Seven years ago, I began a quest to understand why the healthcare industry has become so broken, the collateral damage from its underperformance and whether it could be fixed. The consequences are massive, as I outlined in “The U.S. Has Gone To War For Much Less Than What Healthcare Is Doing To America.” This is what The Big Heistfilm project and the talks I give to medical and business groups are all about. While the causes are multi-factorial, the foundation of the solution to fix healthcare is surprisingly straightforward. You can’t fix healthcare if you don’t have a strong primary care foundation. Unfortunately, employers have unwittingly created an economic depression for the middle class by supporting a flawed healthcare system that has gutted primary care. Wise employers are recognizing that they should hire forward-looking, independent third-party administrators (TPA) who value the foundational role primary care plays. Recently, I had the privilege of speaking at the annual customer/partner event of one of those organizations: EBMS. EBMS is a pioneering TPA that has embraced theHealth Rosetta blueprint for wise health and wellness services purchasing. They are unique in that they built a value-based primary care business in-house called miCare. At their event, they wanted to give their customers and partners deeper familiarity with the Health Rosetta and proper primary care. [Disclosure: A LEED-like certification is being built around the Health Rosetta. As I've disclosed many times, the Health Rosetta is an open-source reference blueprint for how public or private purchasers of healthcare should procure health services and a set of guiding principles for health-related organizations (providers, technology companies, life sciences, wellness, etc) to succeed in the new health ecosystem. In my role as managing partner of the Hf Quad Aim Fund, a seed-stage venture fund, the Health Rosetta is the foundation of our investment thesis. In addition, practitioners of the Health Rosetta are a core storyline for an upcoming satirical film about the healthcare system of which I am the executive producer.] If my talk was a reality show, it would be Extreme Makeover: Healthcare Edition, where I connect dots on the extent of the collateral damage from a wildly under-performing healthcare industry and then segue to the proven fixes that are allowing private and public sector healthcare purchasers to spend 20-55% less per capita yet have significantly better outcomes than the volume-driven status quo system. These are the companies who haven’t bought into the biggest lie in business–that healthcare costs can’t be controlled. At every private sector example I’ve seen where there is big savings, proper primary care is foundational and is why companies such as IBM are investing heavily in primary care. At a macro level, proper primary care is also the enabler of Economic Development 2.0: Playing the Healthcare Card. Following my talk, the physician perspective was shared by the multi-talented Dr. Zubin Damania, who has become a YouTube/Facebooksensation known as ZDoggMD. Damania gave a heartfelt explanation of how he broke way from a high-prestige academical medical center that was robbing him of his soul in the “Doctor Declaration of Independence.” Damania describes how Weird Al Yankovic is a hero of his, so he’s taken to doing music video parodies like Weird Al. He’s striking a nerve with over a million doctors, nurses and other clinicians being catalyzed into a movement as a result of Damania’s parody videos and accompanying commentaries. In the latest music video from ZDoggMD, debuted at the summer gathering for the American Academy of Family Physicians, Damania highlighted the forces challenging the renaissance of primary care. He partnered with an initiative of family physician organizations called Health is Primary. [Disclosure: I’m on the technology advisory board of the Health is Primary initiative.] Damania explained the backstory on this song, and why he launched it with Health is Primary, here. Next-generation primary care doctors ignore elders’ advice Like many aspiring doctors, Damania was encouraged to steer away from primary care. In his case, his father was a PCP, as he stated in his song: Once I was 20 years old, my daddy told me “Don’t be a PCP like me, do derm please.” Fortunately, Damania ignored his father’s advice. Who can blame his father when we’ve done everything imaginable to undermine primary care in the U.S. and turned primary care into a milk-in-the-back-of-the-store referral machine to high-margin services? Consequently, that advice is consistent with conventional wisdom. However, it is at odds with where the greatest successes are coming from in achieving the Quadruple Aim and the direction of healthcare moving from a reactive, siloed model of healthcare to a proactive, outcomes-based model. In this model doctors (some call them “extensivists”) focus on deeply understanding underlying causes of disease and the totality of what drives health. In contrast to the old model where we catastrophically misaligned resources waiting around for five-alarm fires to materialize, next-generation primary care physicians look at the totality of what drives health—not just the small subset represented in the traditional sick-care system. Graphic courtesy of Cascadia Capital: The Future Health Ecosystem Today – Overview The leading population health managers are primary care-led and are mindful that what one calls “messy human stuff” is central to maintaining and returning health. In fact, the former chief medical officer of one of the best next-generation care models is now working on a new model that integrates traditional healthcare into a residential context so that the other factors driving health (e.g., social, health behaviors, physical environment) are also optimized. As they state, “We have an integrative care model that investigates and addresses the root causes of problems, not just symptoms.” A myopic view of primary care stuck in the past would certainly lead one to steer away from that specialty. Though I’m not a scientist, it’s clear as can be that each human is a mini-ecosystem of sorts. It’s great to have specialists who understand particular facets of the “ecosystem”; however, the reality is that there will be an explosion of insights that need to be aggregated into a complete picture as we gain access to more information from the environment, wearables, microbiome, genomics and more. Primary care is the specialty best positioned to interpret the myriad sources of information. For this reason, I’m excited that two new medical schools (UT-Austin’s Dell Medical School and Washington State University) are opening now or in the near future. In both cases, community health and primary care are central to their focus. They benefit from a blank slate unencumbered by often-sclerotic medical schools stuck in bygone eras. Rural medicine is a particular focus of WSU’s new medical school. This recent article from Tennessee is a great example of the need. We’ve needlessly gambled with patients’ health and squandered life savings in what one doctor calls roulette medicine. This Wall Street Journal piece written by one of the architects of Obamacare demonstrates how policy makers are waking up to the reality that hospitals taking over medical practices–especially primary care–only increases costs with little positive impact on outcomes. I don’t have a dog in the fight but as one who has studied what works and what doesn’t, it’s a safe bet that reinvigorated and reinvented primary care will save us one patient and one community at a time. It’s hard to imagine there being a better time to be an independent primary care physician when working in the right kind of organization. There are more options to stay independent where one can work with an organizations such as Aledade, AtlasMD, Hint Health, LibertyDirect, MedLion and others that are designed to enable primary care practices to stay independent. The other option is working with an organization that views primary care as a central point of differentiation, rather than as a loss leader optimized around gaming the volume-centric, fee-for-service disaster that is behind the devastation of the middle class that is unsettling countries around the world–the U.S. is just the one with the most acute problem, but it’s coming to other countries as well. Fortunately, some of the smartest investors have put over $1 billion into enabling next-generation primary care models. Earlier, public company investors have been able to indirectly make bets on primary care through DaVita’s $4.4 billion acquisition of HealthCare Partners and Wellpoint’s $800 million acquisition of CareMore. For technology investors, no technology company has done more than athenahealth to support independent physician practices with their Let Doctors be Doctors and Unbreak Healthcare initiatives. Many primary care doctors felt there was no other choice than to work inside of a large health system as primary care was undermined. Every day, there are more and more options beyond that. Source
