No Villains in the US Healthcare Industry

Post COVID, some key themes that emerged in the US Healthcare industry included Health Equity, Social Determinants of Health (SDOH), Community Care Delivery, Virtual Care as a true modality of Hybrid Care Delivery and our Future Blueprint for Healthcare Innovation & Care Delivery using the incredible success of our COVID response. Also, many healthcare experts predicted that we have a great opportunity to make a final attempt at disrupting our failing healthcare system and make a permanent impact for the good of humanity. Unfortunately, after the dust settled down, we are very close to the same situation in the US Healthcare industry as we were prior to the pandemic with some new pressure points introduced like higher-than-expected utilization of healthcare services. As expected, we are back to villainizing the usual suspects in our healthcare industry and chasing red herrings. In this article we will assess how each player is doing what they can to make a positive impact on the industry while dealing with challenges, many of which are not in their control. We will explore what could be done to make a meaningful impact for the better in this industry while continuing to do what’s working well for us.

But before we do that, let’s familiarize ourselves with how the current landscape looks like. We call it the 5 Ps. The 5 Ps (per John McDonough from Harvard T. H. Chan School of Public Health) that represent the healthcare industry are

• Patients - consumers, citizens, taxpayers
• Providers - physicians, nurses, hospitals, LTC (Long Term Care) facilities; pharma and device makers
• Payers - insurance companies, pharmacy benefit managers, governments, large businesses, consumers (for out-of-pocket costs)
• Purchasers - businesses/employers; consumers
• Policy Makers - national/federal; state/province; local; quasi-governmental

Patients – While many would sympathize with patients as victims instead of villains, one cannot deny the fact that if all of us decided to maintain a healthy lifestyle and choices, the pressure on the healthcare system would go down. Knowing that there are those among us who cannot afford to live a healthy lifestyle even if we want to due to income and other limitations, we will be able to shift focus to assist those in need. There is no lack of ideas on how to do the same (SDOH etc.), but we could scale appropriately and channel a portion of the $5 Trillion to do the same.

Providers – Shifting focus to the Providers, we certainly cannot villainize them as they are the supply side of the industry. We know physicians and nurses’ professions are under a lot of strain and reaching their breaking point. While health systems, pharma and device makers are certainly no villains, they should look to maintain a healthy balance between profitability and health outcomes. Many of them do a good job at the same and we cannot interfere with the capitalist market forces as we should remind ourselves how the healthcare industry is one of the largest employment sources. Most importantly, we do not want to adversely affect the innovation that is the hallmark of our industry.

Payers – One of the most misunderstood players in the industry, Payers play a huge role in keeping the healthcare cost at where they are and without the Payers, they would be much higher than the current state. Certainly, there is room for improvement in the way Payers could keep the healthcare cost low, but we need someone to police the cost to prevent a freefall. Nationalizing this function is not realistic if we were to let capitalist market forces play out in this industry as well as enable the freedom of choice for the patients which is a unique feature of US patient mindset that we are not willing to give up.

Purchasers – Similar to Providers who serve as the ‘supply’ side of this industry, Purchases serve as the ‘demand’ side of the industry. As a result, Purchasers are not villains and are increasingly bearing most of the cost of care. We need to keep an eye on how we reduce the abrasion faced by the Purchasers and look to improve their experience and value for the money they spend from their pocket.

Policy Makers – Finally, the Policy Makers have a crucial role to play in influencing meaningful change in the industry. As evident from the pandemic, our public policies were subpar compared to the rest of the world and we need to figure out a way to influence better food habits and living choices in our population. We have other western nations to model after around how the population is health conscious that results in better health outcome and in the process lower cost while not stymieing innovation. Policy Makers, as elected officials that our population chooses, have the best chance of influencing the population by breaking bad habits and adopting better habits. After Physicians, Policy Makers are our most influential players in making meaningful changes in our industry.

In Summary, there are no villains in the US Healthcare Industry while we still have a lot of room for improvements in making the industry more efficient, experience and outcome driven, socially aware and cost effective. However, those challenges are not unique to our industry and the rest of the world has been struggling with the same. At the same time, we want to continue to be unique from others in being the source of most, if not all the innovation that fuels lifesaving drugs and care for the world. We should continue to encourage all the players to strive for better health outcomes while we let the macroeconomics trends like aging population pressure subside in the next few decades while hoping that our population chooses to follow healthy habits and choices.