Four Strategies to Improve Disease Management

February 26, 2015

Our healthcare system is fragmented, misaligned, full of conflicts of interest, and tragically ineffective. Here are four strategies to fix it.

If you are a healthcare provider, you are stuck in the economic morass of a system that doesn't work. This, however, is no excuse to sit on the sidelines. It is a call to action.

If you are a policymaker, legislator, state or federal healthcare official, please pay attention. You make the rules. You fund much of the system and control private insurers through regulation.

First, getting people insured is a step in the right direction. It is, however, predominantly an economic strategy that serves government, not a healthcare strategy that serves people.

Your power is economic and regulatory, and you misuse it.

Your own researchers and analysts tell you that four out of every five of the $3 trillion in annual healthcare spending healthcare is spent on chronic disease. Simple math, that's $2.4 trillion. Three-fifths of that is spent on preventable chronic disease, or $1.8 trillion per year.

Completing the equation, investing to equip, enable, and empower physicians to have the analytics, actionable information, and control to perform population health is the best way to manage and prevent chronic disease.

Instead, present policy underequips, underpays, and overworks primary care, crushing physicians with regulation, busywork, preparing irrelevant reports, and chasing a few extra dollars by laboriously hustling to meet quality measures that would be a breeze to achieve were they properly equipped.

Sorry, no, EHRs do not do the job. Each system is an island unto itself making it a feat of genius with a fat wallet to even hope to convert that data into actionable, sharable information that physicians need to move disease management to a more effective and efficient level.

Four Keys to Improve Health Status, Lower Costs

To even begin to get real about disease and disease crisis prevention, we must invest in population health driven by actionable diagnostics, analytics, and disease stratification. It's not just patients who have to change their behavior; physicians do, too.

We can never achieve even modest success in improving health status at lower cost today, and rolling back spending over time, without doing these four key things, each of which can be accomplished with a few paragraphs of legislation at the federal level to set the low bar and at the state level to set the correct bar. They will still take the better part of a generation to take full effect, and we have waited too long:

1. Require EHR data to be reported so that Company A's data is in exactly the same place with the same name and format as Company B's data. Regulators and legislators established a standard platform, but allowed EHR companies to place and name data however they wanted, creating the single most overwhelming and expensive barrier to fix our broken system: denial of clinical data for population health.

2. Eliminate the conflict of interest between hospitals and hospital systems (whose business is managing medical crises) who are buying up physician practices (whose job it is to prevent medical crisis). Our present economic, political, and regulatory model that funds hospitals to prevent health crises, upon which they rely to survive, is a root cause of our system's failure. Hospitals are a local and national resource not only for individual crisis, but for local, regional, and national disasters from multi-car crashes to pandemics. They are a matter of national security, including their role as a home for training and research, not commerce.

3. Change government's economic, regulatory, and legislative focus from price to cost when it comes to healthcare. The prime example: reducing the price of managing chronic disease by cutting reimbursements perpetuates and multiplies the cost of treating their consequences. As chronic disease steadily increases, the cost of starving its managers of the resources needed to implement and execute population health through analytics and risk and cost stratification and transforming primary-care physicians from service providers to clinical managers, is assured. Give physicians a fighting chance by at least evening the playing field.

4. Lastly, and most troubling, is that immense amounts of time and money are invested in lobbying legislators and regulators to preserve the status quo masked by cosmetic change while the innovators and agents of real change - physicians and health expert entrepreneurs - are left to fend for themselves.

For those legislators now in control of the federal and most state government, here's a message: No one cares who broke healthcare; fix it. Start here.