Every year I look back at the interviews I did or the webinars I reported on and pull out some of the quotes that really made me rethink some of my assumptions about the healthcare system. So here are a baker’s dozen of 2023 that I hope will make you think too. I look forward to more interesting debates on health policy, IT and trade issues in 2024!
“If hospitals and other nursing employers really want to address the causes of burnout, they really need to do away with these ideas of hosting pizza parties and holding resilience training and instead respond to what nurses say they need, which is manageable and safe workloads.”
—Karen Lasater, Ph.D., RN, associate professor at Penn Nursing
“We have created a system that has a lot of overhead associated with it, many of which do nothing for anyone. Think about how many federal taxpayer dollars go into Medicare Advantage marketing. It’s amazing”.
— Sachin Jain, MD, MBA, President and CEO, SCAN Group & Health Plan
“With issues like granular consent… it doesn’t help patients and it doesn’t build trust in EHR systems, HIEs or the federal government that the overwhelming consensus seems to be that this is too difficult. Try something. And at least be willing to come out and say ‘we’re not going to do it right the first time.’ This is complicated, but we know it is a priority.’”
— Nichole Sweeney, JD, in-house general counsel and chief privacy officer at Maryland-based CRISP Shared Services
“You could probably get all the people in America who really understand mental health parity together in a big ballroom. And because of that, you have a lot of fear and a lot of confusion as to what’s really involved… You have people saying, ‘Finally, I have a hammer that I can use to get those insurance companies to do everything they’re supposed to do.’ they must do.’ And the insurance companies say, ‘Oh, great, here comes a hammer, and they still haven’t even told me exactly what to do.'”
—Shawn Griffin, MD, CEO of nonprofit healthcare accreditation organization URAC
“If the capital markets and private equity in particular and others are investing all this money to try to transform healthcare, if you don’t play that game, they will move the cheese on you without you being involved. So a big part of the reason I think a lot of people work with us and other players is because they’re trying to figure out what the market is telling them. In any corporate function, all day long you are like a horse with blinders on. You’re trying to make sure you keep your operation running. I can say this because I’m a former business leader, and that’s how I ended up at LRV because so many things happened when I was at Premier, especially in AI at the time, that I didn’t have any visibility into. And I thought, who could I go talk to, who could I go work with to be a market translator for me? “So you’re trying to eliminate those blind spots.”
—Keith Figlioli, managing partner at venture capital firm LRVHealth
“Physician groups that are adopting Medicare Advantage tend to have a primary care function, where they have attribution of covered lives and where they can keep the savings from capitation and where they can also largely control the coding of diagnoses and care management, while the hospital systems that have decided to avoid Medicare Advantage are those that do not have a primary care base and rely on referrals, where denials and prior authorization really matter for people’s access to them. So it is still unclear whether these two divergent paths will continue and whether one will survive the other. “Neither pathway has been rigorously evaluated to date, and frankly, it’s too early to say what the implications are for providers or patients on a large scale.”
— Zirui Song, M.D., Ph.D., associate professor of health care policy and medicine in the Department of Health Care Policy at Harvard Medical School
“Secretary Mark Ghaly of the California Health and Human Services Agency had an informal chat with us in the fall of 2021. He’s really been a big supporter of this idea that a rising tide lifts all boats. It’s certainly not an uncommon phrase, but I think it was very appropriate for him to use it given how he and the state agencies under him have come together to address the population as a whole in that public sector multi-payer alignment. They really have done it wonderfully. To me, that is an important message that states need to hear, because they have the power. They don’t have to wait for the private sector. Medicare gets to do it at the federal level. Medicaid can do this at the state level. And depending on the state, the public employee benefits program can be a great additional partner, especially for states that have large enrollment in those plans. They have the ability to drive quality in a very powerful way. “That’s what I would say is the biggest opportunity when it comes to addressing equity.”
— Kristine Thurston Toppe, vice president of state affairs at the National Committee for Quality Assurance (NCQA), a health care accreditation organization
“We created a roadmap over three years in a certain order, because some things depend on others. I want to do some smart things with data, but first I need the data infrastructure. I want to automate the bots a bit, so we need to install the bots and software and train people on how to use them. Analyzing when to do things includes asking: How prepared is the organization for technology? How mature is the technology for the use case? How interested are users in gaining access to that technology? If it’s something that’s a shiny object that excites all the nerds, but doctors aren’t very interested in it, I’m not going to bring it up. A good example is touch and go. You take your badge and tap it to log in. Emory hasn’t implemented it yet. I’ll do it right away, because I know from previous experience that everyone loves it. It is easy to do. Other things are much more complex. In terms of home care, a lot of logistics will be needed, so that will be in the next few years. But it’s still on the list.”
— Alistair Erskine, MD, MBA, chief digital and information officer at Emory Health
“As long as we are hospital-centric in all of our processes and approaches to delivering supplies, resources and labor, it is very difficult to move to a different environment and really think about that environment as the cornerstone of care, rather than thinking about the hospital as a cornerstone of care. So this is a big paradigm shift. “I think there is a growing recognition of its viability and, increasingly, its value.”
— Christine Ritchie, MD, MSPH, professor of medicine at Harvard Medical School
“Once we started using telehealth only, more than 30 percent of all new patients coming into our program had never been to an in-person visit. [opioid use disorder] treatment program before. We were finally taking advantage of that invisible 90 percent that other programs don’t serve. And that’s all there is to trying to truly address this public health crisis.”
—Brian Clear, MD, Chief Medical Officer of Bicycle Health
“The laboratories have taken a long time to join, even though they are an actor under the information blocking prohibitions, and it is a small crusade of mine to try to help the laboratories understand that they should join. All laboratories are required by the federal government to share data today, without delay, without special effort in the form and format that was requested and they simply are not doing it. If I need to get all of David’s lab work from every lab that has seen him in the last 10 years because I want to see his longitudinal lab record, that’s not possible because people are literally breaking the law.”
—Steven Lane, MD, MPH, Medical Director of Health Gorilla
“Part of the reason I came to the VA from the private sector, beyond feeling honored to have the privilege of caring for our nation’s veterans, is that I thought the VA can serve as a model for what they should be like.” care and payment models. for CMS and the private sector. The VA has an incredible opportunity and flexibility to do this. That’s why the VA was a leader in telemedicine long before the COVID pandemic. What we can effectively demonstrate could be part of conversations about what changes should happen in the private sector. “We are achieving the results and measuring the things that are critically important to our veterans and avoiding costs necessary for long-term sustainability.”
— Cole Zanetti, DO, MPH, interim director of value-based care at VHA’s Center for Care and Payment Innovation (CCPI) and senior advisor to VHA’s Innovation Ecosystem
