A Conversation Alongside Dr. Pandey On Healthcare Transformation
Dr. "Ravi" Pandey is president of BIPRO Inc., a consulting company, which focuses helping organizations across the globe to accomplish sustainable increment inward functioning as well as consumer satisfaction. He is an proficient inward functioning improvement as well as strategy, as well as has rigid ideas nearly healthcare reform, which he expresses on his Healthcare Transformation blog.
I've known Ravi for over a twelvemonth as well as abide by his intelligence, knowledge, experience, as well as dedication. We engage inward weekly discussions nearly fundamental issues focused on transforming our healthcare system. Following I reconstruct a conversation we've been having nearly healthcare policy as well as strategy.
Policy
Dr. Beller: What are your thoughts nearly the healthcare reform struggle these days inward our country?
Dr. Pandey: Oh, don't learn me started on it. I was really optimistic earlier. Now I catch lots of speak but no substance. If nosotros tin line off something meaningful, it would last a miracle. I mean, shout out upwards nearly it, nosotros don't fifty-fifty remove hold a clearly defined goal? What would an ideal healthcare scheme be? And yet nosotros are already arguing nearly cost.
Dr. Beller: Some people believe that you lot should know the toll first, thence that you lot tin determine what the finish should be. What's your accept on it?
Dr. Pandey: It is all tricks to confuse as well as distract us from the existent issues. How tin you lot speak nearly toll unless you lot remove hold a clear vision of the goals as well as the attempt needed to accomplish them? When I state goal, I don't hateful it inward damage of universal healthcare, or unmarried payer, co-ops, or anything similar that. Instead, let's state our finish is to accomplish world-class healthcare; thence what does it mean? We postulate to clearly articulate that. Then, nosotros tin struggle nearly how to accomplish it.
All this give-and-take nearly toll is premature...It's a empty-headed give-and-take to remove hold at this time. Let me enquire you lot this: We all concord that our healthcare scheme is every bit good expensive, correct? If that is the case, thence wouldn't spending to a greater extent than coin conk far to a greater extent than expensive? We already remove hold the money, nosotros postulate to utilize it better.
Our healthcare scheme costs 30-40 per centum to a greater extent than than it should. By the way, this I also heard on CNBC program. Sen. Frist was proverb the same matter that nosotros remove hold nearly 1/3 of coin is wasted. That's to a greater extent than than 700 billion dollars of waste. This is non a toll issue. It is an efficiency, policy, as well as direction issue.
Dr. Beller: We'll come upwards dorsum to this toll number later. Let's focus for the fourth dimension existence on the policy as well as politics. Lots of people are proverb that the authorities can't do anything right. If they run healthcare they volition screw it up, too.
Dr. Pandey: Again, that is only a scare tactic. We should enquire those people if they are living inward the best province inward the globe or not! WE are the government. If authorities is non good, nosotros remove hold made it that way. I hateful the federal authorities is 1 of the biggest employers. Many of us Americans are working there. Now if nosotros state it is unproductive system, thence nosotros are basically proverb that many of us are no goodness as well as are wasteful.
I also shout out upwards nosotros vanquish upwards the authorities for everything. Let me enquire you lot this, which of the next has given demonstrated spectacular functioning Enron, AIG, WorldCom, the Big three auto makers, private wellness insurers? I remove hold seen the private sector upwards unopen as well as personal. I am non certain if their functioning is anything to boast about..
Dr. Beller: So, are you lot proverb nosotros should remove hold a authorities controlled healthcare?
Dr. Pandey: No, that's non what I'm saying! I remove hold expressed my ain ideas inward bits as well as pieces on my blog, the Healthcare Transformation.
When it comes to healthcare reform, what I catch instantly is to a greater extent than of a patchwork existence done. It is non a reform nib as well as it is non a healthcare for all bill. Instead, it's a "healthcare for to a greater extent than bill"... to a greater extent than people as well as to a greater extent than money. Secondly, in that location is every bit good much finger pointing as well as distortion. That's because our scheme is built upon adversarial forms of competition. Unless you lot create a constabulary where no 1 tin render misleading information, insurance companies, the AMA, hospitals, large pharma, as well as medical device manufacturers remove hold the ability to derail the whole matter through blame shifting as well as misinformation. Remember the ads inward 90s against healthcare.
For whatever healthcare reform to work—which I would rather telephone telephone "healthcare transformation"—we postulate to create a scheme that takes into trouble concern human relationship the needs of everyone, including patients, doctors, insurers, etc. This tin last done yesteryear creating a competitive collaboration.
Dr. Beller: What do you lot hateful yesteryear "competitive collaboration?"
Dr. Pandey: In a traditional sense, when nosotros compete, nosotros non alone essay to do better, but also nosotros essay to wound the competition. Creating a world selection to compete amongst private sector insurers could do that. There's some other way to spell the market. Let authorities last to a greater extent than focused on wellness care. The PCPs [primary attention physicians] would serve every bit wellness managers, that is, they would focus on managing their patients' health…keeping them good as well as making certain they learn the right attention when sick. There should utilisation evidence based guidelines as well as utilisation functioning metrics, such every bit a wellness index, that measures attention character as well as cost. And the insurance industries could render the supplemental insurance.
In that way nosotros are non competing, but complementing the marketplace needs. This is what I telephone telephone competitive collaboration. You piece of job together to succeed yesteryear leveraging each others strengths. Not yesteryear undercutting each other.
Strategy
Dr. Beller: Back to the coin issue. If nosotros do what you lot said before as well as define the finish of healthcare transformation, volition in that location last plenty coin to pay for it? Where volition that coin come upwards from?
Dr. Pandey: Of course of teaching in that location is. Let's start amongst administrative toll for insurance management, the toll of treating over a 1000000 avoidable injuries, malpractice premiums, over-testing as well as excessive treatments, under-utilized capital, as well as thence on. In addition, insurance direction as well as profits add together upwards to 30% of the premium payments, compared to 3% that Medicaid as well as Medicare spend. There's plenty of error as well as inefficiency to conk around as well as hospitals remove hold every bit good many managers as well as bureaucracy, which agency in that location is huge chance for productivity improvement.
Additionally, I heard this guy on CNBC panel give-and-take state that if you lot tin create a wellness plan as well as cut people's weight to pre-1991; it volition salve nearly a trillion dollar. I am non certain where he is getting his numbers from; but in that location is at to the lowest degree conceptual validity to his argument. He was also quoting nearly some written report that a Japanese ethnic grouping is twice to a greater extent than probable to learn cancer inward USA than inward Japan. It's due to our eco-system as well as life style.
So, I shout out upwards coin should last the to the lowest degree concern. What nosotros postulate is to define clear strategies. I bet you lot could accomplish all the objectives as well as nevertheless salve some money.
Dr. Beller: How do you lot propose this last changed inward society to create an efficient healthcare scheme that works?
Dr. Pandey: The people working inward healthcare scheme cannot alter it. It is non nearly their competence, it's nearly a scheme that has learn incredibly complex. We remove hold to redesign the system.
I hateful healthcare is a human relationship betwixt doctors as well as patients. You improve their productivity yesteryear using nurses as well as technicians. Then you lot mightiness add together some diagnostics equipment. Would you lot non shout out upwards everything else is a waste? It is a simplistic thought to brand a point. However, what I hateful hither is that these are the logics you lot tin utilisation to catch what should last the toll of an ideal system. There's your benchmark then.
Dr. Beller: But wouldn't productivity last to a greater extent than greatly improved if those doctors knew how to deliver the most cost-effective attention as well as were rewarded for doing so?
Dr. Pandey: Yes. That is the argue I was talking nearly creating a novel scheme that incentivizes the right behavior. And nosotros postulate to pass resources on research. You know that nosotros do non remove hold plenty data to individualize medicine. We launch a production as well as oft times nosotros discovery months later on that it needs to last taken off the shelf. Why are nosotros failing? Where are nosotros failing?
A major burden is non on doctors, but on the pharmas. They should last doing their inquiry properly. Doctors prescribe based on what they remove hold been told. So a ameliorate correlation betwixt medicine as well as an private volition improve the attention delivery effectiveness. I shout out upwards though it is long way away.
Dr. Beller: What nearly wellness information technology as well as informatics?
Dr. Pandey: They remove hold a large role. However, these are alone platforms. Unless nosotros changed the procedure as well as behavior, the information technology volition alone accelerate the bad things. I remove hold been a large critique of most of the products existence sold today. I was glad to catch lately an article where Dr. Blumenthal's business office was quoted every bit proverb that the electrical current EMRs are non upwards to the measure since they do non accept into trouble concern human relationship of the needs of the stakeholders.
In my view, these products are piece-mealed together. In a sense, they were developed as well as thence people tried to check them to encounter the healthcare industry's needs rather than agreement the needs as well as thence developing the software. There are lots of horror stories nearly implementing computer science products. To last fair, nosotros also postulate to improve the character of processes as well as projection management. We volition succeed if nosotros showtime focus on edifice the procedure frame piece of job for healthcare delivery as well as management. And thence create information technology products to automate it. Right instantly nosotros only conk along on adding functionalities inward existing products as well as it keeps on getting worse as well as worse.
Take the illustration of EHRs as well as PHRs. Why do nosotros postulate ii systems? It creates unnecessary confusion as well as duplications. Personal health, every bit you lot know, is a combination of genetics, medicine, habits, environments, etc. So if the solution to wellness is a holistic approach, thence why non create systems that back upwards the holistic needs.
I shout out upwards a non bad scheme that tin last implemented amongst relative relaxation as well as tin last developed inward nearly $1 billion or a fleck more. Over $20 billion existence allocated yesteryear the white identify volition terminate upwards inward the same hands that remove hold spent years to railroad train a non-workable system. They are smart, but they do non know how to exit of the maze that has been created. information technology civilization of production evolution isn't suited for production pattern for healthcare manufacture due to its critical nature. They postulate to convey some exterior experts to aid railroad train their products. When MS Window crashes, it is non a large deal…but you lot do non desire those kinds of issues. Our information technology scheme has to transform its ain mental attitude towards production quality.
Dr. Beller: How would you lot summarize what should happen?
Dr. Pandey:
- Create a clear Definition of ideal healthcare system. And create strategies around that.
- Create a civilization for good for you lot living.
- Improve the character as well as efficiency of medical research.
- Demand a toll reduction of over 30% across the sector.
- Create a tiered scheme of coverage...basic provided yesteryear authorities as well as advanced through private insurance.
- Implement a novel scheme for handing malpractice claims.
- Scrap the entire wellness information technology scheme as well as recreate...it volition salve tons of money.
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This concludes the showtime component of our discussion. Check dorsum for more.