This recent blog on the Forbes site is very interesting from a number of perspectives. Take a look at the article, try to get beyond the politics, and note the underlying theme that there are solutions being found for the healthcare crisis. This is very good news, especially if you have the imagination to see where the current experiments will lead in the future. Perhaps the more important lesson is to see how “narrow-minded” those who criticized attempts to improve the system look as things are unfolding.
Make sure to get to the trailer for the movie Escape Fire at the end of the piece. This should be a must view for those of you in healthcare, and perhaps everyone in the country. Note the high praise Donald Berwick is getting throughout the blog and the video as one of the visionaries who painted a future for healthcare in our country. His work at CMS provided the blueprint for Accountable Care Organizations (ACO) as a key response to the challenges seen during the passage of the Affordable Care Act. The ACO, embraced by both government and commercial payers, has been one of the most important developments in healthcare delivery in the last three years. The concept of rewarding providers for cutting costs while maintaining tight quality standards just makes so much sense. This along with the increased access so critical to improving the overall system could be the foundation for getting out of the mess we currently have.
When the ACOs were first envisioned, it was unbelievable how many said they had no chance of working or even getting started. Oh, everyone had their reasons. The system was too complex. There were FTC issues. There were overhead and startup challenges. There were database deficiencies and organizational design issues. There were significant changes needed in the way healthcare was delivered and change is tough. ACOs required a different way of looking at the current problems. They hurt those currently in power and required new players, such as IT entrepreneurs, to make the system work. So much was needed that the challenge just seemed too great. Thank goodness there were people that just saw the opportunity and were willing to fight through the challenges to make it work. At this point we are not sure the long-term viability of the ACO concept but we are pretty sure the fundamental concepts will live on.
It is a little strange that we are quick to point out why things won’t work or what is potentially wrong with the new thinking, but don’t have the imagination to see through the obstacles to the endpoint. The strange part is that we live in a world that has changed so dramatically in just the last few decades and yet most seem to bet that further change won’t be possible. We work on an iPad and say climate change is too big a challenge. We teleconference with Asia and can’t figure out how to stop gun violence in our own cities. We go to space but can’t teach math and science to our grade school children. We can watch almost any movie ever made whenever we want in our living rooms but can’t figure out how to lower poverty in our country to a rate lower than we saw when Johnson was president.
I think it is really all about imagination which is the first step towards innovation. Perhaps we have gotten so comfortable with the status quo that we turn off our imagination. In the pharmaceutical marketing world these issues are just so relevant. We are so much into the old ways of doing things. We think the model of reps calling on doctors is still working. We think physicians are still independent decision makers. We still think we can beat managed care with co-pay cards and tools to fight prior approvals. We think generics are irrelevant as they are not cutting edge drugs. Medicaid patients are not profitable. Only high “decile” doctors matter. Yet we cling to all these truths while the business for traditional brand name drugs deteriorates. We need imagination, experimentation and change that will eventually lead to solutions. Let’s work on our imaginations and begin to dream again.