At the 2017 Comp Laude Gala, Kimberly George from Sedgwick hosted a conversation with Dr. Robert Pearl, former CEO of The Permanente Medical Group. Under Dr. Pearl’s leadership he had responsibility for 35,000 staff, 9,000 physicians, and the care of 4 million Kaiser Permanente members on the east and west coasts. The discussion focused on the state of healthcare today and how it must transform for tomorrow while addressing opportunities and correlations for the workers’ compensation industry.
Dr. Pearl was inspired to write his book “Mistreated” because his father was one of thousands of people who die every year due to preventable medical errors. People think we have the best healthcare in the world, but statistically our healthcare system ranks low among industrialized nations in just about every possible outcome measure. Healthcare is personal and Dr. Pearl shared his father’s personal health story which resonated with attendees, as healthcare is personal for each of us.
During the fireside chat, Dr. Pearl shared his thoughts on America’s broken health care system and four major health care pillars which need to change. Integrated care is at the top of his list. Care needs to have primary care emphasis and focus on wellness, not specifically on treating disease which is today’s best practice. The integration of practitioners and systems will improve quality and costs. Moving towards a value-based, capitation model for reimbursements is critical and was number two on Dr. Pearl’s list. Fee-for-service drives more care with less quality whereas capitation models focus on quality outcomes and metrics, collaboration, ongoing reviews, and stakeholder agreement. An important third pillar is improved medical technology. Health systems often use 50 year old processes and technology is not deployed in an integrated or patient focused way. Finally, Dr. Pearl shared his insights on physicians leading physicians and the fact it takes a physician to understand a physician.
One of the topics Dr. Pearl touched on which resonated with the audience is the need to understand value and assist with streamlining the physician authorization of care process. If we agree a physician or health system is bringing value and delivering quality care, allow the physicians to treat the patients efficiently.
How do you tell good health care from bad health care? This depends on the perspective. The physician will view this one way, and the patient another. From a physician’s perspective, they consider good healthcare to be following established industry protocols. This does not mean the protocols are correct, but they are filling the heard. In fact, there have been many studies that showed established protocols were flawed but it took years for the medical community to make the adjustment from a patient’s perspective, how do we know if we are getting good healthcare? Statistics are kept on which medical facilities have the best outcomes and which physicians have the most complications, but this information is not widely available to patients. Quality and outcome data needs to be made easily available so patients can make informed decisions.
The industry does not focus on transparency and helping consumers make health decisions based on quality and cost metrics. Opportunities to encourage patient education and awareness will help improve the healthcare system. The patient has to be at the center of their healthcare experience. They need to understand their health, make informed choices, and get the preventative care they need. This is challenging today because we do not give patients the information they need to make informed decisions.
The drug companies manufacturing these medications drove the opioid crisis. They trained physicians on the use of opioids and told untruths to physicians. State laws were passed requiring physicians to focus on pain management. This led to the perfect storm where physicians freely handed out opioid prescriptions which were clearly unnecessary and inappropriate.