According to a Commonwealth Fund report, the US ranks last among high-income countries in healthcare access, efficiency, and equity. Our health system has vast potential and can achieve Moonshot-like outcomes, but it still struggles to address people’s day-to-day needs.

The world’s largest health ecosystem comprises five fundamental stakeholders — patients, payers, product innovators, policymakers, and providers. And while they should work in harmony, they remain primarily disconnected, operating in silos with financial performance as the measure of success. With the fear of economic failure nipping its leaders’ heels, the system prioritizes fiscal responsibility over patients’ healthy longevity. It leads to a “sick-are” over healthcare strategic mindset.

A System Disconnected

While medicine is a “team-support,” the health industry positions its sectors like boxers — each pitted against the other. The concept of a fragmented health system is not new. Nearly 20 years ago, Dr. Alain C. Enthoven, a renowned health economist, argued that the US health sector suffered from a fundamental lack of coordination and misaligned incentives, leading to inefficiencies that primarily burden patients.

In her book Fragmented, Ilana Yurkiewicz, MD, illustrates the real-world consequences of this disconnect. Patients often find themselves bouncing between specialists dedicated to one piece of their patient’s anatomy, grappling with conflicting medical advice, and navigating a bureaucratic maze that often results in disparate, delayed, or denied care.

Economic pressures fueling consolidations and layoffs have led major players to go slow on much-needed ambitious health information initiatives. The much-heralded digital transformation, which promises AI-driven operational efficiency, seamless data exchange, and improved patient outcomes, remains unrealized.

Meanwhile, patients are finding themselves trapped in a complex, hard-to-navigate medical maze where medical records are often inaccessible, treatment plans are inconsistent, payer decisions feel opaque, and pricing remains elusive. The effect is profoundly dehumanizing.

The Patient is Out of the Picture

Financial pressures outweigh the fundamental goal of healing, and the loss of patient focus and a significant decline in empathy remain the system’s most glaring obstacles. This absurd reality is captured in a satirical moment from Yes Minister, where a lawmaker appointed by the UK Prime Minister visits an award-winning hospital — shockingly operating without patients. While comedic, the scene reflects an all-too-real aspect of modern health systems. Administrative structures, insurance approvals, and reimbursement models dictate operations, often sidelining the very individuals who seek care and healing.

As economic priorities continue to reshape industry, hospitals that once promised solutions struggle to sustain themselves, leaving patients increasingly marginalized. While improving patient outcomes should be the central focus of government policymakers, they too often become secondary considerations.

As the US Congress considers budget decisions, cutting Medicaid state subsidies does not mean economically struggling patients will be denied urgent care. Instead, when they seek treatment in the ER, hospitals will absorb the cost. This shifts the financial burden, further straining healthcare systems already operating on razor-thin margins.

Doctor Burnout: Primary Symptom of a Broken System

Physicians enter medicine purpose-centered with a desire to heal, yet the system relentlessly applies administrative and financial pressures that shift their attention elsewhere. Many doctors experience burnout, driven by excessive paperwork, prior authorization hurdles, and unrealistic patient quotas. According to a Mayo Clinic Proceedings study, nearly 63% of physicians report signs of burnout, including emotional exhaustion and depersonalization.

Designed to streamline care, electronic medical records (EMRs) are still a significant source of frustration. Physicians spend hours dealing with complex interfaces rather than engaging with patients. The demand to see more patients in less time — dictated by billing and reimbursement structures — further erodes the doctor-patient relationship, leading to dissatisfaction on both sides.

A 2023 survey by the Primary Care Collaborative and the Larry A. Green Center found that 62% of primary care physicians report not having enough time to adequately meet patients’ needs, which impacts treatment and preventive care discussions.

This dissatisfaction manifests as a breakdown in communication. While effective dialogue between providers and patients across specialties and within the broader health ecosystem is essential for treatment and prevention, patients and physicians struggle to find time to connect.

Burnout is not simply a professional hurdle; it’s a crisis that directly affects patient outcomes. Overworked, exhausted doctors are likelier to make errors, experience lower job satisfaction, and even leave the profession altogether. If the system fails to address professional despair and its causes, the shortage of health professionals will only worsen, limiting access and compromising care.

The Business of Health Over the Health of People

While business considerations shouldn’t take precedence over people, the financial structures underpinning the health sector drive decision-making that deemphasizes people’s health. The silos within the health ecosystem exacerbate this issue, preventing a shared understanding of economic and operational realities, limiting coordinated action and shifting the focus away from the patient.

Insurers prioritize cost control without recognizing the pressures this places on providers. Pharmaceutical companies innovate without fully considering how reimbursement models shape prescribing behaviors. Policymakers create regulations with a limited understanding of their clinical innovation impact. This lack of cross-sector awareness perpetuates fragmentation and inefficiency, and patients ultimately pay the price.

Digital health companies, once hailed as the future of care efficiency and effectiveness, are struggling with financial sustainability, forcing many to pivot or shut down entirely. Biopharmaceutical companies triage drug development pipelines, looking for future medicines with a high probability of regulatory success rather than encouraging research that may fail but illuminate a pathway to even more significant discoveries. Again, it is the patient who pays the price.

The Cost of Failing to Invest in Care and Caring

There is enough blame to go around, and we must stop looking for a convenient villain. If we attack one piece of the ecosystem rather than look at the totality of our problem, we will fail to make meaningful changes.

We can’t throw our health system out and start from scratch; we must find a way to work within and through it effectively. The primary lever that will drive reform of the health system and improve its functioning is bringing everything back into empathetic focus, with the patient at the center of care. Whether we are payers, product innovators, policymakers or providers, we must ask if our actions are built on a foundation of empathy — from heartfelt “care.” First and foremost, we must cooperate in the service of the patient.

The health sector is an industry, but it must be more than that. At its core, it should recognize that we are always people — only sometimes patients. Yet, financial pressures have overtaken its fundamental purpose: healing. This system-wide disconnect erodes trust, drives up costs, and leaves too many without the care they need. Until the key players in the health ecosystem realign around a unified, patient-centered mission, fragmentation will persist, outcomes will fall short, and lives will remain at risk. The stakes are too high to accept anything less.

Unless we build on a foundation based on “how would I feel” empathy, our system will not be built to last. It will be structured to fail.

The post Business of Health: When Patients Become Secondary to the System appeared first on Medika Life.

Health system CFOs across the country face a unique quandary. Operating margins remain low, staffing shortages restrict services, industry-wide buying power is waning, organizational credit ratings are at risk, and inflation rapidly affects reimbursement and patient affordability. From the CFO’s point of view, it is prudent to look toward other industries and adopt a holistic approach to managing their organizations’ financial health.

The following seven habits can be employed by health system CFOs leading through turbulent economic times:

Embrace Adaptation in the Post-Pandemic Era

The pandemic disrupted traditional operations, requiring a departure from established norms. In this post-pandemic era, CFOs must acknowledge that returning to the pre-pandemic status quo is not feasible. Rising labor costs and supply chain challenges in the face of capped payor contracts demand fresh strategies. Relying solely on traditional approaches and partners in this new environment will not work. To remain effective, CFOs and their operational leaders must lead their organizations in adapting to the new post-pandemic reality.

Repurpose Savings for Clinical Impact

Non-clinical departments often struggle to inspire clinicians, but CFOs can bridge this gap by strategically connecting clinical goals with repurposed savings from overhead departments. Healthcare leaders should embrace innovative cost-saving approaches, such as considering non-clinical spending as a strategic category of costs to negotiate. CFOs can funnel those savings back into the clinical environment, easing pressure on physicians and nurses and enhancing patient care. An annual habit of exploring non-clinical spending to fund clinical initiatives can pay off for both resources and morale.

Shift from Volume to Efficiency

The age-old adage “volume is everything” in healthcare may not go away entirely, but it is evolving. CFOs increasingly steer their organizations toward cost-efficient practices rather than merely focusing on volume growth. Shifting performance measures from volume to efficiency is worthwhile, even if it is a departure from traditional thinking. This habit is needed as the industry acknowledges the importance of cost-effective care delivery—and the value within risk-based payment programs.

Execute Beyond Technology

Technological solutions typically rely on business cases and aim to provide essential tools for modern operations. However, this technology assessment must go beyond adoption and implementation. The true value lies in the execution of the solution and the insights gained from its use and performance. Sound systems require good data to meet their potential. As an example, a national home goods retailer conducted an RFP and needs assessment for its 1,200-truck delivery fleet. The organization derived information to extend the contract with a current vendor. The negotiation resulted in over $1.8M in savings through invoice credits, cash retention bonuses, and contracted cost savings. Most notably, the negotiation never disrupted distribution. The habit of “focus and finish”—connecting technology with non-tech performance measures—ensures that insights are effectively translated into actionable strategies. The discipline to perform a rigorous “look back” analysis on major technology investments is essential to achieving the promised ROI.

Embrace Data and Strategies Beyond Your Four Walls

There is a world of insights and opportunities beyond the healthcare industry. Although healthcare is unique compared to other industries, there are insights and lessons to be learned from looking at how business is conducted outside of healthcare. For example, wouldn’t a hospital want to know what the local university pays for groundskeeping in the same city? What about bank processing and other financial fees? In one case, the CFO of a big-box retailer looked beyond the industry for insights and saved over $10M by uncovering overcharged credit card processing fees that had slipped past their internal process for more than four years. With this information, the CFO and team negotiated a refund of the fees and all credit card agreements.

Knowledge sharing across industries can be valuable for all organizations. The habit of expanding a network of partners and collaborating with businesses outside the industry can provide fresh perspectives and solutions, which ultimately benefit the health system’s financial performance.

Question the Status Quo

CFOs should embrace the habit of challenging industry norms and targets. It’s a requirement to push change management boundaries in pursuit of effective solutions. One industry norm worth challenging is the singular reliance on group purchasing organizations (GPOs) to aid in spend analysis and negotiations. With GPOs addressing only 25% of non-clinical spending, there is an excellent opportunity to address cost savings in these categories. Unlike direct clinical spending, health systems compete with all industries to secure optimal non-clinical product and service contracts. Leading companies outside healthcare often devote more time and resources to secure better contracts. Continually setting the bar higher—to renegotiate contracts, adopt cutting-edge technology, or pursue innovative partnerships—can drive tangible results and transform the financial trajectory of health systems, no longer leaving money on the table.

Manage Non-Clinical Costs Proactively

Non-clinical cost allocation, akin to investments in a personal portfolio, requires constant monitoring and adjustment. CFOs should adopt a proactive habit of managing non-clinical costs that consume approximately 20% of revenue. By acknowledging the dynamic nature of healthcare finances, CFOs position their organizations for financial success. Also, the CFO can no longer assume that existing structures and partners are sufficient to control these non-clinical costs. Research shows that 75% of non-clinical spending falls outside GPO and procurement contracts. With today’s financial challenges, this leaves a gap in controls that must be addressed. The habit of managing non-clinical costs proactively pays off.

Proactive management of v costs has been proven to result in favorable contracts and significant savings in both annual direct costs and signing bonuses. This outcome was demonstrated by a discount retailer that conducted an RFP and needs assessment with their 10-year incumbent Warranty provider. The proactive assessment resulted in a more favorable contract with higher vendor engagement and training support from a new vendor. Beyond the service value, the resulting savings were $4M in annual direct costs and a $4M signing bonus in the contract’s first year, with the new vendor covering all transition costs.

Today, the role of a health system CFO extends beyond traditional financial management. CFO leadership requires a blend of strategic vision, adaptability, and innovative thinking about benchmarking and managing change. CFOs who embrace these seven habits can navigate the healthcare industry’s challenges in a post-pandemic economic climate, foster financial resilience, and ultimately contribute to enhanced patient care, organizational success, and highly competitive service delivery.

******

Special thanks to co-author Mark Van Sumeren, who has more than 40 years of experience in healthcare strategy, operations, and supply chain management. As the General Manager of the healthcare practice at LogicSource, he spearheads cost-savings initiatives within nonclinical healthcare supply chains. Previously Mark held senior executive positions at Owens & Minor, Ernst & Young, and Detroit Medical Center, collaborating with major integrated delivery networks and academic medical centers to enhance operational efficiency and supply chain practices. 

The post Seven Habits of a Highly Effective Health-System CFO appeared first on Medika Life.

Media colleague Eric Wicklund, associate content manager and senior editor for Innovation, Technology, and Pharma for HealthLeaders, has penned a ViVE preview piece with a power grabber: “CAN VIVE 2024 SOLVE HEALTHCARE’S BIGGEST DILEMMAS?” That headline question isn’t rhetorical and doesn’t require an answer.  Resolution is not the responsibility of the ViVE co-organizers CHIME Health and HLTH.  ViVE puts the collaborative opportunity for health ecosystem players to face the challenges and opportunities in motion.

At the heart of these dilemmas is how payers, patients, product innovators, policymakers, and providers source and maximize health information.  No doubt everyone is jumping on the AI, ChatGPT, and GenAI bandwagon, excited that technology will solve the problems of system-wide fragmentation.  But like any tech shift or bolus of information, it all comes down to what innovation theorist John Nosta calls the “Introduction of the Cognitive Age.”

While some express trepidation that this technological revolution is the dawn of all fears that smart machines will replace health professionals, Nosta suggests that the “Cognitive Age leverages AI as a partner, augmenting and enhancing people’s ability to access and act with heightened intellectual and even technical (i.e., physical ability).

Once again, ViVE has teamed up with Galen Growth to provide insights on digital health in the US health systems. Galen Growth connects the importance of partnership and recent trends influencing not only the US health system – but also the close reader how health information and innovative technologies will transform the delivery, quality, and cost of patient care – including the influence on clinical evidence, decentralized clinical trials, and connective and home care.

Access the Galen Growth 2024 Digital Health Report here: LINK

ViVE is the space where all these conversations – the good, bad, and ugly – of the (predominately US) health ecosystem can be explored, and ideas can be identified and pursued.  VIVE partners with Galen Growth – the global digital health research and analytics specialist. It uses its proprietary database HealthTech AlphaTM to track more than 680 million data points, documenting 14,200 digital health ventures worldwide to produce its “Digital Health Innovation | 2024 Report.”

“In an era of rapid technological advancement, the 6,129 hospitals within 407 Health Systems1 across the United States are at the forefront of transforming healthcare delivery for diverse communities nationwide, notes Julien de Salaberry, a co-founder and CEO of Galen Growth. As the Digital Health landscape evolves, Health Systems play a pivotal role in bridging gaps, enhancing patient outcomes, and addressing persistent pain points.”

But the most significant challenges to accessing the potential of these new digital health technologies are not in ideas themselves – rather the innovators’ understanding of how the US health system works (or is dysfunctional); too often, the founders of these companies are unaware of how to engage leading hospital systems – find champions, integrate within the system, and address cost benefits and ongoing support issues.  Failure to navigate the complexity of countless decision-makers too often leads to ventures running out of capital and vanishing.  The Galen Growth Digital Health Innovation Report documents the roadway to potential success.

CTOs and CIOs within significant health systems are not immune to unprecedented challenges facing hospital economics and the cost of technology. Digital health leaders also recognize that they will hit a brick wall without clearly expressing ROI.  Health systems require measurable outcomes and evidence-based results from digital health partners, and to succeed mutually, they are creating incubators, venture groups and partnership models.

Health systems – hospitals, long-term care communities, and home care providers – will make giant leaps very shortly, drawing on information and technological changes.  The Galen Growth Report issued at ViVE on Monday, February 25^th, is the analysis and roadmap to understand better the economic priorities and investments driving these changes.

What is evident from the Galen Growth Digital Health Innovation Report is that while the total dollars of investment in digital health saw a steep decline from the exuberant investment during the height of the COVID pandemic, the category has gained greater importance among health systems seeking to make significant advances in how patient-care, work-flow processes, preventive care and reimbursement analyses play out.

AI, ChatGPT and GenAI investment is not aspirational – the focus is mainly practical and operational.  Those accessing the full report during ViVE will immediately gain valuable information to guide internal planning. Medika Life will update this article tomorrow with a link to the full report.

Will ViVE solve – as Eric Wicklund teases readers – the health system’s “biggest dilemmas?” Is that even it’s mission?  Likely not. But the people who attend ViVE will be looking for insights and information that can guide solutions. The Galen Growth “Digital Health Innovation | 2024 Report” will be one of the big takeaways that will spark conversation, ideas, and hopefully, as Eric reflects, some concrete solutions.

The post Galen Growth + ViVE 2024 Champion Digital Health Innovation as a Salve for an Ailing US Health Ecosystem appeared first on Medika Life.

While San Francisco certainly has a historical impact on global health innovation, the Boston health ecosystem is fertile ground to be the nation’s power hub for innovation, research, and economic growth. Boston has emerged as a key player – perhaps the place – in the life science sector with its world-class universities, renowned hospitals, and investment community. Innovation accelerates when talent, infrastructure, and finance converge on a geographic area. 

Boston’s concentration of top-tier academic institutions, including Harvard University, MIT, and Tufts Medical School, attract brilliant minds worldwide, leading to groundbreaking discoveries and pioneering research in biotechnology, devices, genomics, and pharmaceuticals. These innovations applied to patient care have improved health outcomes and fostered collaborations between academia and industry, driving innovation and the development of life-saving therapies.

Employment Opportunities Abound in Boston

The Massachusetts Biotechnology Education Foundation’s “2023 Massachusetts Life Sciences Employment Outlook” reports that the life sciences sector in Massachusetts is home to 132,000 jobs. This study predicts another 42,000 new jobs will come online in 10 years.

The presence of world-class hospitals and community safety nets like Boston Medical Center, Massachusetts General Hospital and Brigham and Women’s Hospital offer scaled and start-up biotech, contract research organizations, digital health, medical device and pharmaceutical companies a base to listen, learn and apply. These institutions attract top medical talent, providing a foundation for companies to tap into great minds as advisors on the practical issues facing innovators – how to navigate the fragmented US health ecosystem – even how to recognize revenue.

Not at BIO, but at another nearby life science digital health meeting. Barry Finette, MD, Ph.D., founder of ThinkMD, a physician, who has worked around the world in emergency medicine, is among those who have transitioned from full-time medicine to the innovation sector reflects why change is so urgent:

“The US has the most sophisticated high-quality healthcare in the world if you can afford it and have access to it. For too many Americans, neither is the case. The US healthcare system is in crisis, even though we spend more on healthcare per person per year (>$11K) than any other country in the world, and yet, the US is ranked in the 20-30s in the world for most key health indices and have a life expectancy that has been decreasing.”

Beyond BIO, Digital Health Leaders Meet at the Digital Healthcare Innovation Summit to Explore Needed Changes

The Digital Healthcare Innovation Summit 2023 (#DHIS2023 and #DHISEast) meeting is a hidden gem.  Though the meeting rooms are packed, this annual gathering held in Boston still needs to be discovered.  Its attendees and speakers represent the health ecosystem of decision-makers who must learn more about each other’s business agenda – how their models work and thrive economically.

The unscripted panel sessions almost guarantee that the mainstage conversationalists will “tell it like it is.” The speakers are drivers of change and include Sree Chaguturu, MD, chief medical officer of CVS; Christopher Brooker, partner, Frist Cressey Ventures; Magann Vaughn Watters, vice president, New Ventures & Strategic Alliances, LabCorp; Tarun Mehra, vice president, Healthcare Strategy, M&A and Partnerships, Microsoft.  The impressive list of speakers and attendees reinforces the value of this gathering – more so – it underscores the power of Boston as a microcosm of the national health system and its possibilities.

[Photo: Moderator Nancy Brown, General Partner, Oak HC/FT explores with panelists Neel Shah, MD, CMO, Maven Clinic; Lori Evans Bernstein, Co-Founder & CO, Caraway; Angela Glyder, VP, Clinical Operations, Lucina Analytics, and Sukanya L. Sonderland, senior vice president Blue Cross Blue Shield of Massachusetts, on “Women, Families, and Health – Understanding the Market, Its Impact and How You Measure Success”]

The Summit jumped into pressing access to-care challenges – sometimes conflicts – facing the US health system. CVS’s Chaguturu outlined the retail pharmacy giant’s strategy around the acquisition of Oak Street Health and the evolution of its Minute Clinic model. CVS has also invested in Maven Health to improve greater access to women’s health.

Maven Women’s Health founder and CEO Kate Ryder smartly outlined how this unicorn enterprise has succeeded by focusing on its customers’ – women’s health – needs rather than enticing tech platforms.  Maven has built one of the more comprehensive platforms providing support across fertility, pregnancy, adoption, parenting, and pediatrics. The company received the Digital Healthcare Innovator – East Coast Award.

Boston – A Model for Harmonious Health Innovation and Navigating the Health Ecosystem

“Culture crushes change,” reflects health innovation theorist John Nosta, president of Nosta Labs.  Too many significant changes that might help heal the disjointed health ecosystem fail – not because the invention will not improve people’s care – it doesn’t mesh with the system’s economic sensibilities.  The greater Boston region may be part of the treatment for failure.

Listening to the speakers at #DHIS2023, it’s noticed that many of the leaders on the stage and conference room are not engineers; they are rooted within the medical system. Some are trained health professionals and others work within the health system – they are part of a closed-loop community and seek collaboration. 

Instead of bemoaning the interference of AI and ChatGPT, they imagine how these technologies can integrate successfully into their workflow. Instead of looking for ways to reject ideas that will change the care process, they are rolling up their sleeves to figure out how to untangle the links in the supply chain of patient care.

If BIO is the place to explore business development and partnerships, DHIS is the forum for experts in the trenches of digital and health tech to transparently examine how all this work comes together as the system seeks to change.

We’ll be back in Boston later this month to explore how these leaders will change the future of health innovation development through diversity in clinical trials.  Stay tuned.

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To suggest patients can influence the machine that drives modern healthcare is naïve and indicative of a flawed understanding of the realities of the industry. It is nothing more than pandering to the cash cows of the industry – you and I.

It is not merely the patients who are powerless cogs in the machinations of healthcare. Their care providers suffer a similar fate. Caregivers are not responsible for the systematic erosion of patient centered medicine, they too are victims. Focusing on relationships between provider and patient is therefore a wholly fruitless endeavor.

Systemic remedies are required

As an analogy, consider if you will, the provider and the patient as cellmates in a high security prison constructed and manned by pharma, insurers and their intermediaries. No amount of debate and planning between the two cellmates is going to result in their release or an improvement in their living conditions. Their only hope lies in reprieve and relying on the humanity of their jailers. If it is lacking, the pair are doomed.

Call me cynical (guilty as charged) but I cannot envision a world in which healthcare companies suddenly decide to eschew profitability for the benefit of their customers. If anything, with every passing decade, rampant capitalistic profiteering will likely worsen the lot of patients and providers, as more intermediaries emerge in the ever growing chain of healthcare and market share declines with negative population growth.

In short, our current health system globally, warped over decades from a humanity based, service industry into the profit based system of exploitation we now deal with, is as good as it gets for you and I. It cannot and will not change.

Appeasing the masses

No one likes to feel they are trapped in a system over which they have little or no control. As the healthcare system evolves and refines itself, incremental changes will center care on establishing dependency (treatment, not cure) and further isolating the farmers (providers) and their flocks (you and I) into managed farming units focused on maximizing revenues.

If you’ve seen intensive chicken farming, you get the idea.

All the signs are there and have been for the last two decades, but like all unpleasant realities, we simply turn a blind eye, as we understand on an instinctive level that we are powerless to affect change. And yet, we continue to posture, we continue to whistle into the wind. All to no effect.

While it is true that patient advocacy groups do occasionally secure small victories, these victories inevitably come at a price, usually exacted on services or pricing in a fashion so subtle that the further erosion of control goes unnoticed.

Patient activism is even encouraged by the industry to pacify the masses. The industry will go as far as sponsoring and participating in many of the patient advocacy groups that proliferate the healthcare market. Appearances matter, results however, cost extra and never at the expense of the bottom line or without a quid pro quo.

Escaping Alcatraz

So what choice then, for patient and provider, caught up in the gears of a machine intent on using them for the pursuit of profits? It is too late to walk any of this back and it cannot be undone. We lack the social backbone to address it and those who can address it lack any form of incentive that supersedes profit.

How do we return healthcare to its former heady days of doctors serving their patients, of ethical medicine, of deep bonds of trust and respect between both patient and provider. How do we ensure that future generations can benefit from technology and medical advances to improve their health, rather than being cycled into a chain of dependency, for those fortunate enough to afford anything approximating to care.

If we cannot change the existing system, the unpleasant alternative is to part ways with it. To strike out into the medical wilderness, forgoing healthcare insurers, pharma and the wretched leeches that inhabit the spaces between. To separate, permanently, the ties that bind both patient and provider to flawed systems that perpetuate abhorent levels of care.

I firmly believe this to be our only option if we are to ensure fair and free access to healing for future generations.

How this future would look and what it would encompass for doctors and patients remains to be seen, but the break needs to be made, before the gates shut for good on the flock.

The post Patient Engagement is a Pointless Pursuit appeared first on Medika Life.

The digital health sector has grown significantly during the past decade, primarily mobilized to address unmet health-system and care needs. From $2 billion invested in 2011, that figure morphed 28-fold to $56 billion in 2021. In the shadow of the COVID pandemic, unprecedented investment poured into digital health during this two-year window, accelerating the adoption of AI, remote patient monitoring, telehealth, digital therapeutics, wearables, VR and more.

DOWNLOAD THE FULL REPORT HERE

Galen Growth and FINN Partners have collaborated – for a second time – to offer the entrepreneurial invention and investment industry a wealth of data that can guide financing life-sustain – perhaps saving – enterprises.  With this detailed report, data is shared not as “one-off” ideas but as puzzle pieces assembled to provide actional insight into a dynamic and evolving digital innovation sector that offers the transformative power to find effective detours around health ecosystem fragmentation.

The Damocles Sword of Access and Outcomes

The two companies avoided hype and biases to create this analysis enabling investors or potential business partners to weigh subjective decisions alongside objective facts in recognizing that the fragmented health ecosystem centers around preserving the system itself are vital to helping product innovators and patients navigate the healthcare labyrinth. That economic return on investment is weighted along with patient experience and outcomes.  This is the Damocles sword that inventors and investors must always consider – reimbursement that ensures access to care and meaningful and measurable outcomes.

While digital health venture capital fell short of the exorbitant funding of 2021, it closed ahead of 2020 levels. A closer look at the year-on-year development of funding value by funding stages shows that funding in 2022 nearly maintained the level of 2021 for the Early Stage and Series A funding rounds. However, it lagged behind the 2021 values across late-stage enterprise funding.

Investors learned and began to put their due diligence into action – targeting their energies toward specific geographies, sectors and needs (e.g., clinical trials).  They looked for therapeutic categories receptive to digital health innovation.  Within the disease-specific investments, oncology saw the highest participation of investors (9%), followed by mental health (7%) and women’s health (7%).  C-Suite leaders and their funders will do well to study the report data and to determine next steps.

Just Facts – 250+ Million Data Points Analyzed

While other studies highlight “media grabbers” and numbers disconnected from insight into where the money is going — from the investment stage to disease states— The Global State of Digital Health connected more than 250 million critical analytic dots. This report will guide C-Suite leaders, business development and therapeutic area heads, private equity funds, and financial analysts to make savvy decisions that drive return on investment—whether the goals be financial or patient care.

After an extraordinary two-year pandemic funding spree, there are apparent shifts in how investors place their economic bets. In this year of geopolitical turmoil and uncertain financial performance, digital health remains vital to the future of the health economy and in addressing public health press points. However, the development stages in which funds are directed, therapeutic categories selected, provider systems that demand transformation, and the regions where innovators establish headquarters are now investment factors.

Bottomline, funding levels exceed the pre-pandemic values. Digital health ventures are busy – submitting more than double the number of regulatory filings in 2021 than before the COVID era. There is a dramatic increase in partnering activity over 2021. If dollars and Euros are the only indicators of energy and commitment, it is easy to see why hand-wringing news stories prevail. Look at all the metrics that determine a vibrant sector.

In combining investment, regulatory filings for new product introductions, and partnerships, it is apparent that 2022 has been a formative period. Investors and innovators are putting in place the processes and systems – the people and science – that drive adoption and market traction. Investors are no longer looking at the sector as monolithic.

Putting the Right People and Processes on the Innovation Bus

If 2021 was the year of exuberance, 2022 was, as Jim Collins, author of the classic business bestseller “Good to Great,” dedicated to putting the right people – leaders and digital health sectors – on the bus. For example, medical diagnostics ventures had an exceptional year by representing 12 percent of regulatory filings of Digital Health ventures across the globe, taking the top spot for ventures with significant Clinical Evidence (Evidence Signal >40), and capturing the highest investment volume share (17%), with the total cluster funding value falling short of 2021 by 16 percent.

As the report suggests, 2022 is a turning point for digital health – a shift from Digital Health 1.0 to the 2.0 era, with Digital Health evolving into a more mature ecosystem. The recent data reaffirm that perspective and a fast-paced realignment occurring within the sector.

Looking at the past year, it is evident that investor mindsets matured in 2022, and lessons learned were applied. Obstacles – from regulatory hurdles to payer pushback – made incubators, accelerators and private equity groups much more selective in their investment and partnership decisions. They looked beyond “invention” to innovation – where the market seeks to embrace a new product and rally to Foreword its access within the health ecosystem.

The 2022 “Global State of Digital Health Report” does far more than examine monies invested in the broad digital health category — it offers a guide for decision-makers on how multiple data points translate into market shifts and how to pinpoint trends that provide predictive insight and best practices in investment strategies, across regions, Digital Health categories, therapeutic areas and technologies.

Decisions will be made based on this collaborative effort. This report offers a new perspective – the data this report provides – finding the balance between hype and hope to offer balanced optimism is a guide.

The post Digital Health Innovation Continues to Press Forward at Warp Speed appeared first on Medika Life.

In my earlier posts in this series, I have written primarily from the perspective of what primary care physicians can do to improve their patients’ health and reduce total costs of care. Concurrently, they can reclaim their right to practice in a non-frustrating environment with a limited number of daily patient visits. Torinus approaches improving health care from the perspective of a business leader faced with rising health care costs. Here I will quote and paraphrase from Torinus’ book and, since I basically agree with his recommendations, will amplify with some of my own thoughts.

He argues that company CEOs must make health care a strategic priority since it is one of the top three costs for any company. In addition, healthcare costs can make the company noncompetitive if not managed aggressively. However, strategic priority to him also means it is essential for the company to attend proactively to the health and wellness of its employees, not just be the provider of an insurance plan.

CEOs need to consider the long term for their companies and employees. The company and the employee together spend about $16,000 per year for a family for insurance as of his 2014 book publication, obviously much greater than that today! Using his $16,000 estimate, an employee who works for a company for 25–40 years represents an insurance expenditure over a lifetime career that could be as much as $400,000 to $640,000 in 2014 dollars. This drives home the point that it only makes sense to have a long-term view of employee health, beginning with an aggressive approach to maintain wellness, actively reduce risk factors and manage disease as it occurs.

Some repetition here is worthwhile. Don’t just focus on treating disease but prevent disease and maintain wellness. Of course, that will cost some money now, but the end result will be a substantial decrease in total costs over the years. And, don’t just cover disease care but arrange for each employee and family member to have outstanding primary care to avoid unnecessary excessive specialty care.

He observes that the current health care system focuses on specialty care, whereas it needs to focus on the care recipient with high-quality primary care — the patient/consumer/employee. But to be effective, the patient/consumer/employee needs to be engaged. Instead, the current healthcare system disengages the patient — it removes responsibility because the patient is not the doctor’s customer.

In his company, expenses were rising to double digits by 2003, but with their new plan in place, it dropped to 2% or less per year.

Torinus’ “prescription” for all companies (and what his company initiated beginning in 2004) follows:

First, every company, including small companies, should self-insure with an added stop-loss catastrophic policy.

Second, employees should be offered only a consumer-directed healthcare policy (CDHP), in essence, a moderately high deductible plan (often about $2500) with either an associated health savings account (HSA) or a health-related account (HRA.) The company should prefund the account with an amount (often about $1500 or more) that the individual can use for any health care needs with the assumption that since it is now the individual’s money, he or she will spend it more wisely — employee/patient engagement.

Third, the company should insist that each provider have price transparency. Since that’s often difficult to obtain, Serigraph uses various companies like Alithias Inc to provide that for them so that they can compare one provider to another. For example, they determine the price of the all-inclusive (gastroenterologist, anesthesiologist, and facility fee) along with quality data of colonoscopies at the nearest five centers and then rank them. The employee or family member who needs the colonoscopy is told that, for example, the company sees it as appropriate preventive care and so will cover the cost, in this case up to $1,500. [His book appeared before the ACA became law, so the insurance component would cover colonoscopy now, but the principle is still valid.] This is an amount that will pay for, say, four of the five local centers, but if he or she selects a provider that charges more, they are on the hook for the remainder.

Fourth, if the company is large enough, it should provide an on-site primary care clinic at no cost to the individual. For example, at Serigraph, the clinic includes a concierge-type physician (meaning that the physician is salaried, has a low number of patients under care, and gives ample time and energy to each employee/family member patient, consistent with some of my previous posts) plus a nurse practitioner, a health coach, a dietician, and a chiropractor. On the other hand, if the company is too small to justify a full-fledged clinic, then the company can pay the retainer for a nearby direct primary care/membership/concierge physician who works with others, such as a health coach.

Fifth, the clinic, with particular attention by the health coach, gives all employees a health risk assessment annually and then works one-on-one with each employee (and family member) at no cost to maintain wellness and health, including the use of behavioral change programs around diet, nutrition, exercise, stress management, and smoking cessation.

Sixth, the clinic staff gives very intense management of chronic diseases and coordination of specialist visits when needed. (See my earlier article on care coordination by the PCP)

Seventh, Serigraph uses what Torinus calls Centers of Value for procedures beyond those that the primary care physician does. These are doctors/institutions that have outstanding quality records yet a competitive price for, say, a knee replacement. Serigraph gives their employees $2,000 toward the deductible or covers the deductible for the surgery when they use these Centers of Value.

Seventh, his company gives (and he recommends others do likewise) generic drugs for free, and all of the above prevention and wellness programs are supplied free of charge. Finally, the company makes free counseling available for developing advanced directives, and if an individual requires end-of-life care, hospice is available free of charge.

I notice that his company spends considerably on extensive/comprehensive primary care, including wellness maintenance, proactive prevention, behavioral health, and chronic care management. In return, the company is rewarded in return with lower total costs and healthier workers.

Given that healthcare has become a company strategic priority, then it needs to be managed, and that requires data. Hence, he urges all companies to develop health-related management dashboards, including both a financial dashboard (how much is the company spending) and a health dashboard (how many individuals in the company have uncontrolled blood pressure, uncontrolled asthma, uncontrolled cholesterol, have not had appropriate mammography or colonoscopy, etc. — all information collected from the clinic in an unidentified manner to protect individual privacy).

These approaches are based on fundamental principles, including individual responsibility; marketplace discipline — installing consumerism, steering business to the best quality and price (“do good work and you get our business”); proactive care — maintaining employees’ health and wellness and give extensive care to those with chronic illnesses; and sound management — putting those who pay, i.e., the employer and the employee, in charge.

Torinus suggests that there are multiple rewards for following this basic approach (I added number 2 since he implied but did not write it.)

1) The reward for business is a healthier workforce and more affordable healthcare expenditures.

2) The reward for individuals is more health and wellness, less illness, and fewer dollars spent.

3) The reward for high-value providers is more business.

4) The reward for entrepreneurs comes if they innovate with better care provided at a lower cost

5) There could be a reward for taxpayers — if governments (federal, state, and local) were to utilize these approaches.

Sound advice? I certainly think so.

The post A Business Approach To Reducing Healthcare Costs appeared first on Medika Life.

My friend Susan in the first article of this series was a good example. Presenting to her PCP with a somewhat unusual symptom, she was sent from specialist to specialist without ever learning what was causing her symptom, much less resolve it. It was a true waist of time, money and her emotions when the answer was there if only a doctor spent some time to listen to her.

To further exacerbate the problem, the doctor and patient no longer have a “contract;”. The patient and doctor are bystanders to the decision-makers. Frustration by doctors and patients is high, and physician burnout has become rampant.

 Add to this is a significant change in the common serious diseases – complex, chronic illnesses, mostly preventable, for which American medical care has not established suitable methods of prevention or adequate methods of care. In addition, what should be the role of the primary care physician has been compromised by the insurance industry (both commercial and government-sponsored) that puts the incentives in the wrong places. The result is a sicker population, episodic care, and expenses that are far greater than necessary.

Our current delivery system was designed early in the past century with the expectation that the patient would pay the doctor a reasonable fee for the effort, skill, and time involved.

Insurance developed during the past 70 years initially to pay for unexpected, highly expensive care, such as surgery or hospitalization. But over time, insurance transitioned into what is essentially prepaid medical care and along the way eliminated the financial “contract” between you and your primary care physician (PCP or Nurse Practitioner.) The contract today for both you  and the doctor is with the insurer The patient and doctor are bystanders to the decision-makers. Frustration by doctors and patients is high, and physician burnout has become rampant.

Worse yet, insurance pays primary care providers a pittance, driving them to “make it up in volume” by seeing too many patients per day, often 24 or more. Of course, this means short visits, perhaps three per hour, which translates into about 10-12 minutes of actual face time with you.

The delivery system was developed to deal with acute medical problems, where it is reasonably effective. For example, consider the pneumonia that a single internist can treat with antibiotics, an appendicitis that can be cured by the surgeon, or the fractured arm that the orthopedist can cast. But our medical care system works poorly for most chronic medical illnesses and costs far too much. Chronic illnesses include diseases like diabetes with complications, cancer, heart failure, chronic lung and kidney disease, and Alzheimer’s.

These chronic illnesses are increasing in frequency at a rapid rate and consume the bulk of health care expenditures. They are largely (although not entirely) preventable.

A century ago, the most common causes of adult death were infections – pneumonia, typhoid, and tuberculosis. Today these are uncommon and treatable. Now the most frequent causes of death are chronic illnesses – heart, cancer, and stroke, with Alzheimer’s and diabetes just behind. Other than some cancer, most others are not curable.

Most chronic diseases are related to lifestyles and are preventable. A myriad of social, environmental, financial, and personal reasons has led to non-nutritious diets, lack of exercise, chronic stress, inadequate sleep, smoking, and excess alcohol. Obesity is now a true epidemic, with one-third of Americans overweight and one-third obese. The combined result is high blood pressure, high cholesterol, and elevated blood glucose, which, combined with the long-term effects of the above behaviors, leads to diabetes, heart disease, stroke, chronic lung problems, kidney disease, and cancer.

No one pays for prevention, for maintaining health and wellness. Insurance is for disease care. Government does little (except with tobacco) to assist. As a result, as a country, we do not attend to actual healthcare and maintaining wellness, which in turn means greater pressure on the medical care delivery system. We don’t have a health care system, it is a medical care system that focuses on disease, its diagnosis, and treatment. Wellness and prevention are largely ignored. That is unfortunate because most of today’s chronic diseases could be prevented. Attention to prevention is the logical method to maintain and improve health and is much less expensive than treating a disease once it occurs.

When any of these chronic diseases develop, except for some cancers, it usually persists for life. These are complex diseases to manage and are often very expensive to treat – an expense that continues for the rest of the person’s life. Preventing them is equally complex but a lot less expensive.

Although not adequately appreciated, primary care physicians can handle most of today’s chronic illness care. They have the knowledge, experience, and skill level to do so. But this does not happen with short visits. All too frequently, the patient is referred to one or multiple  specialists when the PCP could have dealt with the problem had they had enough time. That extra time would not have cost much, but the referral, of course, means an increase in the costs of care, often substantial.

Some patients with chronic illnesses will need a team of caregivers, but the various specialists and the PCP are not a true team working in a unified manner. For example, consider a patient with lung cancer who may need a surgeon, radiation oncologist, medical oncologist, pulmonologist, pain specialist, palliative care team, nurse practitioner, and many others. Primary care physicians generally do not have the time needed to coordinate the care by the specialists. This is very unfortunate because coordination is absolutely essential to ensure good quality at a reasonable cost. You might think that one of the specialists might take on that role but that rarely occurs. More often the patient starts with a surgeon who refers him on to a radiation oncologist who then refers to a medical oncologist who then may or may not call-in others as needed. 

Any team needs a quarterback, and in general, that person is or should be the primary care physician. The PCP needs to be the orchestrator of the various specialists when needed in these complex patients. This need for a team and a team quarterback for the patient with a chronic illness is much different than the needs of the patient with an acute disease in which one physician can usually suffice. A team quarterback dramatically reduces the total costs of care if only because it means continuity and organization of care, keeping the patient’s welfare upper most in mind.

This shift to a population that has an increasing frequency of chronic illnesses mandates a shift in how medical care is delivered. Unfortunately, our delivery system has not kept up with the need. This is no way to run a railroad.

Join me with the following articles as I address more of the Whys and Hows and What to Do.

The post Complex, Chronic Diseases Are Rampant Today appeared first on Medika Life.

Not too long ago, our family joined the rare disease community. For years, our child exhibited a multitude of disconnected symptoms that all seemed to have different explanations, if they had explanations at all. The growing list included dizziness, rapid heart rate, stomach aches, rib pain, joint pain, unexpected dislocations, migraines and others.

Spider-Web-like Health Ecosystem

The symptoms accumulated, along with a cascade of specialist appointments, diagnostic tests and treatments. So did the hours of speaking – and negotiating – with our health insurance carrier. Along the way, we encountered all sorts of personalities in our spider-web-like health ecosystem, most compassionate and wanting to help our child, others bewildered or frustrated, and still others deaf to our worries and requests. The boldest and best among the health professionals we worked with were those willing to confess their uncertainty. In medicine, the response “I don’t know” is now an act of courage.

Fifty years ago, when modern medicine came of age, there were far fewer treatments for common, non-communicable diseases such as high blood pressure, cardiovascular diseases or mental illness. While medicine has become more advanced and specialized, it has also become increasingly fragmented. The important family physician – who should have sufficient time and compensation to coordinate care – is often out-of-the-loop as patients rush to a myriad of medical specialists – each hyper-focused on their piece of the biological puzzle.

Fee-for-service care disadvantages primary care medicine and a patient’s coordinated care.  This financial model may work for simple – in and out – cases, but when it comes to chronic illnesses, it does not. Add to that the complexity of electronic medical record systems with limited interoperability. Now, specialists face “telephone-game” obstacles to accessing colleagues’ clinical notes and diagnostic data for a shared patient.

Now, shift from common non-communicable diseases to needle-in-the-haystack conditions.  It’s baffling for patients, parents and providers.  Over time, doctors may even become frustrated with these patients. People with multiple, disparate symptoms with no “one pill to heal them all” are sometimes labeled problem patients owned by no one. In these circumstances, young female patients often experience gender bias and provider judgments that the puzzling symptoms must be “in their heads.”

Communication is Part of the Care

When you hear hoofbeats behind you, think horses, not zebras. As 14^th-Century theologian and philosopher William of Occam would suggest, the more common explanation is the correct diagnosis. But medical students – and the doctors they become – need to be careful not to develop a foolish consistency.  This is not the Middle Ages of Medicine.  It is the 21^st Century of miracle medicine where patients must have a voice.

While it is easier to treat confusing and contradictory symptoms than to ask why a patient is experiencing them, savvy doctors rely more on their patients’ collaboration to help them solve medical mysteries. Information, communication, and advocacy can build a bridge linking doctors and patients.

Traumatized by the Medical System

But, most often in healthcare, the gatekeepers – providers and payers – feel they know best. This overconfidence can quickly unravel in the face of the challenges of rare whack-a-mole diseases. Physicians trying to help feel helpless and grasp at straws when their initial diagnoses and treatments do not solve their patient’s problems. Over time, many patients are traumatized by a medical system that seeks to help, but is seen as fallible.  As different solutions are sought, the system pays more and more for that same patient over time. The patient’s underlying illness remains unaddressed. No one wins.

This two-decade journey to arrive at my child’s diagnosis (Ehlers Danlos Syndrome) has taught me several lessons.

• TEAM:  Any successes result from the passion of individuals —parents, physicians, payers or policymakers — who are determined to work together to find solutions and willing to listen.

• TECH:  Good health information begins to force our fragmented health system to converge around the patient. When data is accessible, artificial intelligence finds needle-in-a-haystack solutions, uniting the myriad of like cases so that health professionals can learn, engage, and arrive at answers sooner.  Physicians who also engage patients promptly through the EHR system are more than answering the questions of anxious patients; they demonstrate partnership in the care.

• TRUST: I have seen how critical advocacy is. As a health communicator, I have been fortunate to serve on the boards of organizations such as the American Academy of Pain Medicine Foundation, American Heart Association, Leukemia & Lymphoma Society, The Marfan Foundation and Let’s Win for Pancreatic Cancer, which unite healers and patients, and participate in the Centers for Medicare and Medicaid Part D Working Group: all great forums for accurate information that improve public health through informed decisions.

These lessons all point to passionate, informed collaboration as the key to restoring clarity and sanity to the fragmented health system and driving quality care for patients, whether they have common ailments or rare conditions. I integrate these lessons into my work to benefit clients and, most importantly, change the lives of the patients they serve.

Our family’s lives were changed by one cardiologist who dared to utter a simple sentence: “You need a team.” Her idea to put one together should not have been so revelatory, nor so atypical, but it was. She understood collaboration fundamentally and saw patients and their caregivers as her partners in healing.

Collaboration – Overused Word; Underused Strategy

For those whose work touches patient care and public health, I encourage you to collaborate, talk, and merge your experiences with others. Remember, this work directly touches people’s lives. This work makes a difference. Give thought to how you can bond with others to change the course of care. Collaboration is an often-overused word but is too often underplayed as a behavior.

I call on my readers and colleagues to look to the innovators of ideas, products and relationships and recognize that through collaboration with each other, we have an opportunity to recast the health ecosystem. Recognize that our work is a life-saving effort about being part of people’s transformational moments. And be courageous enough to know when you don’t know.  From there, we can begin the journey toward healing, together.

The post Looking for Zebras: Medical Mysteries and Transformational Patient Moments appeared first on Medika Life.

On the one hand, we have incredible science, technologies, drugs, devices and providers. On the other hand, we have a truly dysfunctional healthcare delivery system.

America has exceptionally well-educated and well-trained providers committed to your care.

America is the envy of the world for its biomedical research prowess uncovering the basic science of human biology, funded largely by the government via the National Institutes of Health and conducted across the county in universities and medical schools.

The pharmaceutical and biotechnology industries continuously bring forth lifesaving and disease-altering medications.

The medical device industry is incredibly innovative and entrepreneurial. The makers of diagnostic equipment such as CT scans and handheld ultrasounds are equally productive. 

Consider these examples: The science of genomics is revolutionizing medical care in profound ways, such as producing targeted cancer drugs, predicting later onset of cardiac disease, offering prognostic data to guide cancer treatment, rapidly identifying bacteria and its antibiotic susceptibility, indicating whether a drug will work in a specific person and determining if a drug will cause a side effect in that person. 

The pharmaceutical industry has brought us statins to reduce cholesterol, drugs to prevent blood clotting and effective means to control high blood pressure. The rapid development of multiple vaccines and treatments against Covid-19 has been an incredible tour de force.

The device industry has created a potpourri of new approaches that have transformed, for example, cardiac care, including angioplasty, stents, pacemakers and intra-cardiac defibrillators. We even have the ability to replace the aortic valve without major heart surgery. 

Organs can be imaged noninvasively in incredible anatomic detail while also showing their inner cellular workings. The operating room is equipped with devices that make surgery less invasive, more effective and much safer.

Simulation technology has completely changed how trainees learn the basics of procedures from the simple, such as drawing blood, to the complex, such as laparoscopic surgery and cardiac catheterization. Robots are assisting surgeons in open heart and prostate surgery and are integral to today’s large hospital pharmacies and central sterile supply systems.

We may be on the verge of using genetically modified animal organs transplanted to humans for heart, lungs and kidneys.

The electronic medical record allows rapid access to information at any time and place, helps the physician to select the correct medication and dose and speeds up prescription transfer to the patient’s local pharmacy.

Radiology and pathology images can be sent via the Internet to a distant site for interpretation by a specific expert. A video of an ongoing surgical procedure can be evaluated by a distant authority in real time to give advice to the operating surgeon, such as in a battlefield situation far from home. And some surgery can even be done distantly via robotic controls.

We can be appropriately awed, proud and pleased about what is available for our care but to a large degree, we don’t fully benefit because —

We have a very dysfunctional health care delivery system. It is highly flawed and just does not work well.

Image from Peterson KFF Health System Tracker

America spends nearly 20 percent of its Gross Domestic Product on medical care, which is double that of the average of 9.9% for the other 34 economically-developed countries (such as Canada, Britain, France, Germany and Japan) in the Organization for Economic Cooperation and Development. On a per capita basis, America spent ~$12,000 on health as of 2020, which is more than twice the average of the other countries and well above Switzerland, the second highest country in expenditures, at ~$7000.

Despite these expenditures, our lifespans are somewhat shorter with Japan and Hong Kong at the top of the charts averaging 85 years and the United States ranked at number 46 with an average of 79 years and falling somewhat in the past few years. This decline is not for lack of medical advances but is rooted in the social determinants of despair and disease and the linked epidemics of obesity and type 2 diabetes.

There are thousands of preventable hospital deaths each year, and there are ~100,000 deaths due to hospital-acquired infections.

On a direct personal basis, you experience the dysfunction personally in many venues. You pay a high price for your health insurance yet you get only 15 minutes with the doctor. You are frustrated, perhaps angry and the doctor is equally frustrated and increasingly burned out. Tests and procedures are way overutilized. Trips to the ER and admissions to the hospital are much greater than necessary. Plus, these incredible technologies and lifesaving drugs are often used in ways or settings in which the marginal benefit barely, if at all, exceeds the marginal cost.

This is not an enviable record.

A report from the National Research Council and Institute of Medicine, summarized in the Journal of the American Medical Association, found “the health outcomes [of the United States] are generally worse than those of other wealthy nations. People in the United States experience higher rates of disease and injury and die earlier than people in other countries. Although this health disadvantage has been increasing for decades, its scale is only now becoming more apparent.”

Although there is better control of high blood pressure and cholesterol and there are lower cancer and stroke mortality rates, U.S. citizens have a lower life expectancy, higher infant mortality, higher rates of premature birth and thus lower birth weights, a higher incidence of HIV-AIDS, the highest prevalence of obesity and diabetes and the second highest rate of death from coronary artery disease, among other ills. To repeat, this is not an enviable record, especially given the level of expenditures. 

In sum, the paradox is that America has the providers, the science, the drugs, the diagnostics and the devices needed for outstanding patient care. But the delivery of care is dysfunctional at best and far too expensive. You are not getting the full potential of care that could and should be available and you are paying too much for what you do get.

In the articles to follow, I will delve into the what’s and why’s of this predicament along with practical approaches to improvement. Please join me.

The post The Paradox of America’s Healthcare System appeared first on Medika Life.