• Learning from Singapore and Switzerland

    Posted over 5 years ago
    by pnblog}

    So this week’s question from the Washington Post RX Blog was:

    Which country has the best health-care system and why? Can the U.S. follow its model?

    My response -- Learning from Singapore, Switzerland -- is below.

    To realize the goals of providing increased access while maintaining fiscal responsibility, we have to dramatically change how we 'do health' today -- whether we're doctors, hospitals, or consumers.

    Health is complicated no matter where you go in the world, and there are different challenges in every country. There is no 'best' system anywhere, but there are best practices from around the world worth exploring. Two immediately come to mind:

    Singapore's system has characteristics that reflect what we'd expect to see in our own system - personal responsibility, competition and choice. Working people are obliged to put money into a personal savings account for out-of-pocket expenses. The money remains completely in each person's control; each decides how to spend it. And there's choice -- at the Raffles Hospital, one can choose a $1,438 luxury suite with a 24-hour nurse and other amenities OR a $99 a night dormitory room with the six other beds. Procedures cost the same, and are transparent (Publication of the cost of hospital procedures is mandatory, turning the purchase of a hip replacement into something similar to buying a pair of shoes), but there's choice. Contrast this to our system where it's difficult to even get a price in advance, let alone make choices.

    Switzerland's system also offers interesting models for consideration -- universal access, individual choice from an array of private insurance options, and a higher level of personal accountability (shared costs by individuals). All citizens are required to buy health insurance and private insurers are required to offer coverage to everyone - regardless of age or any previous medical conditions. Insurers offer a basic package on a not-for-profit basis, and supplemental packages on a for-profit basis that consumers can choose for things like home care, alternative medicine, and so on. Competition is basically about price and service. For those who can't afford the basic package, the government offers direct cash subsidies. In addition, the system provides incentives for consumers to avoid unnecessary treatments by requiring them to share some costs at a higher level than in the U.S. It's not perfect, but it is customer-driven.

    In a democratic nation where capitalism flourishes, personal accountability and choice ought to be at the heart of the system.

    Please feel free to comment with your own thoughts – I’d like to hear from you.

  • New delivery models will solve the cost crisis

    Posted over 5 years ago
    by pnblog}

    This week's question for the Washington Post Health Care Rx blog was:

    Has Congress done enough to constrain long-term, health care spending growth? What cost containment strategies would you advocate pursuing?

    My response, New delivery models will solve the cost crisis, below:

    I was again reminded at last week's Partner's Connected Health Conference about how much potential there is for innovation in health - for industry transformation. The session titles speak for themselves:

    • Wireless Tech and Patient Self-Management: Opportunities, Applications, and Barriers
    • Get Your House Smart: Aging in Place, At Home, Aided by Technology
    • The Emerging Use of Videogames for Health: Innovations, Impacts, and Issues
    • Mobile Health: Leapfrog technology for the developing world?
    • And the list goes on...

    What this showed me is that there are many innovations starting to happen with promising implications for tomorrow's health care system. To get there, we need less focus on the costs of today's system, and more on enabling a new delivery model for the future. We, as consumers, manage the rest of our lives from our phones or our PCs - our finances, our travel, our shopping. When we want to make any purchase or investment, we have all kinds of services we can leverage to get informed and act. Every industry that touches our lives has been transformed - complex, expensive products and services once only available to few are now accessible and affordable to the masses and provided by those (people or even software) with far less training.

    In health, if we continue to 'do it' the way we always have, costs will continue to skyrocket. Not to mention that our current delivery model simply won't be able to keep up with the advances in medicine - think about a world of personalized medicine (we're on the cusp of some amazing things). Today's delivery model just isn't set up to handle the amount of personalized data, decisions and so on.

    We can see pointers to the future -- virtual care from American Well, new delivery channels such as Minute Clinic, patient self-serve at Kaiser-Permanente, personal health management platforms like HealthVault and Google Health. We're seeing an influx of investment into health start-ups focused on making treatments or healthcare information more cost-effective and accessible to patients. But we haven't yet seen widespread change or adoption.

    Why? Congress has carved into stone our current system, but this traditional 'fee-for-service' model just isn't flexible and won't enable the kind of innovation required.

    We need Congress to create a new framework that drives value, rewards experimentation and enables innovation. This is what will transform health and ultimately drive costs down.

  • Personal Accountability

    Posted over 5 years ago
    by pnblog}

    So this week’s question from the Washington Post RX Blog was:

    The Senate Finance Committee passed a bill containing its version of the health-care overhaul. Are you satisfied with this bill? What does it miss?

    My response is below.

     

    There's a long road ahead for health-care reform -- five bills to be merged and countless hours of debate still to come. A lot could change over the course of the next few months, and the content of the final reform bill is likely to vary from any of these individual bills. The question we need to keep asking ourselves is whether reform will drive the kind of wholesale transformation needed for the industry and consumers -- the kind we've seen in banking, travel and other service industries. Ten years ago, we wouldn't have imagined that people would do so many things themselves. Technology and business model innovation enabled new types of services -- putting consumers in charge, dramatically changing engagement and economics. Imagine the possibilities for new services in health.

    Taking this into account, what's needed is a new 'health delivery' framework that drives value, rewards experimentation, puts consumers in charge, and enables innovation--essentially changing the attitudes, beliefs, and behaviors of everyone involved in health delivery. We all have to be prepared to work together in different ways.

    We have an opportunity now to move the traditional healthcare business model in a new direction:

    • Shifting the value of healthcare from treating people when they are sick to finding ways to keep them well (allowing physicians to focus on and be accountable for outcomes vs. volume)
    • Transferring the management of routine diagnosis and treatment from highly-skilled professionals to newer, more efficient/convenient, and cost-effective delivery methods like minute clinic, self-serve, nurse practitioners -- so doctors can focus on using their skills in the most effective way possible (allowing physicians, health systems, and 'new entrants' to be accountable for value and innovation)
    • Encouraging consumers to make better lifestyle choices. We need to help them engage in their health differently, be wiser purchasers, and understand the trade-offs involved.

    At the end of the day, the ultimate success of health-care reform will depend as much on how we will work together and change our behaviors as on the legislation ultimately passed by Congress and signed by President Obama. I applaud the administration for shining the light on health care as it has never been done before.