Getting healthcare back on track — 5 key thoughts from Chuck Lauer

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The healthcare industry has undergone tremendous changes in the last few years. As technology advances and patients demand high quality care, the healthcare industry must overcome intransigence to meet these demands.

"The industry has always been reluctant to change," says Chuck Lauer, former publisher of Modern Healthcare magazine and now an industry consultant. "There is so much improvement that needs to be done. Many people are working toward that, and I believe we will get to the point where we put the patient above everything else and give patients quality care."

Consumers will continue to demand great care at reduced costs, and the industry is taking certain measures to meet these goals.

Here are Mr. Lauer's five thoughts on where the industry is headed in 2016.

Consolidation: Friend or foe? Every facet in our economy is consolidating, and while healthcare may be late to the game, it is no exception. The industry tells consumers consolidation is necessary to provide efficient, superior care, but Mr. Lauer is hesitant to jump on the consolidation bandwagon.

"Instead of standing alone, organizations want other organizations with them to strengthen their core product," say Mr. Lauer. "A lot of organizations are coming together, saying they will improve efficiency, and I am not sure if that is the case."

In September, Advocate Health Care and NorthShore University Health System announced plans to merge, creating a 16-hospital system in Illinois. The merged entity would rank as the 11th largest nonprofit health system in the nation. The Federal Trade Commission moved to block the merger on Dec. 18, claiming it would stifle competition and significantly raise prices for consumers.

"There just isn’t much evidence that these larger systems are delivering on promises of serving patients better at lower costs," Mr. Lauer explains. "Consolidation will continue in 2016, and it will be very interesting to watch whether the goal is market power and leverage with payers or creating efficiencies to make healthcare more affordable for patients."

Healthcare IT is lagging. Technology will continue to mold the industry, but it doesn’t come without its flaws. "I am not sure if technology has revolutionized healthcare or has been a detractor of what healthcare is trying to do — deliver more adequate, efficient care at reduced costs," says Mr. Lauer. "I can't yet make the case that it has been a net benefit."

Many healthcare experts share Mr. Lauer's opinions with physicians and facilities often citing interoperability as a major frustration with their electronic health systems. The healthcare industry, as a whole, is reluctant to integrate technology into its operations at the same rate as other industries.

"Risk-taking has not been a part of the healthcare industry," Mr. Lauer says. "Although there is plenty of change going on, I am still upset that health IT remains way behind what other industries have done. After all the billions of dollars spent, interoperability is so far from fruition that it is scandalous."

Physicians are losing power. Physicians are finding it increasingly difficult to stay independent, forcing many to join hospitals to become full-time employees. Mr. Lauer questions if this change is beneficial to either the physicians or the hospitals. "Instead of having medical groups, hospitals come in and take physicians over, and I am not sure hospitals are better off because it is costing them a lot of money," he says. “Anecdotally, I hear CEOs say the productivity of newly employed docs falls off tremendously.”

Beneficial or not, independent physicians are becoming an endangered species. "Physicians are seeing the different regulations and the way payers are tight on reimbursement," says Mr. Lauer. "Consequently, they are thinking it would be smart to become an employee and have a guaranteed income on an annual basis."

The American Medical Association is not as respected as it was in years past, says Mr. Lauer. Once thought of as the powerhouse of healthcare, the AMA lost popularity among some physicians after it became the stark opponent of Medicare in the 1960s and continued to fight reforms over the ensuing decades.

"Physicians are losing the power they once had because they haven't been represented well the last few years," Mr. Lauer explains. "The AMA has lost its way as it has become more interested in politics and more of a business entity."

The Affordable Care Act is a mixed bag. "In many ways the ACA has done some good things, but I also think it hasn’t worked very well," Mr. Lauer says.

The Affordable Care Act made a slew of promises to the American people, including that they would never lose their physician. "This is not the case with narrow insurance networks; many Americans have lost their physicians and their preferred hospitals," Mr. Lauer says.

President Obama said with his Healthcare.Gov website, prices will be transparent. He said, “It will say clearly what each plan covers, what each plan costs. The price will be right there. It will be fully transparent.”

However, the ACA fell short in this regard, Mr. Lauer says. "Pricing is so convoluted, patients never really know the actual cost and I think that is wrong," says Mr. Lauer. "There is such a wide variance in our country, and patients should know going in how much their episode of care will cost and how much of that they will be on the hook for."

Young entrepreneurs may help solve the problems in implementing change such as price transparency, paving the way for quality, affordable healthcare through their innovations, he says. Mr. Lauer refers to these individuals as the ‘Ubers of healthcare.” Mario Schlosser is a prime example of a young innovator working to make a difference for patients. Mr. Schlosser co-founded the health insurance company Oscar with Josh Kushner and Kevin Nazemi in 2012. The payer promotes transparency by tools such as Doctor Finds, which allows consumer to find a physician based on location, cost and experience. In 2015, Oscar's enrollment tripled from 17,000 members to 40,000, amounting to nearly $200 million in annual premiums.

"There are new ways of doing things, and young entrepreneurs are the ones who will make great changes in the industry," says Mr. Lauer.

Patients should be first priority. Most professionals in the healthcare industry entered the field with a goal to help others. Administrative and bureaucratic matters often detract from healthcare’s ultimate mission of helping the patient. "The patient should be the total preoccupation of anyone working in the healthcare industry," Mr. Lauer says. "I think we sometimes forget our No. 1 mission — giving patients the care they deserve."

There are leaders in the field who work tirelessly to ensure patients are receiving great care. They want to improve the lives of patients so they can walk out of a facility to lead whole, productive lives. Safety-net hospitals, such as Mount Sinai in Chicago, have dedicated staff members who work each day to assure their patients receive optimal care. "A lot of people that come into safety net hospitals don’t have insurance. Watching the dedication of the staff at those institutions is really incredible," Mr. Lauer says.

Unfortunately, many of these hospitals don’t receive sufficient funding, and may close as a result.

With healthcare spending beyond $3 trillion annually, and health cost inflation rearing its head once again, the industry must find ways to reduce costs, or patient care will surely suffer. "We have to get healthcare costs under control," says Mr. Lauer. "If we don’t, we will spend 90 cents of every dollar and we will ruin the economy."

Mr. Lauer has many questions heading into the new year, but he also sees great leaders working hard with the resources available. "There are a lot of well-meaning people trying to do good things for their communities and their patients," he says. "Overall, I am somewhat optimistic that change in healthcare – chaotic and uneven as it inevitably will be – will help us achieve our mission of high-quality, safe and affordable care."

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