The State of Healthcare Part 3: Areas of Opportunity for Healthcare To Do Better
By Craig Beam
Welcome to the third and final part of my series taking a look at the state of healthcare. With the arrival of a new year — and a new decade — this is a good time to reflect on opportunities of the future and where we still have work to do to create better tomorrows for the patients we all serve.
At Petra, we partner with health system and hospital CEOs every day, giving us keen insight into the unique challenges they face and are working to solve as well as emerging trends and new developments that impact how they serve patients every day.
My three-part blog series takes a look at the state of healthcare from three different angles:
The State of Healthcare: Areas of Opportunity for Healthcare To Do Better
There are many exciting developments on the horizon that will positively impact the lives of the patients and communities we all serve. Sadly, solutions to some key issues have yet to come into focus.
Let’s take a look at four areas in which healthcare needs to do better — hopefully sooner rather than later:
1. Consumers lack price transparency. Consumers today know the prices of things they buy frequently. But they’re bad at pricing items they don’t buy often. Until recently, cars fell into that category. Healthcare still does. The rise of high-deductible health plans is changing the game. But the legacy of price posting known as the ”Chargemaster” dates to the inception of Medicare in the 1970s and continues as a major barrier for consumers understanding the true price of healthcare services.
Thanks to the internet, we have a high degree of price transparency for virtually everything we buy. We can compare costs in just a few seconds. But not for healthcare. Today hospitals post their prices as their “chargemasters.” It’s like the sign on a hotel room door that says “The maximum charge for this room is $1,500” — and you’re paying $125! Nobody pays $1,500. It’s the same for the chargemaster. Unfortunately, this is typically the only readily available price for healthcare services.
Pharmacy cash prices can be even more difficult to establish. Many pharmacies entered into “rebate” programs with Prescription Benefit Managers to rebate part of patients’ copays back to insurance companies. This practice leads to many pharmacies being “gagged” from disclosing the cash price, which may be less than the copay. Adding to the problem is the practice of intentionally delaying the introduction of generics, or the occasions where sole manufacturers of a drug control costs. Both result in high drug costs — sometimes exponentially, like with the EpiPen.
The current administration is working to address price transparency by requiring health systems to post the rates they have negotiated with insurance companies. While this is a step in the right direction, it is still often higher than what a consumer can negotiate as a cash price. There have also been calls for new requirements for pharmaceutical pricing and the ban of rebate practices.
Change can’t happen soon enough. So when can consumers count on better price transparency? Stay tuned.
2. Internet misinformation is dangerous and deadly. False health information is not only dangerous, it can be fatal. Yet such information is widely available on the internet, accessible 24/7/365. One tragic example is the 4-year-old boy in Denver who recently died of the flu because his mother consulted anti-vaccination advocates online for advice about treatment. She opted not to give her son doctor-prescribed Tamiflu.
Media coverage online — and, admittedly, offline as well — can also warp consumers’ perception of the “real risk” of illnesses, often leading to unrealistic fears and even panic. The current coronavirus coverage is one case in point. Coronavirus reports dominate the news. But the truth is, the flu is much more common — and much more deadly. Similarly, most Americans fear cancer, but more will die of heart disease.
Health misinformation isn’t just “fake news,” it’s a life-or-death condition for which we must find a cure.
3. Behavioral health facilities are behind the times. Mental health issues are finally receiving the attention they have long deserved. The declining U.S. life expectancy — recently reversed — was, to a large extent, tied to mental health and addiction. As reimbursement for mental health issues is moving toward parity with other health issues, the facilities to deliver mental health care continue to lag. There are, however, several notable movements around delivery that are worth noting.
First, most mental health patients in distress are taken to the local emergency department, which is woefully underequipped to address these issues. Most states have provisions for a “72-hour civil detention” requiring evaluation and treatment prior to release. In a typical ED, this means an emergency physician will attempt to stabilize the patient, and the patient is sent out the door after the hold — without addressing the issues causing the crisis. Several communities have begun to address these challenges through the creation of networks that integrate outpatient facilities with the acute needs, including in Texas and in California, including in Orange County and Los Angeles. These programs hopefully will serve as models for others.
Second, from a design and construction perspective, behavioral health facilities have special requirements. Most prominent is the need for anti-ligature hardware and line-of-sight to holding and treatment areas.
Finally, the need for broader support systems is becoming apparent. Even when someone is stabilized there is often a lack of a support structure to allow them to re-enter the community. In Los Angeles, the National Healthcare Foundation has stepped in by purchasing and repurposing motels as recuperative care facilities to provide a social safety net to assist patients as they re-enter society and continue their medical regimen.
It’s time to make appropriate, available behavioral health facilities a priority. Period.
4. We need to empower data to improve care. Access to data is a research game-changer for improving patient care, efficiently and effectively. Yet barriers to the free flow of data are preventing researchers from harnessing its power and leveraging its full benefits. Data allows us to use real-world experiences to inform research and improve outcomes. However, in addition to technology itself, privacy and policy issues contribute to compounding the challenges of data availability.
The power of data is especially critical in pediatrics, where traditional clinical trial research methods have ethical implications — no one wants their child to receive a placebo. In fact, the National Cancer Institute just launched the Childhood Cancer Data Initiative addressing the critical importance of data in addressing cancer in young people.
In a major move, the National Institutes of Health recently drafted a policy requiring data sharing among its researchers, for mutual benefit. Though many questions remain, it is an important step forward. The final policy is due for release later this year.
Data collection and data accessibility are critical to solving healthcare issues and improving outcomes more quickly and more accurately than ever before. What are we waiting for?
What do you think? When considering the state of healthcare, what other opportunities do we have to do better? Email your thoughts to me directly at . You can also visit our LinkedIn page to comment on our post featuring this blog.
No matter what the future brings, Petra will continue aligning healthcare trends with strategic intent and serving as a strong partner healthcare leaders can rely on to help them adapt to changes in the healthcare and construction industries — to ensure every project meets tomorrow’s healthcare needs.
At Petra, we are true partners with our clients. We’re team players, and collaboration is the name of our game. We’re proud to be trusted advisors who work side by side with our clients. Our entire team is driven by our shared passion to create better, because we believe every patient deserves better. Together we create better every day.