In a series of LinkedIn Influencer blog posts, Humana President and CEO Bruce Broussard shares insights and ideas about the future of health care and discusses the importance of working together to improve the health-care system as well as our own health and well-being. His latest — Can Car Factories Teach Us About Health Care? — is reprinted below. To see all of his blog posts, click here.
We’ve all owned a car that went far longer than we expected. Maybe it was the extra maintenance that helped extend it to 200,000 miles. Or we just benefited from a well-built car. Or maybe it was a little bit of both.
Yet one thing is certain about a car: the longer you own it, the more things will break. To get a high-quality, long-lasting car – successfully assembled from hundreds of parts – you need integration. You have to design around a specific outcome and meet multiple production-line goals.
Despite this massive complexity, the deliverable is simple: a healthy car that runs. In the world of health care, we have a fragmented system that’s delivering uncoordinated care to hundreds of millions of people. Yet this fragmentation leads to a question: What is the goal, and why aren’t we aligned?
The Product, Not the Components
A fragmented system is an inefficient one. An interesting story in The Economist examines how “innovation and production are increasingly interwoven” in auto manufacturing and how “linking the design of both the product and its manufacturing process more closely to production can help improve all three.”
So what does an improved process in the automotive industry have to do with making a person healthier? The answer is that in the world of manufacturing, advances in technology enabled the industry to better define a finished product. The automobile industry was able to integrate highly specialized functions, from the supply chain to product design, to deliver a consistent product and a user experience specialized to the user.
In health care, the definition of a finished product, the patient’s health, is not easily defined. Is it to restore or maintain health? If so, in what context? Do you do this for the day, the week, the year, the condition, or something else? Physicians have different perspectives given the individualities of the people they serve. It’s even harder given the numerous people who serve the patient, including a multitude of specialists, and no centralized point of care.
Impact of Specialists
Let me be clear. The growth of specialists in health care has been a positive thing, and it’s enabled millions of Americans to live longer. Specialists will be absolutely critical in helping people manage their chronic conditions.
Yet primary physicians, whose role is to coordinate patient care among the specialists, account for only 30 percent of physicians in our country while specialists account for 70 percent. Some experts argue that the ideal system should be the opposite. One story also found that the “primary-care gap is particularly acute in about one-third of states, which have only half or less of their primary-care needs being met.”
Our health system has a significant number of independent specialists, but they’re not integrated to deliver the connected patient experience. When health care became more contemporary in adding value to society in the previous century, it was because the general hospital and the primary care physician started to collaborate together to serve people under one roof.
It’s the same thing with manufacturing; the parts are collected, and the car is assembled under one roof. By mastering this global assembly and integration, the automobile industry has been able to successfully and efficiently deliver an experience that represents the personality of the car a person chooses, all in an affordable manner. Can it be said that health care has this level of integration that enables a personalized experience?
Elements for Success
Helping people with their lifestyles is critical to this structural change. In the past, it was episodic care — you needed surgery for a broken arm or a heart attack. While these are obviously still critical services, the health challenges of the 21st century will be ones of chronic conditions that start to show themselves dramatically as we age.
We have an obesity epidemic and sedentary lifestyles. People have access to manufactured, less-healthy foods, and there’s the stress and strain of living in today’s fast-paced, digital environment. All that sugar you ate won’t impact you at 50, but it sure will at 70. It’s a recipe that leads to poor health.
To bring affordability to health care, we have to talk about the ineffective structure of the health care system. By focusing on health outcomes – and paying doctors based on those outcomes instead of services performed – we will bring about change. If we really seek to lower the cost of health care, we have to focus on individual health outcomes, integration of care, and provider motivation.
Achieving affordability in health care requires us to address three core principles:
· Define the Outcomes (Products). Given the multiple specialists that will be necessary for helping treat a person’s chronic conditions, there are naturally going to be different diagnoses. The health care industry of the 21st century must focus on a consistent definition of the individual health outcome, aka the product, and provide an engaging experience tailored to the personality of the person. This outcome must reflect the person’s health and well-being, not just how the patient responds to specific disease treatment.
· Structure for Motivation. Today, physicians are reimbursed for the services they provide (fee-for-service), which can lead to increased utilization and duplicative services. In a value-based world, physicians are reimbursed for the health of the people they serve. More than 1.6 million of Humana Medicare Advantage members, on average, experience better health and improved quality from the physicians who serve them. Value-based care will help structurally change incentives in health care to keep the focus on the health of the individual, not the services performed.
· Integrate the System. Given the fact that 10,000 people a day are aging into Medicare, combined with the fact that “chronic diseases account for 86% of our nation’s health care costs,” our health care system must have an integrator to address these demographic changes. The primary care physician is the key to integrating the myriad of specialists who serve the individual. As advances in medicine and technology increase life expectancy, we know the “car” will eventually break down. In a health care system centered on value-based care, it’s not about the parts; it’s about holistic mental and physical well-being.
Driving affordability into the health care system requires us to go beyond health access to address cost and a fragmented delivery system. We must move beyond the fee-for-service environment that just encourages services, not measurable impacts.
We need an integrated system that is financially incentivized to reward for optimal health, not optimal utilization. Only by integrating the clinical, health and lifestyle components, with a personalized, high quality and efficient experience as the end product, can we help transform health care.
If it can be done for cars, it can be done for people.