A surge of external forces, new partnerships and a collective outcry to fundamentally change healthcare's status quo aim to force the relatively stagnant healthcare industry to adapt, with a select group of stakeholders looking to lead the charge.
For the most part, the healthcare industry hasn't been able to get out of its own way, as it has withstood new competitors and consumer demands that have overhauled transportation, retail, banking and other industries.
While President Donald Trump tops the list of the 100 Most Influential People in Healthcare for the work he and his administration have done to drastically alter the healthcare landscape, Modern Healthcare also named a dozen executives from health systems, insurers, pharmacy, venture capital and technology companies who aim to take matters into their own hands.
“Look at Amazon, Berkshire Hathaway and JPMorgan Chase,” said Dr. Stephen Klasko, CEO of Jefferson Health and one of Modern Healthcare's select group of leaders working to change healthcare from the inside out. “That is the 'we're mad as hell and not going to take it anymore' cohort that have given up on the traditional players because all they have done is blame the other person.”
Major employers and technology companies are partnering to create new coverage models and democratize health data. Healthcare providers and insurers aim to align to form new delivery pathways. Health systems are stepping into new roles to mitigate high drug prices and meet consumers' growing demands for convenience and transparency.
Yet, these larger organizations have the resources and capital to invest in new technology, staff training and outreach programs that have begun to transform the industry at the uppermost levels. Implementing industry-wide change as providers straddle conflicting payment models is a difficult feat.
It helps when incentives align to lower the cost of care in integrated delivery systems like Geisinger Health, said the Danville, Pa.-based health system's CEO, Dr. David Feinberg.
“You can only do that if incentives are aligned,” said Feinberg, one of the dozen disrupters. “You can't do that if your business model is made only from profiting from sending people through buildings that deliver care.”
And that holds true for the C-suite as well, though the healthcare system has proved resistant to change. Bonuses for executives need to be tied to improvements to the health and well-being of their surrounding communities rather than bigger market shares, Klasko said. “It's hard to get someone to change when their salary doesn't depend on it,” he said.
Some of that is a product of a system with strongly entrenched practices that can't be easily changed without buy-in from competing stakeholders. “Most CEOs have focused on maintaining their cost structure and remaining profitable in the context of a model that is inefficient and not getting to better outcomes at lower costs,” healthcare consultant Rita Numerof said. “I don't want to imply being profitable isn't a good thing, but that side of the delivery equation is dominated by the status quo mentality that has been historically focused on bricks and mortar and heads in beds.”
Geisinger is trying to change that by providing fresh-food pharmacies in food deserts, which have improved diets and significantly decreased blood sugar levels. It provides free transportation for medical care as well as trips to friend's houses, church and other social events within 50 miles to combat loneliness.
“Loneliness and isolation is as negative a health effect as heart disease or cancer,” Feinberg said. “Both the medical and humanistic aspects of care are vital.”
Geisinger offers Lyme disease screening for residents who live near forests and Methicillin-resistant staphylococcus aureus screening for those who live near livestock. “What really matters is your genetic code, ZIP code, behaviors and things like if you have access to good food,” Feinberg said. “Kale and quinoa can be better than prescription medications.”
The integrated health system is making genomic testing part of the routine to catch diseases earlier. They are eliminating waiting rooms, reimbursing unsatisfied patients' co-pays, providing same-day appointments for nearly half of its primary-care visits, and offering free follow-up care for joint replacements.
While many providers are moving patients as quickly as possible through the system, Geisinger has set minimum time restrictions for care. Its doctors must spend at least 40 minutes with elderly patients. That has reduced productivity and raised costs, but patients and physicians are happier and emergency room visits are down, Feinberg said.
“We don't think that it is innovative,” he said. “What we are doing happens in every part of our patients' lives in every other sector and healthcare is a lagger.”