Steve Jobs, the visionary of Apple computer just recently retired as CEO for health reasons. If you know the history of Apple, he was fired from the company at the age of 30, started two new companies called NEXT (later purchased by Apple for their later operating systems) and ) PIXAR, the company behind Toy Story and introduced the world to computerized graphical cartoons.
Behind this was vision, drive and money. Under Steve Jobs, Apple has invented new categories of stuff that just works as advertized. He simplified ideas and took existing ideas such as tablet computers which were bulky and simply, awkward and created the Ipad (word has it that the ipad was in the idea stage before the Iphone). The Ipod took the mp3 player to a new place where everything you needed in music existed in the Apple universe and it just worked. Apple computers had a great interface and once you knew the operating system, the apps just worked and worked well, because of high scrutiny. The Iphone followed the same path through Itunes and applications (another idea that had been around for years but until the iphone, never took off), became part of our culture.
What is wrong with healthcare and how would Steve Jobs fix it?
Healthcare is full of people who think inside the box. Being a healthcare provider, nothing is more frustrating than seeing a patient spend thousands on a problem that can be solved easily after having someone apply treatment to a problem that is understood and that just works. How many people do you know have been to health care providers for a problem, been pushed from doctor to doctor, therapist to therapist for a problem and still had the problem, except after having stuff done to them including surgeries, still did not feel any better?
Healthcare is also full of people adverse to true change because those who are making huge profits from within the system do not want change. Why would you, as a business person want to damage the moat that protects your business model. The idea of curing cancer comes to mind when I say this because a cure for cancer will outmode billions of dollars of equipment used to radiate, extract and chemo people at a cost that is outrageous, with results that are not so great but with side effects that are. Sloan Kettering would not want to find that cure. And so it goes…
At the risk of being offensive to those who are defensive, and with Steve Jobs having free reign to see what really works and what needs to be working better, what would happen if he had a purely objective panel of health care providers, from all sorts of backgrounds including medicine, chiropractic, osteopathy, acupuncture and created a new model that just worked?
Things that need to change
1. Multiple healthcare companies with multiple rules and ways to say no to medically necessary treatment. Medicaid needs to go because simply, it pays doctors too little and the other companies and those without insurance are gouged to make up for the loss of revenue. That is just plain dumb. This is why people with Medicaid go to the emergency room, at a high cost; few doctors will take it.
2. We need a national healthcare system run like a private company, with a global budget, that is non profit.
3. We need to change the healthcare paradigm so doctors again can use their hands and their minds to diagnose like we did 40 years ago, before the tests arrived such as MRI. These are huge cost drivers, yet offer limited benefit when ordered to just find out. Doctors need to better understand the musculoskeletal system, since it comprises many of the symptoms that seem like organ system dysfunction and many of the tests could probably be eliminated if they were sent to the right healthcare provider first, saving the system billions. Those who are in medicine may not entertain the idea very well that chiropractors are good choices because of the way they are taught to think.
4. We need everyone in healthcare to be in network, but to be reimbursed fairly for the work they do. Currently, many healthcare providers in network are underpaid and many out of network charge egregious fees. This creates a non level playing field.
5. Rehabilitation needs to have a lower co payment than a typical specialist visit, that you see once. Someone with a $50 co pay is not going to get their needed treatment 3x per week if they make an average or above average American salary. Horizon Blue Cross Blue Shield finally realized this and lowered co payments on these services to $30 for chiropractic and physical rehabilitation, because it costs less to rehab it than to replace it.
Rehabilitation needs to be rethought as well because much of it is under today’s symptom paradigm. Simply explained, an elbow problem often is created by problems in the shoulder, core, feet ,body style or more. Looking at the elbow only is a waste of time and healthcare resources. The same could be said of the knee. Billions are spent on knee problems, for MRI and surgery and rehab, and it is all directed at the knee, yet the problems usually exist both above and below it, and the knee takes the brunt of it.
6. The symptom paradigm is not working, and as people age and we have ignored their problems with readily available medications for pain, inflammation and stomach complaints most health providers do not understand, we age, those joints go bad and then at huge costs, replace the joints. We need a paradigm that looks at function, and understands the problem, rather than dumbing it down by following a flow chart of symptoms.
7. We need a national data base of records for everyone, accessible by electronic health record systems (EHR) that runs on simple systems with simple input that does not overburden the doctors who use it. The ipad comes to mind as the killer vehicle for this.
8. We need to rethink drug advertizing. On television, they create new categories of conditions, and the patients ask for the product by name. The side effects and the lawsuits that follow are not inexpensive, but the name brand drugs are and we expect insurance to pay for them, even though the idea of a chemical change for a symptom we do not understand is not scientific, it is just loosely based on science and in the end, it does not fix anything.
9. We know when it is appropriate to save a life, and have data that shows when the inappropriate resources are put toward doing it that the life will be short, the family will be traumatized and millions of dollars in healthcare resources are squandered. We also know we are all going to be around for a period of time and eventually, we all go. We need a healthier alternative to forced feeding of a terminally ill person who is either miserable or being tortured by lifesaving methods with little chance of working, but is done anyway. We need more sensible alternatives for people who are in their last days, and we need to even let them die at home where they may be the most comfortable.
10. We need decisions based on the needs of the patient, rather than the needs of the system. A good example of this is the new medical home concept. This attempts to limit the roll of providers to who would be best for which problem. The problem is that it is controlled by the people who gave us the same messy system, the hospitals and the doctors who now have a smaller pie to slice into. This is like having the old president of Bank of America who was at the helm of one of the greatest banking disasters fix it, after it was all said and done. Simply, nothing changed and bonuses flowed as usual.
Healthcare deserves to have different ideas, without a stake in its own philosophy such as chiropractic, osteopathy, physical therapy, allopathy and walk away from its own dogma to solve the problem looking at the way forward, seeing a bigger calling than to stick to your simple roots and to use what works cost effectively.
11. We need to stop making people scared about their own demise and using this as the basis of preventative care. Fear is used in politics, in healthcare, and in other areas as a motivator. It needs to stop because people make expensive and unreasonable decisions when faced with unreasonable challenges such as their own mortality.
12. Malpractice reform – We have way too many attorney’s trying to eat, and more are on the way. Attorney’s serve a need, however, certain things like childbirth do not come without risk. We need to rethink the whole concept, however, reforming the healthcare paradigm will also improve the safety of healthcare. Getting it wrong with unsafe drugs is expensive!
13. We need to revisit the idea of prevention, and what it is. In my office, prevention begins while our patients are young. We look at their build, their body style and determine who requires inserts in their shoes which can help prevent knee, hip, and back problems later in life. Some vaccinations have shown they are good preventative policy. The jury is still out on the flu vaccine and yet others, have been taken off the market (remember the tick vaccine, lymerix?).
The Steve Jobs Challenge… How to refine our expensive and inefficient system of healthcare.
1. ICare… Catchy name, isn’t it. What if this was the name of the new Medicare system. Forget about the social implications, but care from cradle to grave with one difference, it is cost controlled by introducing a better paradigm that just works.
2. Ipad EHR – Imagine, your doctor comes in to visit you, and your full record is on an 8 x 10 pad rather than a file that is ungainly in its size. Tests are icons on the screen and pop up instantly. During the visit, the doctor while speaking with you, and a few touches of the pad makes a referral, sees your MRI from the other doctor you saw earlier that week, puts in his exam findings real time and if you have an appointment with another specialist that week, the other specialist can pull up the same records from a data base in the cloud.
3. Iagnosis – Traditional diagnosis of symptoms and tests have been replaced with the doctor listening to you, since it is now less profitable for doctors to simply do tests and procedures, and more profitable for them to spend the time with you to diagnose the problem properly. Doctors can spend an hour and be paid by Icare for the hour, because it costs less than the tests do and yields more cost effective care. The definition of primary care is expanded into acupuncture, naturopathic doctors, napropaths (some of these names were eliminated or marginalized by the American Medical Assn. who succeeded in containing and eliminating their existence years ago in the united states), chiropractors, and traditional medical providers. The model is turned upside down and medical providers begin learning a more functional and systematic system of diagnosis that requires fewer referrals and overall costs less. Former surgical specialists have gone back into primary care because that is where the money is.
4. Ihab – Going away from the former philosophies of rehabilitation, rehabilitation is now geared toward fixing the problem, and active evaluation methods find and efficiently tell the provider where the problem is and how to treat it. Rehab becomes more than doing stuff to it and is now about scientifically understanding the problem and resolving the dysfunction, cost effectively. Care is active and includes exercises when the region can finally support gravity, not prior.
5. Hospitals no longer live or die because of location. Since Medicaid no longer exists, and everyone has Icare, cradle to grave care exists for everyone and even those who visit the emergency room. On the other hand, having a better paradigm means hospitals need to reinvent themselves, since many conditions may go to hospice, or as more people elect to die at home (with icare helping with the expense, of course), they will need fewer beds. Having cancer finally cured caused the demise of some vaulted institutions but alas, people eventually will succumb to something else. Remember Disney’s “Great Circle of Life”.
Further, the trip to the ER will still be the same, but since the ER is now properly funded because of Icare, the rest of us will now pay less to visit it.
Future hospitals will be also built with efficient care in mind, however, since there will be fewer surgeries, the hospitals will need fewer beds.
6. Ihealthcloud becomes the new cloud based service that helps doctors to coordinate care, eliminating duplication of tests and services from provider to provider.
7. Side effects of Icare – doctors’ offices have fewer employees because certification and traditional HMO referrals are no longer necessary. Hospitals have streamlined as well for the same reasons. finally, healthcare is no longer expanding because the system just pays the facilities and a more honest system has arisen that pays for the services it provides with one biller, one payer and electronic records that make sense, and remove the excess burden from the provider. Healthcare is better, more streamlined and safer because of iagnosis and healthcare just works.
What do you think? As always, I value your input.
Read my new book, Cheating Mother Nature, What you need to know to beat chronic pain available on Amazon.com and on Createspace.com.