Summit on Healthcare: Addressing Affordability, Access and Quality In a Broken System

On January 29, 2016 Charlie Gibson, veteran television journalist and news anchor, moderated the Summit’s first day program of speakers and panelists— nationally respected medical and healthcare experts—who addressed a broad spectrum of healthcare issues: cost; access; value; technological advances; medical and non-medical determinants of health; politics; and “patient first” innovations in care. 

 Mr. Gibson’s humor and call for “facts, reason and respect” set the tone for a day of intense examination of the systemic flaws in the U.S. healthcare system and possible innovations, changes and solutions for improving it.  As moderator, he raised an overarching question before introducing the speakers: Why does the U.S. spend more money per capita on healthcare than any other country in the world, but still have worse health outcomes and lower life expectancy than the other top 5 industrialized nations?

The speakers provided specific insights through the lens of their particular healthcare focus.  But despite the diversity of backgrounds and disciplines, there was strong agreement about what was broken and what needed to be fixed. The main issues fell under three categories: affordability, access and quality.  Everyone agreed with Dr. Ken Thorpe’s statement that our health care system is “not making investments in the right things.”

The consensus was made clearer when, later that day, Mr. Gibson asked the six panelists, “If you could make one change in our healthcare system what would it be?”  Two answered, “payment reform”; a third said, “stop fee for service reimbursement.” The fourth person said, “change the incentives for primary care providers and patients to encourage a health model, not a sickness model.”  The fifth person answered, “figure out the right balance for how to allocate services” and the sixth person said, “require greater transparency around quality and cost. 

The following is a very condensed summary of issues that affect affordability (cost), access and quality and impact healthcare.

Dr. Ken Thorpe, from Emory University’s Rollins School of Public Health, gave an overview of what drives cost.  America spends $3 trillion a year on healthcare.  86% of those dollars are spent on chronic disease; 70% is spent on patients with three or more chronic diseases. Obesity—and its correlation to diabetes and other chronic diseases-- is a major factor driving rising costs. 

70-75% of health issues are related to environmental issues and personal choice leading to rise in chronic disease and higher incidence of mental health disorders—another driver cost. Education and IBT (intensive behavioral therapy) are necessary to change behavior.

 He advocates:

  • A paradigm shift from disease treatment (reactive) to prevention (proactive.)
  • Coordinated care, team based care
  • Change in payment model; fee for service with no follow-up doesn’t work
  • Offer bundled payment options

Dr. Gail Wilensky, former administrator of Medicare, talked about social determinants of health, noting that non-medical determinants of health—income, education, economic opportunities, early childhood development—are MORE important than medical determinants.  

Healthcare outcomes—including premature death—result from these factors

  • 30% Genetics
  • 10% healthcare access
  • 40% Individual behavior
  • 20% Environmental Factors

She advocates:

  • Improvements in early childhood development; healthy places to live; decent places to work; recognition that people need lifelong protection
  • Nutritional Assistance for pregnant mothers and young children
  • Reading to pre-school children
  • Telemedicine using Smartphones and computers
  • Consider health effects from all legislation, not just health legislation

Julie Rovner, healthcare journalist for Kaiser Health News, looked at “political realities/possibilities.” Healthcare creates political division over the issue of States’ rights vs. Federal government, which dates back to our founding fathers.  Partisan politics also divide over free-market healthcare plans versus a single-payer system.  In this year’s presidential campaign, polls indicate that healthcare costs are #3 on the list of major campaign issues.  She said, “The public loves the benefits of the Affordable Care Act, but they hate the Act.” 

Toby Cosgrove, President and CEO of the Cleveland Clinic, reported on “transforming healthcare” and said the ACA is the biggest change in American healthcare in 100 years.  Innovations under his leadership, reduced costs, increased profits, improved outcomes and patient satisfaction and turned the Cleveland Clinic into a world-renowned health care facility.

He believes: value = affordability, access and quality; access isn’t just having health insurance—it’s seeing someone quickly; transparency fosters accountability; we need to promote well care vs. acute care

He advocates:

  • PATIENT CARE FIRST; emphasis on compassion and empathy
  • One-year contracts for the clinic’s employees, including himself
  • Salaried personnel.  81% of hospital employees are salaried.
  • Monetizing intellectual properties and patents to offset costs
  • Transparency: in all areas; externally and internally; particularly around cost and quality
  • Metrics that actually measure quality
  • Establishment of retail clinics
  • Telemedicine; virtual visits
  • Consolidation of hospitals to reduce surplus of beds (now only 65% occupancy
  • Increase outpatient care to reduce hospital stays
  • Addressing issue of doctor “burn-out”; national problem affecting 40-50% of medical doctors
  • Care Path Progress; coordinated care, team approach healthcare
  • Electronic Records, Big Data for patient care coordination
  • Watson, other technological advances for making correlations that benefit
  •   Diagnostics and Health Outcomes and can aid in teaching: holograms for anatomy classes
  • Shared medical appointments; groups share experiences, have better outcomes
  • Mobile Units—to treat stroke victims on site; stroke cost per day down 25%

Tim Hardison and Al Delia talked about an exciting health education program called MATCH Wellness Program out of East Carolina University, that targets 7th-graders and teaches them about issues concerning obesity, nutrition and establishing healthy habits for a lifetime.  The data from a decade of follow-up indicates a dramatic reduction in obesity and concomitant health-costs, maintained over years.  It’s a program that could be replicated across the nation. 

Deborah DiSanzo, introduced the wonderful world of WATSON, the computer whose artificial intelligence, 30 billion images and 15 trillion pages of data may revolutionize the ability to process and analyze data and point health practitioners to “what they need to look at.”

Chris Trimble, from Dartmouth’s Tuck School of Business, talked about low-tech, common sense innovations to “fix healthcare.” He listed four common sense ideas:

  1. Standardization: care processes defined into “care pathways.”
  2. Coordination of care—team care
  3. Prevention—targeting hot spots and using early intervention and education
  4. Improving medical decisions—having patients and providers slow down and consider all the options; informed and educated decisions, not reactive

Neal Kassell, chairman of the Focused Ultrasound Foundation talked about “curing with sound.”  He gave the example of a malignant tumor that was targeted and destroyed using focused ultrasound.  It is far less invasive than surgery, with little recuperation time required.  He reported that 10,000 patients a year are already being treated with focused ultrasound and its possibilities are only beginning to be explored. 

The panelists laid the foundation for Saturday’s discussion about what local Summit participants could do to improve healthcare in the Lowcountry.  They listed three things individuals on Hilton Head could do:

  1. Continue learning about healthcare
  2. Develop community-based programs that help change lifestyle behaviors that adversely impact health
  3. As private business owners develop and incorporate wellness programs for employees.

On Saturday, January 29th the agenda focused on “bridging the gap” from national issues to a local, action-driven response. The goal was to identify what initiatives might have the most direct impact on the health of our local citizens.

Mark O’Neil, President of MTO Healthcare Consulting, welcomed and introduced panelists Amanda O’Nan, Principal of Hilton Head High School, Jeremy Clark, CEO of Hilton Head Regional Healthcare, Brandon Gaffney, COO of Beaufort, Jasper, Hampton Comprehensive Health Services, Ray Cox, Executive Director of Volunteers in Medicine (VIM) and Peter Gates, Executive Advisor, Healthcare, Parthenon-EY.

There was a general discussion about the shortage of primary care doctors in South Carolina, the fact that only 12% of the population is “health literate”, the need for education and nutritional aid, particularly for pregnant women and children.  The problem of inadequate access falls disproportionately on the poor, minorities and immigrants, especially those in rural areas. 

Mark O’Neil then charged the participants to decide on one concrete initiative members of the Institute could take action on. In response to the alarming rise of obesity—nationally and locally—the Saturday participants decided the most effective action was to learn more about the MATCH Wellness Program at East Carolina University and determine how to establish a program locally.