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All Posts Tagged: Healthcare

We Have Too Much Healthcare and That’s a Problem

On Target Article – Tide is Changing

Robert J. Ault, D.C., M.B.A., CCSP

As a follow-up to the article I wrote, in the last issue of On-Target, regarding healthcare and technology, Amazon, Berkshire Hathaway, and JPMorgan are now joining forces to take on the healthcare industry.  The CEO’s of these powerful companies, Jeff Bezos, Warren Buffett, and Jamie Damon have publicly stated that they vow to use “technology” as their main method for solving the healthcare riddle.

I have to again, reiterate my position from my last article, which is… technology is not the answer to fix our healthcare system.  There is no doubt that Bezos, Buffet, and Damon are the titans of their industries, but retail, investing, and banking are not healthcare and thus technology alone cannot solve the healthcare industry. 

Let me ask any of you practicing chiropractors who’ve ever switched over to Electronic Health Records from paper charts.  Did your EHR raise your expenses (cost of the software, data management, PC’s, IT professionals) even though you were promised that EHR’s would lower your costs?!  Exactly.

Sure, healthcare is a messy industry, and yes technology can increase some efficiencies in our offices, but a main driver for fixing the ballooning costs of our healthcare system, technology is not.  I would make the argument that the healthcare industry would better be fixed if there was just “less” of it. 

There is too much healthcare in this country, and that is a problem.  A value-driven approach has the potential to fix this broken system.  On the surface, what I just said may sound crazy, but read on and maybe I can convince you.

Americans filled a record 4.5 billion prescriptions in 2016, that is nearly double the 2.4 billion filled in 1997, according to Consumer Reports.  Did disease in our nation double in the past 20 years?!  The answer is of course no.  What we have on our hands is a crisis of what is appropriate for a patient.  Consumer Reports stated that more than 50% of all Americans are on four or more prescription medications.  This is a sign of how entrenched our problem has become.  Our nation has created the “medicalization of daily life.”

I have no doubt that Amazon, Berkshire Hathaway, and JPMorgan can easily influence and lower healthcare costs, by negotiating lower bulk pricing and reducing supply chain costs.  I can also easily see them muscling out the pharmacy benefit managers, and insurance middlemen to lower the costs of prescription medications, but the real question should be… Do people even need these medications?  As chiropractors, we already know the answer to this question.

We cannot forget that medications cause health problems as well.  The opioid crisis just happens to be one of the many expensive and deadly problems that have developed due to overprescribing and thus “too much healthcare.”

If Jeff Bezos wants to be a true innovator and disruptor to the healthcare industry like one very famous disruptor, B.J. Palmer, then he needs to start listening to the healthcare providers that are on the frontlines of this battle in his own state. 

According to a new detailed report provided by 21 Washington state physicians, who are part of the non-profit, Washington Health Alliance, 45% of the healthcare services that were provided were, upon examination, determined unnecessary.  It showed that 600,000 patients in Washington underwent medical services that they did not need at a cost of $282 million in one year.

When these costs were broken down, examiners found that 22% of prescription meds, 25% of medical tests, and 11% of medical procedures were unnecessary. 

Let us not forget that the 3rd leading cause of death in the U.S., behind heart disease and cancer, is medical care.

For years the question has been, “How do we pay for the broken healthcare system?” Perhaps the real question should be, “How do we fix the broken healthcare system?”

The answer I would start with would be to expand payment models for rewarding those health providers that are delivering high-value and low risk healthcare options to their patients, and not just dishing out “more healthcare.” 

If there was only some type of healthcare discipline that existed in our country that was high value, extremely low risk, and much less expensive than traditional medical care…

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High-Tech Healthcare: Don’t Believe the Hype

Will advanced technology transform and therefore save the American Healthcare System?  Will fancy wearable devices, mobile apps, and patient tracking software make Americans healthier?  Don’t count on it.

Silicon Valley experts are seeing a future in which doctors and patients alike are tracking health conditions in real time to ensure healthy habits and compliance with medicine and therapy treatment protocols.

Does all this sound too good to be true?!  Because it is.  High-tech will indeed change the practice of healthcare, but more by augmenting current norms, not revolutionizing it as predicted by tech gurus.  Sure, computers could make radiologists and pathologists obsolete by better interpreting blood labs, x-rays, CT and MRI scans, and pathology slides than humans can do.  Super computers can easily digest billions of data points much more easily than humans and thus can make a more accurate diagnosis for an ailing patient and in less time.  But is this the real problem with the American Healthcare System?  The answer is no.

America’s currently unsolved healthcare crisis is how to change the behaviors and attitudes of the American patient.  According to the Centers of Disease Control (CDC), 86% of all U.S. healthcare spending is for patients with chronic illness such as:  heart disease, diabetes, emphysema, arthritis, etc. 

How are we to make real solutions for these problems?  We need to drastically lower the number of Americans who suffer from these diseases by getting them to change their habits and lead a healthier lifestyle.  This lifestyle should include eating a healthy diet, exercising, not smoking, engaging in conservative pain management protocols such as chiropractic instead of opioids, and engaging in healthy stress management protocols.

Current studies suggest that no matter how fancy or ingenious the newest gizmo is, high-tech interventions have absolutely failed to improve patients’ health.  In one 2016 study in the journal, Lancet, researchers at Duke-NUS Medical School randomly assigned employees from 13 organizations to one of four groups, in an effort to encourage exercise.  One group got a Fitbit Zip tracker, two other groups got a Fitbit Zip tracker plus money that they could use for themselves, and the last group got no tracker.

Do you want to guess what happened?  The study found that the device increased moderate-to-vigorous activity by 20 – 30 minutes per week for the first six months, but only when cash incentives were in play.  When cash incentives were discontinued, physical activity returned to pre-intervention levels.

Again, technology is fantastic at aggregating data and turning it into useful information, but a lack of data is NOT the main challenge.  The real challenge lies in changing patients’ behaviors and habits before a health problem is even identified.  Prevention is key.  And as behavioral economics reminds us, information does NOT change behavior.  Smokers know that they shouldn’t smoke.  Obese people know that they should lose weight.  But this requires changing habits and daily routines and unfortunately the current data shows that the only way to change a patient’s behavior in a long-lasting way is by providing financial incentives.

Financial incentives are decidedly not high-tech, but what they are is high-touch and thus will remain the most effective prescription for treating America’s Healthcare Crisis.  Whether it’s by employers paying their employees more money to be healthier, or by insurance companies lowering their premiums for their healthier customers, America’s Healthcare Crisis will not be fixed by the latest tech breakthrough, or by finding the latest cure, but it CAN be solved by simple economics.  Business can be used as a force for good and with over 20% of the U.S. GDP tied up in healthcare, it needs to be.



*Emanuel, Ezekiel J., The Hype of Virtual Medicine, The Wall Street Journal, Saturday/Sunday, November 11 – 12, 2017

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