article is the ninth in a 14-part weekly series, in which I am sharing insights from the 2024 Healthcare in the Age of Personalization Summit. We heard from a wide range of healthcare experts—leaders spanning all facets of healthcare organizations from the boardroom and C-suite to the patient’s bedside. We covered topics such as why personalization is important, how we can shape our organizational cultures to facilitate it, what leadership skills are required, how personalization is achieved when people know they matter, how to inject personalization into your employer brand., and why better care requires honoring individuality.
In this article I’ll share highlights from the panel discussion about the challenges of transforming the U.S. healthcare industry, considering how different this industry is from any other.
Panelists included:
- Sumita Yadav, MBBS, MHA, system vice president for operations & cardiovascular service line for Catholic Health
- Alen Voskanian, MD, chief operating officer for Cedars-Sinai
- John Baldwin, chief operating officer for TriStar Southern Hills Medical Center, HCA Healthcare
Incentives Work Against Personalization
All three panelists acknowledged the challenges of trying to change a system in which there’s so much misalignment between what we incentivize and reward versus the outcomes we seek.
Dr. Yadav, who is a physician as well as an administrator, painted a picture of the differences between what we want as a patient versus what organizations are incentivized to do.
“[When I’m a patient,] I want a person who’s going to take care of me, hold my hand because I’m anxious, I need whatever healthcare I might need, and I just want it to be sensible and holistic,” she said.
But the system is “complexity over complexity,” she said. “We don’t know what anything costs. There is no sense of what one hospital is charging versus what another is charging, what one insurance is paying versus another.”
Most of us have experienced that complexity as patients. Here’s what it looks like from the point of view of someone whose job it is to make sure a healthcare system can serve patients while also remaining financially viable.
“If the cost of something is $1, [the government payor] pays 70 or 80 cents and they let you figure out how to do the rest,” she said. “How are you going to make up that gap? That’s when the commercial insurance jumps in, and you try to get the maximum from them, but their only criteria is to be financially profitable. So they’re incentivized to just keep denying everything. Even if ultimately they have to approve, they deny it for 60 days, they hold that money, they get interest on it.”
That’s the business model.
Dr. Yadav said the burden falls onto the healthcare providers: “They’re providing the care, they’re not getting the payments that they need to invest back. Even for the payments that they ultimately might get, they have to fight.”
Dr. Voskanian shared the same frustrations.
“All the administrative back and forth to get approvals for things that get denied, to really be able to get paid, that costs money,” he said. “No surprise, we are the highest [in terms of healthcare costs] in developed countries. Earlier this year I went to Japan and South Korea to study their healthcare systems. They don’t have that level of administrative cost and administrative burden. It’s very clear and transparent what you get paid for, how you get paid for it.”
Imagine if we had a system that just trusted that doctors are making the right decisions for their patients.
Dr. Yadav shared how it could and should be: “Our physicians know the care that’s needed and they’re not just going to operate on people for no reason. If they’re operating, something must be done. So then why do we have to make such a big deal about trying to get that payment? Why isn’t that just automatically happening so that the organization can actually invest back into the care of the patients?”
New Models Also Have Challenges
Dr. Yadav mentioned the new models, like value-based care or bundle payment, and said they can be good but also have challenges.
“Some of those new models are really well thought out,” she said. “However, what they do is actually remove choices from patients or consumers. We say that if you get care within your own system, then it is going to cost less, and there is truth to that. But then you start incentivizing physicians to only refer patients within the network. Rather than the financial incentives or penalties being the things that drive behavior, if we say we’ve trained our people well, we give them the tools to make informed decisions and then hold them accountable for those results, then the entire landscape would start to shift.”
Community Partnerships
Baldwin said the healthcare system can’t reinvent itself on its own, and talked about the benefit of unconventional partnerships.
“As we go forward, we have to know what matters to our people,” he said. “We have to connect with them on a human and personal level. As I think about community health, I think we have to look at unconventional partnerships. We have to start to think differently. I truly believe that today the healthcare system can’t reinvent itself on its own. It’s going to take outside thinking of non-traditional healthcare providers and entities to help get into the space and innovate.”
He shared an example of an organization in his local community that has been focused on addressing hypertension within the Nashville healthcare ecosystem.
“[They had] identified that a specific ethnic group had 50% rate of hypertension, while another ethnic group had a 28% rate of hypertension,” said Baldwin. “They did a multidisciplinary collaborative effort between private and public partnership through government, local nonprofit, and a local FQAC [federally qualified health center]. They did targeted interventions at the zip code level, to help to improve the health outcomes for these very specific individuals, and created tailored personalized approaches for their care needs. That, to me, is starting to create some unconventional partnerships and people that may not be at the table today as we see that model across our healthcare ecosystem.”
Learn From Other Industries, But Remember Healthcare is Different
Dr. Yadav agreed that healthcare needs to learn from other industries. She said she’s all for disruptors challenging the status quo, especially when it involves bringing in new skills and digital innovations. But she also offered a caveat.
She gavve an example of a digital transformation that actually makes the patient experience worse: kiosks in the office reception area. They save expenses, by reducing the number of staff time needed to check people in. But it puts a new burden on patients.
“The burden shifts to the patient to self-register rather than having someone taking care of them,” she said. “The kiosk robs us of the opportunity for human connection. It’s those connections that could have led to people understanding each other, and to those patients going back and saying, what a fantastic experience—those providers really treat you like a human being.”
How can healthcare providers adopt some of these innovations, but yet continue to respect the human touch in patient care?
“Every room we are in needs a patient voice,” said Dr. Voskanian. “We need patients in our innovations. We need patients in our boardrooms. We need that voice.”
The Role of Data
Baldwin said, when it comes to data, we have to consider what we’re trying to achieve with data, to have the right data points so that it can meet the right person’s needs at the right time to have a personalized approach.
“Our mobile device is how many of us live and operate and do what we do every day,” said Baldwin. “You can travel across the country and be able to plan an experience without having talk with someone, and then have customized and tailored choices.”
There’s potential for personalization throughout a patient’s care experience. Baldwin said we should be able to know a patient’s needs and preferences before they come for care.
“That’s where the technology companies can help us think about the care experience differently,” said Baldwin. “[We could be] aggregating different data points so our providers and our caregivers can help give better, compassionate care that is empathetic to the needs of the patient of what they need at that time.”
Dr. Voskanian agreed and added to that vision.
“If data is present for a physician at the time of care, that could help them with clinical decision making,” he said. “[That could include] bringing forward data from patient’s chart that is meaningful to alert them to something like this patient is on a blood thinner, instead of the physician having to look through the chart.”
Data can also bring to the surface considerations around health equity.
For example, Dr. Voskanian said, “If you’re prescribing this medicine for this patient, based on the patient’s demographics, [there might be a recommendation for] colorectal cancer screening.”
Dr. Voskanian shared an example of how he uses data to personalize. Even though he’s an administrator, he still sees patients.
“I often ask patients about their life, and sometimes they share a story of their excitement about their granddaughter graduating from college,” he said. “And I am genuinely interested in it. I have a place in the chart where I write, this patient’s granddaughter is graduating from Berkeley, or this patient just adopted a rescue puppy. And then next time they come in, I bring that up. Hey, how’s your puppy doing? That’s how data could also help us with personalization.”
Watch this short video for more from the panel.
Next time: What nursing can teach physicians and CEOs about leadership.
