396. The American Healthcare Puzzle: Solutions and Strategies feat. Vivian Lee

Our healthcare system is a complex dance of costs and inefficiencies, yet it's one we can't afford to sit out. What results have flowed from shifting the cost of healthcare to employers, and how have attempts to change that system sometimes backfired in unexpected ways?

Vivian Lee is a healthcare executive, an Executive Fellow at Harvard Business School, and an author. Her latest book is called, The Long Fix: Solving America's Health Care Crisis with Strategies that Work for Everyone. 

Vivian and Greg discuss the disconnect between healthcare consumers and payers and dissecting the employer-based insurance model. They scrutinize payment models and incentives, discussing the stark consequences of shifting healthcare costs to employees and the resultant avoidance of crucial preventive care. Vivian talks about the financial motivations of health providers versus patient demands, creating a landscape where escalating costs and quality care seem to be in constant conflict.

*unSILOed Podcast is produced by University FM.*

Episode Quotes:

Why we need to know where our dollars are going in healthcare

22:19: I think it's very important that everyone really understands a little bit about healthcare and where their dollars are going. When you look at the graphs, all of us would be doing a lot better if our healthcare expenditures were lower. It's just hidden from us because it's taken out before we even get our paychecks, because our employers are using those dollars that should have been going to our pay raises for the last 20–25 years and using it instead to pay for healthcare costs. I think we need to know it for a number of reasons. One, because we need (we need was deleted in the audio-perhaps restore) the public to move forward to be able to improve healthcare payment policies in this country. We have to act through the way in which we vote. We also need it because we need to understand better our own actions. What of our behaviors are most important for our own health outcomes? And so having a more nuanced understanding of what we can do in terms of our daily behaviors that can impact our own health, I think, would be also really, really important.

The US lacking universal healthcare for everybody is a key factor in its healthcare economy

05:28: In health care, we are responsible for caring for people when they show up to us, and we can't decline people just because they don't have health insurance. So, as a result, we also have this strange subsidization model within health care where we have to overcharge some people in order to cover the costs of care for those who aren't covered.

Money affects change in healthcare

16:49: Any time we want to change the system, it's going to be hard. It is hard because there's already so many dollars in healthcare and there's so many vested interests who, naturally, if they're doing well, want to maintain the status quo. So change is always hard, especially in healthcare, because of how much money is already involved.

How can we maximize the data from digital health systems

37:11: Increasingly, we have the opportunity to use the data from all the operating rooms that are going on in the country and in the world every single day, where we have information about how surgeons are doing things in particular ways with different kinds of patients. We know about the different patients, we know about what the surgeons are doing, and we also know about the outcomes that happen six months, a year later, two years later. We've been collecting these data with our digital health systems for a long time now. What we haven't been doing is using the data to create more evidence to say, "Oh, actually, we really do know that doing it exactly this way with this artificial hip provides really good outcomes," and that would be the evidence that you would need to talk to the surgeon or convince everybody to go to that standard approach.

Show Links:

Recommended Resources:

• RAND Study: Skin in the Game
• KFF Study: Health Care Debt In The U.S.: The Broad Consequences Of Medical And Dental Bills

Guest Profile:

• VivianLeeMD.com
• LinkedIn Profile
• Wikipedia Profile

Her Work:

• The Long Fix: Solving America's Health Care Crisis with Strategies that Work for Everyone
• Cardiovascular MR Imaging: Physical Principles to Practical Protocols
• Genitourinary MRI, An Issue of Magnetic Resonance Imaging Clinics
• Select Topics in MR Imaging, An Issue of Magnetic Resonance Imaging Clinics