What Is Causing Our Healthcare Crisis?

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It's really very interesting, I think there's two fundamentals about what's driving the healthcare crisis today, so the first is that our healthcare system is not responding irrationally as many people claim, our healthcare systems responding very rationally to some very irrational incentives and payment models, and these incentives and payment models basically pay for stuff, they pay for volume, they don't pay for quality, they don't pay for outcomes, so it is a rare environment like Kaiser Permanente and that's why I work there where we have the privilege to say, we have this much money, we have this much of a wellness and prevention on a disease opportunity, how we are going to maximally apply this sort of money to address the needs of the population? And the rest of the industry, the fee-for-service model is infamously driven by an incentive model that any rational person is inclined to succumb to and that's the co-side of doing too many procedures and not enough prevention and wellness.

So Kaiser Permanente is structured in a way where we can overcome a lot of that. Not just through our integrated care delivery and integrated systems, but through an incentive model where our doctors are literally incentivized for the quality the outcomes of the population of people they treat not by how many procedures they do.

So as an integrated are delivery system we can implement our preventive medicine through multiple channels, outreach, digital, text messaging, emails, on our website, but in addition we actually have many patient who fit the following real scenario, a woman comes in to have optometry to get her prescription change, the optometrist is made aware that she is due for a mammogram.

He schedules the mammogram for that day, she gets the mammogram there's an abnormal finding, she sees the surgeon the same day who doesn't need a biopsy, who shows it's an early cancer, and within a week, that cancer has been removed and she's cured. And so the prevention aspect of being able to do the mammogram very very early in the course of the disease because our integrated delivery model and our multiple channels of really implementing preventive medicine.

That woman is alive today and would not otherwise have been alive and we have many tens of thousands of people who are alive today because of that integrated care and preventive model, so it's not just better healthcare, it's not just better outcomes but this woman didn't have to go through the pain and suffering of radiation therapy and chemotherapy and she's cured and alive.

I'm actually convinced that it is going to get a lot better. There are a couple of really missing pieces so the medical school curriculum today the training the experts in health and prevention and wellness is really still very deficient in the behavioral sciences and behavioral economics so when we see a significant shift on the experts side towards for what works and what doesn't work to get people to live healthier lifestyles and be more mindful, I think we're going to see a real sea change in how the expert delivers health care.

On the consumer side I think there's enough knowledge about what's healthy and what's not, what's really missing is the behavior reinforcement and so as we succeed in creating an ecosystem as we succeed in having more of a community sense of health, and resilience, and connecting in social support systems, and as we begin to apply policy to establish some digital equity and some environmental equity across communities.

I think that we are going to see a lot of change so there is a new initiative towards each of those goals everyday, it's exploding and it's hard to know when the tipping will occur and what it will look like but I have no doubt that the crisis that we are in has reached such a severe point that the awareness of the crisis we're in, the the fact that we can't compete internationally because we have 10% handicap on our core structure for everything we export, the fact that we can't get enough military recruits who qualify because they are obese.

The fact that the epidemics of diabetes and obesity and all the attendant co-morbidities are bankrupting us as an economy. We've said for 20 years it's unsustainable and we've manages to continue down the path we're going, but we have reached a true crisis point and the opportunities are there to really change it and the tipping point is coming soon.

I just can't tell you when.