A Health System Anarchist

A friend and leader in his own right, Ari Weinzweig, co-founder of Zingerman's in Ann Arbor, MI, often describes himself as a 'lapsed anarchist'. Ari has overhauled food and customer service to create a wildly successful set of businesses under the Zingerman's umbrella. At the core is a focus on what customers want. 

At the core of healthcare, we should center our thinking on what patients and populations want (and need). We often think from the perspective of the business we are working with. Long-term success will be based on meeting the needs of the people we are serving.

Anarchist - this term resonated with me this morning as I was reading the series of articles that the NYT is publishing in their Health Issue, which will be released in the NYT Magazine: https://www.nytimes.com/section/magazine. I had this thought particularly after reading about the work that David Meltzer has been doing to quantify the value of the doctor-patient ratio (the one we think of as an old model where there is a long-term relationship and the knowledge of lifestyle, issues, and culture that comes with a long-term relationship):  https://www.nytimes.com/interactive/2018/05/16/magazine/health-issue-reinvention-of-primary-care-delivery.html?rref=collection%2Fsectioncollection%2Fmagazine&auth=login-smartlock.

When we look at how we are doing as an industry, we must ask, how healthy are the people that we serve? Do they receive the care they need when they need it? Is the care they receive effective? Are people in a system that considers their culture, their reality, their understanding, and their choices?  If we use health outcomes metrics, we have long been lagging other countries in how well our people are doing. The US' lagging performance has been documented by the Commonwealth Fund, World Health Organization, and others

The ever-increasing cost of healthcare is now one of every family's biggest concerns. Costs for insured inpatients has grown the fastest. The insured and uninsured face higher costs. As deductibles move to ranges that make every healthcare expense a burden, the costs of healthcare is increasingly a top concern shared by all.

The Commonwealth Fund has recently published how our uninsured population is increasing again, thanks to Trump's work this past year to destabilize the ACA. Those measures are often tip-of-the-iceberg; meaning, there are many under-insured whose access to healthcare is also compromised.

We have the technology such that personalized medicine should be our standard of care - not a new innovation. In some ways, the old model was that. And yet, we now know a lot more about what works for specific populations and what does not. Targeted therapies is worthy of the innovation that it is, but the ability to understand patients and develop recommendations with them that they are able to do should not be a novelty. 

I am increasingly a health system anarchist. Like Ari, I believe that a whole new model is needed - in this case, for healthcare. I have written about designing health systems to achieve health. I believe in this model. I believe in empowering patients. I also believe that strategic partnerships can be a powerful strategy (vs. competition only). 

Back to cost: we need an overhaul on what we charge for healthcare and how we pay for it. In the near term, we should expect people (consumers,  patients) to care a lot more about this - because they are paying a lot more for care (insured and uninsured; although at very different rates). 

Value should be defined by the patient, not the payer or health system. If patients are unable to achieve some value in the healthcare they receive, there will be only increased costs as people wait longer and opt out until they must engage. 

It is time for a health system anarchist - or group of anarchists - to carve a new path where value is defined by patients; costs are affordable; and people are able to achieve their full potential.