By Dr. Tim Bartholow
We have said for 40 years that health care costs are not sustainable: It may now be true. With families now experiencing annual deductibles of $2,000, $5,000 or even $10,000, families struggle to afford these deductible levels, let alone increases in coming years.
Why is WEA Trust investing in startups and strategies to enhance quality, which at the same time improve affordability? Simply put, it’s our job to help families and their employers, and quality and affordability need to improve faster.
We know that high deductibles are discouraging and sometimes preventing families from going to the doctor. Not going when we need to go is not quality. When we decide we must go, but we cannot find a mental health provider or a primary care doctor that knows us, that is not the best quality.
We believe Wisconsin is spending enough, but we need to use health care with deliberate choices. For example, telehealth (once a startup) can make rapid access to medical advice and doesn’t require the expense of a facility. When we need care beyond this, families – and even their primary care provider – need to know who will treat them well with low complication rates and focused on what the family can afford.
Health care you cannot afford is care that you most likely did not receive … again, a quality problem.
The amount of money the United States spends for health care is nearly double per person what excellent care costs in other developed countries. Some will say they don’t want health care like other countries, but what is their answer to health care costs increasing faster than wages?
Wages increased at less than 2% over the last five years while health-care costs increased by 4 to 6% during the same span. It only takes humility and soberness to admit this strategy will, in time, if not now, strangle families’ budgets.
For many startups in health care, one business model has been to help health systems find ways to increase their revenue. Medicare has been concerned by this and has launched a series of value-based payment plans to improve quality and slow spending. Payers and employers have a somewhat different business model: How do we use current health-care spending to deliver more coordinated, safer care, with fewer complications, and which is ultimately more affordable for families?
The market is huge. Some suggest that 30% of $3.6 trillion in health-care spending is not helping the patient and is “unintended waste.” If you have an idea, do you bet on adding health care cost that is being aggressively scrutinized, or do you develop intellectual property that addresses the 30% “waste” we spend today?
If you have a technology that will better coordinate care and make care more affordable for you and your community, do not miss your opportunity at this market. At the same time, when you or your family need care, if you have applied your technology to this problem, the care you receive may literally be better and more affordable because of your efforts.
All startups live on tight budgets, much like the constraints of a family budget. Imagine if your startup budget, year over year, was guaranteed only to be tighter? Would you be discouraged and maybe wonder how you would continue? What if, however, we helped families make their dollars go further?
For instance, we know that MRIs in Wisconsin are available for less than $1,000, as opposed to many health systems that require $2,000 to $3,000 for this commodity service. We could make telehealth available for little to nothing compared to the cost of the emergency room. These are just two examples of what we do today, but we are actively looking for the next 10 good ideas that can help families while improving quality.
Here, I want to make an apology: The health-care insurance sector has not always made itself approachable, nor have we articulated fully what problems we need to solve. We must do better on both counts. Let us figure out ways to share what the requirements are for programs that will help our community members. For the health of our community, thank you for your partnership!
Here are some select “pain points” for payers and purchasers:
- Select clinical information from EMR to insurer.
- Provider data passed from provider to payer in a uniform way.
- Engagement of patients in low-cost, high-quality programs.
- Unifying the digital experience to provide care plans and digital therapeutics for each patient.
- Payers need to pass key data back to providers, like no value-add variation between physicians and and pharmacy data on adverse drug events and adherence.
Dr. Bartholow has been a practicing physician, chief medical officer for the Wisconsin Medical Society and is currently vice president and chief medical officer for WEA Insurance Trust. He is also an advisor to Kiio, a Madison-based health technology company. He can be reached at TBartholow@neugenhealth.com.
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