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PA IN THE MEDIA

The future of Healthcare

Chris Steel, healthcare expert at PA Consulting, discusses the future of healthcare in a Q&A with Authority Magazine’s Christina Warner.

Read the full Authority Magazine interview here.

What brought you to this specific career path?

My expertise was originally in engineering and IT and when I first came to the United States I utilized that experience to help Life Science companies deliver major technology related transformation programs. As the healthcare industry began converging, my clients began to move into provider organizations. I followed them and worked with them to improve healthcare delivery and outcomes in their new roles.

My healthcare experience up until about 7 years ago had been primarily in urban environments in the Northeast and West Coast. Then, while leading a major telehealth strategy for a large provider with hospital facilities throughout the Midwest, the challenges of accessibility were brought home. The role that technology can play in addressing accessibility challenges faced in certain parts of the country was made even clearer.

Why are you an authority in the healthcare field?

At PA Consulting, we are all very focused on improving patient outcomes. However it does not take long to realize that healthcare leaders will not invest in a new initiative unless you can also show a very clear revenue impact. My experience across industry has really helped me bring a strong ROI focus to the advice I give my clients, which in turn has helped drive innovative healthcare projects, some of which might not have otherwise progressed.

Our focus on harnessing our ingenuity to create a more positive human future in a technology driven world sets PA Consulting apart. For example, we helped a client create a fetal heart monitor that would allow a mother who had suffered from preeclampsia avoid a lengthy hospital stay in advance of the birth of her second child. This innovation both improved the quality of her life and saved on expensive stays in hospital.

What innovations do you see in the healthcare industry?

The fetal heart monitor example is a good one, but our innovations are not only about creating new technology or devices. We also help healthcare organizations work in more innovative ways to achieve better outcomes. For example, we help clients pilot innovative new ways of working, and then build the pilot enterprise throughout the organization.

Another example would be challenges around bringing telehealth into the mainstream care delivery. Our role has been to build on local innovation and show how that care can be delivered at scale with a robust business model which not only improves accessibility and outcomes but also shows a clear financial benefit. Almost everything we do is focused on addressing the challenge of this triple aim in some way.

What exciting projects are you working on?

I think some of the most exciting and impactful work PA Consulting is doing involves helping healthcare organizations put in place the processes and technologies which will allow their patients to access an integrated view of their own health data more easily. It’s not sexy in the way a shiny new piece of technology is, but it’s the hard yards that need to be taken to integrate data and present it intuitively in a single place through a consolidated portal, for example, that will allow patients to take more ownership over their own health data. This a critical for improving population health and reducing healthcare costs over the long-term.

We’re also excited to be working to support EMS providers to prepare for the changes brought about by the ET3 (Emergency Treat, Triage and Transport) innovation pilot. This will fundamentally change the way that emergency services respond to people in need, enabling them to get urgent help either at home (via telecare) or in an appropriate alternate to an emergency department. It will improve integration across the care system and reduce the costs of care.

The US healthcare system is ranked as the worst among high income nations. Why do you think the US is ranked so poorly?

The primary reason is that the US spends vastly more per capita than any other country. There is an article in Harvard Business Review last month which provides an excellent summary of why US healthcare costs have spiraled over the last 50 to 60 years. I won’t repeat that story here but let me provide a grass roots example of the impact of why costs also make healthcare inaccessible for many people. The minimum wage in Colorado is $11 per hour in 2019. This means that you would earn about $1,408 net after tax every 4 weeks assuming a 40-hour week. If you bought a silver medical plan from the Colorado Information Exchange marketplace, you would have to spend ~$350 per month on an individual plan alone. That does not include vision or dental care. If you had children, you would need to spend more than 20% of your family’s budget on health insurance before you even started on any co-pay and deductible expenses. And yet, despite spending more than any other country, our life expectancy has actually fallen for the last three years in succession. This is unprecedented.

What changes need to be made to improve the overall US healthcare system?

I think there are three primary changes that I would like to see.

  1. The first is not so much a change but an acceleration of a journey that many organizations have already started. That is, the drive towards value-based care. There needs to be a focus on improving the health of a population within the reimbursement / payment model. PA Consulting has recently completed research which shows that the leaders in this area are showing real improvements in health outcomes and costs within a 12-to-24-month period. For example, Aetna/Banner Health have seen population health outcomes improve and avoidable readmits reduce by 7% while lowering costs by over 10%. In turn the burden on the system has been reduced. More organizations need to establish similar Payer / Providers partnerships and joint ventures. Take for example Benevera Health, an East Coast joint venture between Harvard Pilgrim and four New Hampshire providers, the largest being Dartmouth Hitchcock. They have established a capitated model in which they all share in the P&L and are achieving positive results over the last three years.
  2. The second is more controversial and unfortunately highly politicized in the United States. Every country in the world which is rated highly on healthcare outcomes relative to cost has some form of publicly funded universal healthcare system often alongside a privately funded health sector for those that want it. Our current model is unsustainable and raises serious ethical questions around accessibility. The evidence that it works from both a financial and health perspective is clear. There are already examples in the US of where a more centralized approach to the management of healthcare payments is providing significant benefit and not perhaps from states where you might first expect to find it. Tennessee for example has a single-payer model for Medicare which has delivered significant benefits over many years.
  3. Thirdly, and more specifically, I’d like to see much more focus on the way we approach senior care the reasons for which were perhaps most elegantly argued for by Atul Gawande in his book “Being Mortal.” Our seniors receive more medical attention than any other US demographic, and yet the care they receive is not always consistent or even necessary with respect to their personal goals for quality of life. This challenge is by no means unique to the United States, but it is perhaps even more critical than elsewhere given the overall cost of our healthcare system. There is some progress being made, not only in care delivery but also increasing investment in the search for therapies to address the challenges of aging from companies such as Life Biosciences.

What specific steps would need to be taken to implement your ideas?

With respect to value-based care, PA Consulting research shows that healthcare leaders do not see the same challenges to implementation that “followers” do. Those that have not started this journey are primarily concerned about how changes will impact patients, healthcare provisions, and technology and process change implications. However, the leaders have shown that though those challenges are real, they are addressable. We have worked with a number of organizations helping them address these challenges. To quote from another industry, healthcare leaders should “just do it.”

Many major corporations have become so frustrated with the performance of the healthcare industry that they are taking matters into their own hands. Haven, the collaboration between JP Morgan, Amazon, and Berkshire Hathaway, is perhaps the best-known example. Others such as Walmart have been focusing on healthcare for much longer to drive a better outcome at a better cost for their employees knowing that a healthier workforce drives productivity. Many companies will follow-suit and their collective buying power will drive more efficiency and competitiveness within the healthcare industry.

In geriatric care we are facing a profound shortage of specialist gerontologists who are trained to properly care for our seniors. One of the most important adjustments our medical schools can make is to encourage more of their students to enter that field to help improve senior’s quality of life while reducing their burden on the system. To do that effectively, however, we must also develop approaches to value-based care that reward medical professionals for avoiding unnecessary treatment as well as prescribing necessary treatment. This is most easily implemented within one of a fully capitated partnership between payer and provider of the sort that Kaiser Permanente pioneered and will increasingly become the model for the way healthcare is delivered in the United States.

Lastly, as individual citizens we must advocate for improvements to all the factors influencing overall health. We can help drive better behaviors and lifestyle choices to improve population health. Education, exercise, regulation, employment, information access, diet, air and water quality are all determinants of overall health. The full benefits of systematic change will not be realized without individual action. Of course, not everyone has the same freedom or ability to take action so it is even more important that those that do have that ability exercise it to the fullest extent possible.

Our new value-based care research shows why putting patients at the centre of healthcare is important and how to do it

Read more here

 

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