Education, education, education

Rebecca Goozee talks with Skip Irving, Dr. William Jessee and Dr. Francine Gaillour about the current issues facing the healthcare industry.

There are many concerns over the US healthcare industry at present, from the growing population of aging patients to the introduction of electronic healthcare records. Skip Irving, Partner and Managing Director at Health Advances, Dr. William Jessee, President and CEO of the Medical Group Management Association (MGMA) and Dr. Francine Gaillour, Founder and Executive Director of the Physician Coaching Institute, share some of their thoughts on the current state of the US healthcare industry.

Aging patients

There is a large population of aging patients in the US and this number continues to grow. As the largest portion of healthcare spending is in the last two years of a patient’s life it inevitably puts a huge burden on the healthcare system. Jessee points out that in fact there are aging patients around the world, “it is one of those success stories of healthcare – people are living longer and as they live longer they have more chronic illnesses in their aging years.” Irving believes that it is all down to prevention. He states that, “while it is a huge burden, we are doing better than we might have thought in terms of starting to get a handle on that - it certainly isn’t the biggest challenge for the healthcare system today.”

Health insurance

Health insurance is a major issue in the US with over 55 million people having none. What does this mean for the healthcare system? Irving, having said that aging patients are not the biggest challenge for the healthcare system, believes that insurance is. He goes on to say that there are two aspects to health insurance that bring the biggest burden to the healthcare system. The first is that it means no prevention is happening – there is no relationship with a caregiver and there is no opportunity for education. The second aspect is that without insurance when patients need to be treated they are treated in the most expensive setting; they go to an emergency room rather than a primary care office. Jessee agrees, “When they do receive health services it is usually not early enough in the course of the illness, so when they do have an illness it tends to be more severe and tends to require more resources. Since they have no insurance many of them are unable to pay.”

Costs

“Healthcare costs are ridiculously high, nonsensically high” states Gaillour, “unfortunately multiple factors and multiple people are contributing to the problem.” She goes on to explain that everybody wants to “take a piece of the pie” and that there is no incentive for most people involved in the healthcare industry to reduce the costs associated with it, rather there is a perverse incentive as health plans are cost driven. Jessee says, “Every time you listen to someone describing the future of healthcare they talk about immense technological breakthroughs such as genetic medicine and tailoring pharmaceutical therapy, which are going to add more cost. Therefore the real question is, how much society is willing to pay for healthcare?”

Consumerism

Consumerism is affecting the healthcare industry in a big way, and it is affecting how patients view themselves and their physician. Over the past 10 to 15 years a real explosion has happened – people use the web to understand more about care, there has been an increase in direct-to-consumer advertising around drugs and patients have realized that they need to be better self advocates for themselves and cannot rely on solely on the system itself. Irving says, “we have only seen the tip of the iceberg as far as consumerism in the healthcare industry goes. There are aspects of it that are very positive and I believe the solution to the healthcare cost issue is all around education and getting people involved in care earlier.” Jessee, however, isn’t so sure, “for most of the populous, consumerism is only impacting them in terms of increasing their out of pocket expenses. Although, the internet has changed the way that younger people look at physicians and the way they interact with the healthcare industry.”

IT

Healthcare technology is continually improving and can be hard to keep up with. Healthcare executives in particular can be frustrated with the return on investment but should they be? “Although it is very difficult to measure the value of healthcare services and technologies,” says Irving, “the technology advances are critically important and they do have tremendous value in terms of efficiency and in terms of improving patient care.” Gaillour agrees and says that the return on investment is a longer wait. She believes that technology is catalyst for physicians and healthcare teams and can change and improve the way that medicine is practiced. Gaillour goes on to say that technology will automate some workload to provide cost savings but that it also serves as a catalyst and a driver for physicians and healthcare teams to reevaluate how they are treating populations of patients.

Electronic Health Records

North Adams is an example of a community where Electronic Health Record’s (EHR) have been introduced as an alternative other forms of medical record. Jessee comments that, “it proves that with enough capital investment everyone can be on EHR’s. However, it also proves that if you eliminate the economic barrier, physicians will use EHR’s and that it a good thing.” Irving points out that one of the stumbling blocks of using this technology are issues surrounding confidentiality and managing information, however, he is quick to state that despite the risk attached to new technology without it we are unable to move forward. He believes that there is already so much information on him out there in electronic format, from financial information to healthcare information that it just it just isn’t a sticking point for him.

Future

Jessee sees cracks appearing in the healthcare system and believes that there is growing concern about the future of primary care in the US. Jessee points to man power as a big concern for the future – less medical students are becoming general care physicians and more are specializing in order to have more control over their lives. He also counts cost as a huge concern as employers refuse to put more money in to the healthcare system. “I’m pessimistic in the near term and optimistic in the long term. We are in for some rough times but out of those rough times we will likely see some long needed changes that will enable us to provide better healthcare for our patients.” Gaillour is also concerned over the future of the healthcare system in the next few years. “We have a fabulous healthcare system in terms of the quality of nurses, the quality of technology, innovation – we’ve got it all and what is breaking is the business infrastructure. I’m concerned about the next five years and what that will bring.”

Irving is pretty optimistic about the state of healthcare in the US and believes that we are on the cusp of some significant and dramatic changes. He focuses on the positive aspects of care, that people are living longer and more diseases can be treated. He also notes that genomics will play a bigger role in the future as it helps us understand the pathways of diseases and how diseases affect individuals. Irving also believes that education is playing and will continue to play a major part in the future of the healthcare industry. “There is a generational change going on around the education that children get around healthcare, the access to the information that is out there on the web, their awareness of what’s going on and that leads to a very important piece on the individual responsibility of healthcare.” Irving adds that this is a huge change and the 55 million people who aren’t insured are not engaged in this process, they do not have access to the information and are not involved with a caregiver. “Overall, the changes in our understanding of a disease and the ability to educate people around that and take on more individual responsibility is incredibly powerful and I think it is going to dramatically change healthcare in the next 10 to 20 years.”