Thursday, June 20, 2024
HomeHealthcareRube Goldberg Would Be Proud – The Well being Care Weblog

Rube Goldberg Would Be Proud – The Well being Care Weblog


Larry Levitt and Drew Altman have an op-ed in JAMA Community with the can’t-argue-with-that title Complexity within the US Well being Care System Is the Enemy of Entry and Affordability. It attracts on a June 2023 Kaiser Household Basis survey about client experiences with their medical insurance. Lengthy tales quick: though – surprisingly – over 80% of insured adults charge their medical insurance as “good” or “wonderful,” most admit they’ve problem each understanding and utilizing it. And the individuals in truthful or poor well being, who presumably use well being care extra, have extra issues.

Medical insurance is the goal on this case, and it’s a truthful goal, however I’d argue that you would decide nearly any a part of the healthcare system with comparable outcomes. Our healthcare system is ideal instance of a Rube Goldberg machine, which Merriam Webster defines as “engaging in by advanced means what seemingly may very well be accomplished merely.”   

Boy howdy.

Medical insurance is many individuals’s favourite villain, one which many wish to do with out (particularly medical doctors), however let’s not cease there. Healthcare is stuffed with third events/intermediaries/middlemen, which have led to the Rube Goldberg construction.

CMS doesn’t pay any Medicare claims itself; it hires third events – Medicare Administrative Contactors (previously generally known as intermediaries and carriers). So do employers who’re self-insured (which is the overwhelming majority of personal medical insurance), hiring third celebration directors (who might typically even be well being insurers) to do community administration, claims fee, eligibility and billing, and different duties.

Even insurers or third celebration directors might subcontract to different third events for issues like supplier credentialing, utilization evaluation, or care administration (in its many varieties). Take, for instance, the universally reviled PBMs (pharmacy profit managers), who’ve carved out a giant area of interest offering providers between payors, pharmacies, and drug firms whereas elevating growing questions on their precise worth.

Doctor practices have lengthy outsourced billing providers. Hospitals and medical doctors didn’t develop their very own digital medical information; they contracted with firms like Epic or Cerner. Well being care entities had hassle sharing information, so alongside got here H.I.E.s – well being info exchanges – to assist transfer a few of that information (and HIEs are actually transitioning to QHINs – Certified Well being Data Networks, because of TEFCA).

And now we’re seeing a veritable Cambrian explosion of digital well being firms, every pondering it will possibly take some a part of the well being care system, put it on-line, and maybe make some a part of the healthcare expertise rather less unhealthy. Or, seen from one other perspective, add much more complexity to the Rube Goldberg machine. 

On a latest THCB Gang podcast, we mentioned HIEs. I agreed that HIEs had been developed for a great motive, and had accomplished good work, however on this supposed period of interoperability they need to be making an attempt to place themselves out of enterprise. 

HIEs recognized a ache level and located a method to make it rather less painful. To not repair it, simply to make it much less unhealthy. The healthcare system is replete with intermediaries which have workarounds which permit our healthcare system to lumber alongside. However as soon as in place, they keep in place. Healthcare doesn’t do sunsetting nicely.

In contrast to a real Rube Goldberg machine, although, there isn’t any actual design for our healthcare system. It’s extra like evolution, the place there aren’t any model factors, no effectivity objectives, simply credit score for survival. Certain, typically you get a cat by evolution, however different instances you get a unadorned mole rat or a hagfish. Healthcare has much more hagfish than cats.

I’m impressed with the creativity of many of those workarounds, however I’m awfully uninterested in needing them. I’m awfully uninterested in accepting that complexity is inherent in our healthcare system.

Complexity is unhealthy for sufferers, unhealthy for the individuals instantly giving the care, and solely good for all the opposite individuals/entities who make a residing in healthcare as a result of if it. As an alternative of creating ache factors much less painful, we needs to be eliminating them.

If we had a magic wand, we might remake our healthcare system into one thing a lot less complicated, rather more efficient, and far inexpensive. Sadly, we not solely don’t have such a magic wand, we don’t even agree on what that system ought to seem like. We’ve gotten so used to the advanced that we will not see the easy.

I don’t have a Utopian imaginative and prescient of a healthcare system that might remedy all the issues of our system, however I do have some strategies for all of the innovators in healthcare:

  • In case your answer makes sufferers fill out yet another type, log into yet another portal, make yet another cellphone name, please rethink.
  • In case your answer takes time with sufferers away from clinicians, making them do different duties as an alternative, please rethink.
  • In case your answer doesn’t create info that’s going to be shared to assist sufferers or clinicians, please rethink.
  • In case your answer solely focuses on a point-in-time, moderately than serving to an ongoing course of, please rethink.
  • In case your answer is designed to extend income moderately than to enhance well being, please rethink.
  • In case your answer doesn’t acknowledge, acknowledge, report and act on failures/errors/errors, please rethink.
  • In case your answer can’t merely be defined to a layman, please rethink.
  • In case your answer provides to the healthcare system with out lowering/eliminating the necessity for one thing even greater within the system, please rethink.
  • In case your answer steers care to sure clinicians, in sure locations, moderately than looking for the very best take care of the affected person in the very best place, please rethink.
  • In case your answer provides prices to the healthcare system with out uniquely and particularly lowering much more prices, please rethink.
  • In case your answer doesn’t have built-in mechanisms (e.g., use of A.I.) to be and keep present on an ongoing foundation, please rethink.

 I’m positive all these innovators assume their concept may be very intelligent, and lots of are, however keep in mind: simply because an concept is intelligent doesn’t imply it’s not Rube Goldbergian.  They should step again and take into consideration in the event that they’re including to healthcare’s Rube Goldberg machine or serving to simplify it. My guess is that normally they’re including to it.

So, yeah, I agree with Mr. Levitt and Dr. Altman that medical insurance needs to be much less advanced.   Identical to every part else within the healthcare system. Let’s begin taking the healthcare Rube Goldberg machine aside.

Kim is a former emarketing exec at a significant Blues plan, editor of the late & lamented, and now common THCB contributor.



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