A Shared Threat to Health
Let’s face it, we’re all now in the business of healthcare. If the pandemic has taught us anything, it is that we are completely united in the health-related threats that persistently assault us. As a society, healthcare has become the $4 trillion dollar monkey-on-our back; a reality that is inescapable, maddeningly complex, and fraught with near and long term implications. As companies, we wrestle with what has become one of the top expenses and risk-points for our organizations, large or small. As individuals, we face our own mortality in the things we choose through our lifestyle and those visible and invisible biological threats conspiring against us and our families.
COVID has revealed that threat to health is the great equalizer of our time as it has ravaged us economically, physically, emotionally, mentally, and socially. Through this pandemic, we have all found fear, uncertainty, frustration, and anger. No one has been left untouched. COVID vaccination or not, none of us has been or will be immune to all of its effects.
And yet, this pandemic reflects but a fraction of the health threats facing our society. We are painfully aware of the biological threats but we now begin to understand the threats from cracks in our delivery system, how we fund care, how we access care, how we care for ourselves, and even in our philosophy of care. We’ve also begun to see the bad behavior brought-on by these threats as opportunists have taken advantage of the fear and money thrown at the pandemic. Yes, some are charlatans but the chief beneficiaries of the ongoing threats have been corporate and social institutions that form much of the backbone of our healthcare industry.
Besides shareholders, who hasn’t shuddered or gagged a little when they’ve seen the headlines of huge insurance companies pocketing hundreds of billions of dollars even as the threats and struggle go on. Yes, we are all in this together as the threats are very real for all of us. However, there is something fundamentally wrong with our system when a few entities disproportionately benefit from the struggle without bringing corresponding value. Our market-based system cannot sustain itself when profit is harvested where balancing benefit it not accrued. We need to reimagine the institutions we’ve relied upon and the system in which they operate. There will soon be no choice.
Many hope that government will solve our health-related problems, a view that becomes more and more difficult to imagine as we assess the governmental reaction to the pandemic. We’ll be studying and unpacking the last 2 years for many years to come, finding all along the way, the limits of our massive bureaucracy to responding quickly and efficaciously to such threats. Perhaps we’ll find the secrets to a centrally-controlled solution that works well. Perhaps.
In the meantime, we have the threat of a healthcare system that is not working well for most Americans, hiding in plain sight, and arguably complicated by the government interventions that we now have in place. A threat that has been growing for years and threatens to consume greater and greater portions of our economy even as we face more and more threats to our health. In many ways, we are mired in our own tracks, spending ever greater resources trying to make this road work when a new one might be much easier.
We’re All in the Business of Healthcare
The threats are real and we can’t see most of them. However, we can see the cracks and we understand that there are huge implications for all of us. To modify a G.K. Chesterton quote: We’re all in the same boat called U.S. healthcare and we’re all seasick together.
A major enemy of finding a solution is to complicate or broaden a problem to the point of intractability. Trying to boil the ocean of healthcare problems we face is the path to frustration. We need to break the macro into the micro and focus. This is where sponsors of self-funded health plans have a real opportunity and responsibility. Change has to begin with those paying for services, it has to begin small, and it has to produce wins (even small ones) quickly and continuously. We can’t wait for the right legislation, mandate, administration, consultant, weather, or lunar alignment. We need to focus. We need to act. And we need to do it now.
Science of Data
The first major problem for employers working to address healthcare cost and outcomes disappointments is sheer complexity. The universe of health benefits and healthcare delivery is massive, complicated, frequently hidden, and always moving. In this world, even starting small can be challenging. Where do we begin? Start with your data.
What are the facts of our situation? What are we spending? What are our employees suffering? Where are the problems? The first step to getting off the water that is making us seasick is to get on dry land – data is our terra firma. Data gives us the opportunity to find understanding and understanding is critical for us to set our direction. Knowledge derived from our data serves as the truth that we can reference for the moves that we need to make. With it, we can orient ourselves in our current situation and then baseline for future comparison.
We need to be careful here. Not all data are equal. Not all data are accurate. Sometimes, the system dumps too much data on us. Wisdom is needed to discern the right facts in the proper context. Proper understanding stems from good data correctly interpreted.
In The Patriot, Benjamin Martin counsels his sons to “Aim small, miss small.” Good data, properly interpreted, enables us to find the small wins we need to build momentum. It is only with momentum, persistent forward motion, that we can begin to have an impact on the bigger issues. The broad puzzle comes together one piece at a time.
The data points us toward the opportunities for improvement. In healthcare, the opportunities center on individuals and the unhealthy things they choose or suffer. Some can be impacted, some cannot. We need to find the places where we can influence better results and lower costs. We need to find concrete points of potential impact.
Art of Medicine
Why did so many healthtech and healthcare startups experience massive value loss in late 2021? As much as we want to productize healthcare delivery or capture silver-bullet solutions in an app or portal, the fact remains that health and medicine remain highly analog. They require the hard work of dealing with patients. Data, facts, and technology are useless unless they are pointed at the right problem and enable the highly analog activities required in taking care of patients.
Our data science must enable us to focus on the right people and the right problems in the right way. As employers, we may think: “We’re not in the healthcare business so we’ll just insert dollars and let someone else take care of it.” For many of us, that thinking is not working very well. Costs continue to rise and our employees continue to become less healthy. Perhaps we can’t control healthcare or our employees’ choices, but maybe we can have more influence.
To be useful, the insights we find in our data need to point toward something actionable. Here, things can get complicated again. When it comes to health and action, we quickly cross into healthcare. Healthcare centers on medicine and this brings us to the point of influence and another place of mystery. For most of us, medicine is mysterious and magical. It requires knowledge and understanding of another sort, a sort demanding years and years of training. As employers, we wash our hands and leave it to the experts.
Many might argue that medicine is science and that is true to the extent of the known. However, there is so much that is not known and the pandemic revealed something else about threats: they require critical thinking at a level that may not have existed before. When a problem is revealed that has not been broken-down into an algorithm, we need masterful problem solvers – those who can take the known and apply it to the unknown in novel ways. Great thinking may lean upon known science but great problem solving is far more art.
Aim small, miss small. To get to big impact and big change, we must start small. Small wins, in series, create momentum and momentum enables us to play the long game of better health and lower costs. Change will take a long time. Our efforts need to center on influence. Our efforts need to build a bridge to the art of medicine that has the power to effect better results. Not just the blind medicine afforded to us by a summary of benefits delivered after the fact but the kind in which we participate.
No, as employers we will never lay-on-hands to directly heal nor do we need to know that Jane has a particular disease. However, we do need closer contact with the process. Many get this intuitively, that is why onsite and nearsite health centers have proliferated over the last 10 years. We want influence. We want to be closer to that art we call medicine. This is where the small wins live. First we help the individual. Then we help a group of individuals. Someday, we might help all those who need it. Along the way, we are helping ourselves and our company.
Heart of Stewardship
And there we have it: the heart of stewardship. A place in which we’ve aligned the call to do the best with all of our gifts, and with the responsibilities given to us, with the action necessary to fulfill them. With data, we can understand. With medicine, we can influence. With stewardship, we can fulfill the mission. Remember, these days, we are all in the business of healthcare. Good stewardship is about action.
And why not? Why can’t doing good through our business be good business? Why can’t serving the health and wellbeing of our employees also serve our profit motive, shareholders, or market strategies? The truth is that we know it can. We love to demonize the faceless corporations, government agencies, or bloodless firms feeding on all of it but the reality is that every institution in our country is led by human beings. Sure, they may hide behind the corporate edifice but an individual, or group of individuals, are making those decisions. You and I are making those decisions.
Good stewardship isn’t just feel-good altruism. Good stewardship feels good because it occurs when we do our best with what we’ve got. It feels good because it is alignment with something greater than just self-interest. When we steward our resources properly, they produce what they were designed to produce. When we steward our responsibilities properly, they create wins for more than just ourselves.
When we’re properly stewarding our gifts, we find an equilibrium where give and take can live in harmony. We neither give to the point of depletion nor aggregate to the point of usury. Here, we find the best of all worlds.
In This Together
The failings and excesses of our current healthcare system are well documented. Legislators are actively trying to address “bad” behaviors with laws designed to curtail practices. Sometimes intentions are good but such legislation is rife with the influence of special interests. More often than not, such laws disproportionately affect one group more than another and frequently promote creative ways around or entirely new mechanisms for “beating the system.”
Legislators will legislate. So be it. However, make no mistake, we are all in this together and the stakes are far greater than the enrichment of a few players. The threat to health is real for each of us and for each of our organizations. There is a fundamentally better way to do healthcare in this country, and there are many working on it. A shift is occurring and many of the rules are being rewritten.
There are many choices and those of us funding plans, choosing partners, and working for the improvement of the health and wellbeing of our employees are in a unique position to cause positive change. Aim small, miss small. We just need to focus on finding the small wins, influencing better results, and sustaining our efforts through ongoing momentum. The little successes will accumulate and, in the process, great shifts will occur.
The board is set and we’re all in this together. It’s time to act.