In a series of LinkedIn Influencer blog posts, Humana President and CEO Bruce Broussard shares insights and ideas about the future of health care and discusses the importance of working together to improve the health-care system as well as our own health and well-being. His topics range from the powerful potential of technology to the issue of loneliness. His latest, It’s Time to Act on Physician Disillusionment, is reprinted below. To see all of his blog posts, click here.
You’re either part of the solution or you’re part of the problem.”
This overused, one-dimensional rallying cry has been thrown around for years. But it’s not that simple. We often find in life that in order to solve a problem, we cannot look at an issue in terms of black or white and ignore the many shades of gray. In most cases, aren’t we all part of the solution as well as being part of the problem?
Take health care. We have many serious challenges: primary care physician shortage, baby boomer retirement, childhood obesity, you name it. Solving these challenges requires a team effort. If you want to talk about what’s wrong with health care today, be prepared to address what you can do to make it better.
A Welcome Voice
It’s always refreshing when the people we entrust with our health and well-being – physicians – offer their perspectives on not only what we need to do to improve health care, but where they see needed changes within their own roles.
Dr. Sandeep Jauhar, the director of the Heart Failure Program at the Long Island Jewish Medical Center, does an exceptional job breaking down the challenges that physicians face in our country. His article was adapted from “Doctored: The Disillusionment of an American Physician,” a book he recently authored and one I’m looking forward to reading.
In this article, Dr. Jauhar, a cardiologist, provides a detailed, historical analysis of the evolution of the American physician and the low morale and burnout that face the profession today.
What Intrigued Me
Dr. Jauhar spends a great deal of time examining the challenges facing the physician community and his historical analysis also details the positive impact physicians have made on society. For starters, he describes the advances medicine has made in reducing the common diseases of the past. More specifically, he talks about the impact of vaccines and how “once-terminal diseases—cancer, AIDS, congestive heart failure— are turning into complex chronic conditions that must be managed over the long term.”
When you think about the significant progress physicians have made in this area, these advances have given millions of people affected by these deadly diseases new hope. We still have a long way to go when it comes to curing these diseases but unquestionably the expert care from physicians has changed the game.
But how is the new focus on dealing with these long-term chronic conditions changing the health care system, changing the physician’s role, changing society? The economic and emotional burden alone is overwhelming. Where do we go from here? We’re all part of the problem – and part of the solution.
The Primary Care Physician Role
For example, if you think about why some physicians are unhappy, some believe it has to do with the notion that they don’t feel like they’re in control, don’t feel deeply engaged or are actively participating in the entire decision process, and payers can certainly do more to help. Some also speculate that this reflects a high level of despair in the physician community.
Take the primary care physician community. In my conversations with one physician who was also intrigued by Dr. Jauhar’s article, he believes there is a – his words – “significant level of despair” among the primary care physician community. His opinion is that some primary care physicians feel that “my responsibilities are diminished since other people are making decisions for me.”
We need to ensure that these highly intelligent primary care physicians feel empowered to participate; have the accountability they so desire; and are responsible and accountable for their patients’ care and well-being. Participation, accountability and responsibility must be the foundation for ensuring that primary care physicians have the support they need from us to best serve their patients.
What I Need to Do
Dr. Jauhar’s article highlights how the fee-for-service reimbursement system needs to change because the current patient population needs a more holistic-care approach versus one that is transaction-driven. His article also led me to think about comments made by Dr. Henry S. Lodge and Chris Crowley in their book – “Younger Next Year.” In the book, Dr. Lodge also provided a valuable insight into the transaction-driven nature of fee-for-service and the importance of holistic health:
- “I had done what doctors do well in this country, which is to treat people when they come in with a disease. My patients had had good medical care but not, I began to think, great health care. For most, their declines, their illnesses, were thirty-year problems of lifestyle, not disease…Modern medicine does not concern itself with lifestyle problems…Most modern medicine is what lawyers and bankers call transactional: a one-shot deal. You blow out your knee, you have a heart attack, and you see a specialist. A short, intensive period of repair or cure follows, and the parties go their separate ways, probably forever.”
After I read Dr. Jauhar’s article, I began to think about the role my industry plays in health care and my own discussions with the physicians who serve my company’s members. We’re focused on becoming a company that puts the primary care physician at the center of the patient’s care, through pay-for-value models, such as Accountable Care, that help support a holistic approach to better health.
With this approach, physicians are reimbursed for the overall health of their patients and incentivized for outcomes, not interventions. Our industry is making solid progress on moving toward these value-based agreements, but we still have a long way to go. We’ll continue to implement the pay-for-value models because they work.
For example, Medicare Advantage uses the principles of Accountable Care to help millions of seniors get on the path to better health through aligned incentives.
- Accountable Care has demonstrated clear benefits with a reduction in emergency room visits and improvements in diabetes, cholesterol and blood pressure management.
- Physicians moving from the transactional-driven system of fee-for-service to Accountable Care have an ally in this evolution that can provide an insight into an individual’s holistic health: the payer. From value-based payments models to an individual’s claims, payers have the clinical and technological means to help support the primary care physician with a 360-degree complete snapshot of the individual’s health through sharing information in a secure manner.
- At the same time, we can also help primary care physicians transition into a value-based payment model by supporting their compliance efforts for meeting quality measure and clinical guidelines and other Population Health tools.
It Takes a Team
There are other areas my industry needs to prioritize:
The Importance of Empathy – One of the examples that grabbed my attention was how Dr. Jauhar described an encounter with a patient on dialysis who had been informed by another doctor, in an “insensitive” manner, that he had no chance of his kidneys returning to normal.
- Some of us have been in a room with a loved one who has been told devastating news about his or her health. It’s not easy for the patients, their loved ones, or the physician. We must ask ourselves – at every point in the care process – what we can do to better support those fighting a battle for their life.
Let’s Help Physicians – In his article, Dr. Jauhar cites this ER physician’s comment posted on Sermo, an online community of physicians: “Working up patients in the ER these days involves shotguning multiple unnecessary tests (everybody gets a CT!) despite the fact that we know they don’t need them, and being aware of the wastefulness of it all really sucks the love out of what you do.”
- I need to be very clear on this point. It’s not about taking a blanket approach. It’s about trusting the doctor about what tests that he or she feels are · necessary to do–or not do–to help improve the patient’s overall health. If the primary care physician is to serve as the central role player, he or she must be seen as the quarterback when it comes to patient responsibility. They are the ones coordinating the approach to the patient’s health; ensuring that the clinical decisions that are made are done in the best interest of the patient; and, most importantly, feel empowered to manage the care of the patient by doing what they believe is right.
- Investments in information technology are also important because they help make it easier for the physician to have a true 360-degree view of the patient, a critical factor in advancing holistic care. When you look at holistic care, aligned incentives are also critical because physicians are being rewarded for improving their patients’ overall health.
- As I stated earlier, payers like me can help primary care physicians in their quest to experience the benefits of Accountable Care. We can keep helping these primary care physicians move into these arrangements through this holistic-driven approach, combined with a detailed plan to transition to value-based reimbursement.
Reduce – and Simplify – Administrative Tasks – We live in an era of technology that has transformed entire industries. The health care industry needs to step up and let the transformative power of technology improve and simplify the back-office processes so physicians can spend more quality time with their patient and less time on administrative tasks.
- Using electronic submissions for all claims and referrals will be a step in the right direction. For example, Dr. Jauhar talks about how most physicians “said they didn’t have enough time to spend with patients because of paperwork.” Given the importance of electronic health records (EHR), EHRs can potentially enable physicians to streamline the paperwork, thus enabling them to spend more time with their patients.
- Lastly, as an industry, we need interoperability. We can start by linking all of the electronic health care systems to simplify the life of the physician. Too often physicians are burdened dealing with disparate systems. By linking these systems, it’s not only good for the physician, but it also helps the patient (the physician has more time to spend with the patient) and it benefits society because these systems can help reduce costs. Physicians who are engaged and serving as active participants in the process will not only be happier and less disillusioned but the burnout rate will diminish.
Keeping people at home instead of in a home also helps our physician community. For example, leveraging technologies like telemedicine can help people with chronic conditions, some of whom don’t have the resources to travel for care, engage with the physician from their own home. We can do more by creating new programs and expanding existing programs that help those with chronic conditions live safely and comfortably in their own homes.
We are finding that one such program is doing just that. Not only are members telling us that this program, which utilizes in-home visits and personal care managers, is enhancing their health and well-being, but we are also seeing fewer hospitalizations and readmissions among its participants.
We All Have a Role
Dr. Jauhar writes that “medicine is about taking care of people in their most vulnerable states and making yourself somewhat vulnerable in the process.” Regardless of whether or not we work directly in health care, each of us plays a role in improving the physician/patient relationship.
The next time you go to see your primary care physician, don’t just let him or her ask you about your health. Take the time to ask them what you can do to make it easier for them to get you on the path to better health. Listen to them and then take action: eat better, exercise more, reduce stress, spend more time with family and friends…do what is necessary to enhance your own health and well-being.
We must empower our primary care physicians – the quarterbacks – so they truly feel they’re fully accountable, responsible and have the freedom to act in the patient’s best interest. They are in full control of their destiny, plain and simple. If these primary care physicians feel that they’re part of the process, they’re going to help more people get on the path to better health. It’s much better for the patient, the physician, and true engagement from the primary care physician community as a whole.
We can all make it easier on these physicians by practicing what we preach when it comes to good health. By simply making better lifestyle choices, we can alleviate the burden of chronic diseases, many of which are preventable and account for roughly 75 percent of our annual health care spend in the U.S.
Despite all the challenges we face in health care, it’s important to remember that we have the best physicians in the world. They’ve changed the lives of hundreds of millions of Americans for the better. We never want the word “disillusioned” to be associated with the people who care for our families and friends.