“We’ve got a problem.”
That was the opening line to a presentation I made to a room of brokers, advisors, consultants, employers, and clinic management companies gathered at a worksite health clinic conference in January 2020. Though I proceeded to outline a host of health benefits issues facing self-funded
employers, my message was really directed at their advisors and the clinic management companies operating the onsite/nearsite health centers serving their employees.
My message: if you don’t stop playing the status quo, low-value, me-too, race-to-the bottom, game with your health benefits services and instead focus on higher value, lower cost, outcomes-driven solutions, you are going to be replaced.
For those of us spending lots of money to provide health benefits to our employees, frustrations are high. Very high. We’re tired. Tired of the costs. Tired of the complexity. Tired of the obfuscation. Tired of the broken promises. Tired of the annual message that our health benefit costs or premiums will be increasing 10%, 15%, or 20%-plus, with no additional value or improvement of health for our employees. Tired of being told that all we can do to combat those increasing costs is shift more cost to our employees, remove benefits, raise deductibles and co-pays, or somehow restrict access to care.
If you’re like me, you’re asking, “Can’t we do better?” Some might think, “Maybe not,” thanks to headlines reporting on failures like Haven, the joint venture formed by industry titans Amazon, Berkshire Hathaway, and JP Morgan Chase, to combat the issues outlined above. As the venture was dismantled, many thought, “If those massive, well-funded, companies can’t do better, who can?”
More than 150 years ago, French poet Charles Baudelaire wrote, “The greatest trick the Devil ever pulled was convincing the world he didn’t exist.” In many ways, we are living a similar ruse as we look at our $4 trillion health economy and believe there is nothing we can do to change it.
We have been convinced that the seemingly intractable problems affecting our healthcare system are beyond our ability to influence and that we must simply grin and bear its costs and inefficiencies, year after year after year. Well, don’t believe it. We can—and we are—doing better. The movement toward change is happening all around. New ideas. New approaches. New players. New technology. New energy. We’re slowly claiming territory for the change we need, and we, as employers, strategists, advisors, and innovators, must capture, document, and share successes, ideas, and encouragement.
We don’t have to reinvent everything; we just need to reimagine how we engage with and utilize the existing system to remove excess costs while increasing value. Then we need to be willing to do the hard work to foster and sustain necessary change. First within our organizations, and then within our communities. It’s already happening. Best of all, these new ideas don’t have to be high risk, bet-the-farm, all-or-nothing, gambles on the unproven. There is a progressive, more incremental, path. It just takes some vision, some patience, some trust, and some resolve.
Stewardship is a Point of View
First we must understand the barriers holding us back and the real problems we’re facing. Then we need to adopt a point of view that serves as the guiding philosophy toward how we resolve them. For us, it comes down to stewardship.
- Most of the myriad issues with our healthcare system, how we pay for it, and the results it produces, can be bucketed into three categories: access, cost, and complexity. These are simple buckets with serious challenges and no simple answers.
- Our healthcare system will not be “fixed” from the top down. We will not solve the deficiencies through regulation or consolidation, but through innovation that happens bottom-up, through localized efforts in smaller, targeted populations.
- The “fix” must incorporate existing systems but they will need to be enhanced with innovation and reimagined in novel combinations – technology, process, and thinking. We need to think in terms of the “production of health” rather than simply reduced costs, regulation, or single-threaded technology solutions.
- The production of health is an act of stewardship – of ideas, of technology, of resources, of organizations, and of systems; all of which are necessary to create better overall outcomes in health, cost, and experience.
- Healthcare system innovation will be led by self-funded employers and unions leveraging existing pieces in novel ways while simplifying and unifying the healthcare experience with technology.
Full of Possibility
These are exciting times, full of possibility. The challenges remain and the mountains are high, but the rewards are worth the effort. There are many great options available to address the myriad issues. Start by believing you have choices. Don’t get frustrated by the noise and obfuscation, those are just signs that it’s time to pivot. Recognize the noise for what it is: resistance. Resistance to change. Resistance to innovation. Resistance to anything that might reduce control or margin. Remember, the resistance always uses the same tools to maintain the status quo.
You’ve probably heard some of these before: “No you can’t,” “That won’t work,” “The contract says so,” “That report will cost extra,” “That’s proprietary,” “I don’t know,” or “That’s their fault.” These negative, closed, grasping, and controlling, answers almost always point to systemic points of control that maintain the status quo and cost you money. It’s time for something different.
We can do better. And we are beginning to see it.
