The Evolving Health System

At the 2018 American Academy of Pain Medicine Annual Meeting, Amy Compton-Phillips, MD, EVP, Chief Clinical Officer from Providence Health & Services gave a physician executive’s perspective on the evolving healthcare system.

The good news about healthcare is that almost everything is getting better around the world. Life expectancy around the globe is increasing as are infant mortality rates. Access to healthcare and clean water is also improving. What is not getting better are obesity rates in the U.S. and death from poisoning including drug overdoses.

The bad news is that healthcare costs are increasing, especially in the U.S. In the U.S. healthcare costs have increased 30% since 2007 and account for 18% of the GDP. The U.S. spends 45% more per capita on healthcare than the next highest spending nation. In spite of all this spending, the United States ranks last among developed nations in the overall score of their healthcare system. We are also last in healthcare outcomes and access to care.

When you break down the healthcare spending in the United States, hospital costs make up 32% and physician costs make up 20%. Prescription drugs are 10% of the costs. When people are looking to cut costs, they start by looking at the biggest areas of expenditure which are hospitals and doctors.

Genomic testing is going to change healthcare at a rapid pace. The pricing for this has dropped rapidly and the accuracy and depth of the analysis is increasing rapidly. In the foreseeable future, having genomic testing will become part of everyone’s personal health record and it will help predict disease and allow for personalized pharmaceutical medicine for the optimal outcomes.

We also have a greater opportunity than ever before to measure healthcare outcomes across a variety of areas. These outcome studies will enhance the practice of medicine and if eventually this data is made available to patients it will allow them to make informed decisions about their choice of healthcare providers and facilities.

When you review outcomes per costs for certain procedures, you see significant variation. Higher costs does not equate to better outcomes. We need to figure out the way to achieve the best possible outcomes at the lowest possible costs. One example of this is robotic assisted surgery, which is very expensive. If it does not produce significantly better outcomes then you cannot justify this additional costs.

Another area where there is potential for improvement is reducing friction in the healthcare system by making it easier for patients to navigate this. Several healthcare systems and health insurance carriers have launched apps to assist in scheduling appointments, getting test results, providing health coaching, and monitoring.

The medical records system in the United States is also very cumbersome. There is no common system so it is very challenging for patients and providers to transfer records from one place to another. There is no complete health record for everything an individual patient has experienced.

When reviewing the determinants of health you find that 60% is related to behavior and environment, 30% genetic variants, and 10% the actual health care. Because of this, to get the best possible healthcare outcomes for individuals you need to focus extensively on wellness and wellbeing programs that can access that 60% piece. The genetic testing will allow for earlier testing and treatment of conditions.