Each year I look back on the interviews I conducted or webinars I reported on and pull out a few of the quotes that really got me to rethink some of my assumptions about the healthcare system. So here is a baker’s dozen from 2023 that I hope you will find thought-provoking as well. I am looking forward to more interesting discussions on health policy, informatics, and business issues in 2024!
“If hospitals and other employers of nurses are really serious about addressing the drivers of burnout, they really need to dispense with these ideas of throwing pizza parties and doing resiliency trainings, and instead be responsive to what nurses say they need, which is manageable and safe workloads.”
— Karen Lasater, Ph.D., R.N., associate professor at Penn Nursing
“We've created a system that has a lot of associated overhead, much of which doesn't do anything for anybody. Think about how many federal taxpayer dollars go to Medicare Advantage marketing. It’s staggering,”
— Sachin Jain, M.D., M.B.A., president and CEO, SCAN Group & Health Plan
“With issues like granular consent……it is not helping patients and it is not engendering confidence in EHR systems, HIEs or the federal government that the overwhelming consensus seems to be that this is too hard. Just try something. And at least, be willing to come out and say ‘we're not going to get it right the first time. This is complicated, but we know this is a priority.’”
— Nichole Sweeney, J.D., in-house general counsel and chief privacy officer for Maryland-based CRISP Shared Services
“You could probably get everybody in the United States who truly understands mental health parity into a large ballroom. And because of that, you have a lot of fear and a lot of confusion as to what's actually involved…..You’ve got people who say, ‘Finally, I've got a hammer that I can use to get those insurance companies to do everything they're supposed to do.’ And you’ve got the insurance companies saying, ‘Oh, great, here comes a hammer, and you still haven't even told me exactly what I need to do.’”
— Shawn Griffin, M.D., CEO of the nonprofit healthcare accreditation organization URAC
“If the capital markets and private equity in particular and others are pouring all this money in to try to transform healthcare, if you don't play that game, you're going to have your cheese moved without you being involved. So a big part of why I think a lot of people work with us and work with other players is because they're trying to figure out what the market is telling them. In any corporate role, all day long you are like a horse with blinders on. You're trying to make sure you keep your operation running. I can say this because I'm a former leader of companies, and that was how I ended up in LRV because there were so many things happening when I was at Premier, especially in AI at the time, that I didn't have any visibility into. And I thought, who could I go talk to, who could I go work with that would be a market translator for me? So you're trying to take those blind spots away.”
—Keith Figlioli, managing partner at venture capital firm LRVHealth
“The physician groups that are embracing Medicare Advantage tend to have a primary care function, where they have the attribution of the covered lives and where they get to keep the savings from the capitation and where they can also largely control the coding of diagnoses and the management of the care, whereas hospital systems that have decided to shun Medicare Advantage are those that don't have a primary care base and rely on referrals, where denials and prior auth really matter for people's access to them. So it's not yet clear whether these two diverging paths will go and whether one will outlive the other. Neither path has been rigorously evaluated to date and frankly, it’s too early to tell what the implications are for providers or patients on a large scale.”
— Zirui Song, M.D., Ph.D., associate professor of health care policy and medicine in the Department of Health Care Policy at Harvard Medical School
“Secretary Mark Ghaly of the California Health and Human Services Agency did a fireside chat with us in fall of 2021. He's really been a huge supporter of this idea of a rising tide raises all boats. That is certainly not an uncommon phrase, but I think it was really very appropriate that he used it given how he and the state agencies that are under him have come together to address the population as a whole in that public sector multi-payer alignment. They have really done that beautifully. To me, that is an important message for states to hear, because they have the power. They don't have to wait for the private sector. Medicare gets to do it at the federal level. Medicaid can do it at the state level. And depending on the state, the public employee benefit program can be a huge additional partner in that, especially for the states that have big enrollment in those plans. They have the ability to drive quality in a way that's very powerful. That's the thing that I would say is the greatest opportunity when it comes to addressing equity.”
— Kristine Thurston Toppe, vice president of state affairs at the National Committee for Quality Assurance (NCQA), a healthcare accreditation organization
“We created a roadmap over three years in a certain order, because some things are dependent upon others. I want to do some clever things with data, but I need the data infrastructure first. I want to do some automation with bots, so we need to put in the bots and software and get people trained up on how to use it. The analysis on when to do things includes asking: how ready is the organization for the technology? How mature is the technology for the use case? How interested are the users in gaining access to that technology? If it's something that is a shiny object that excites all the nerds out there, but the doctors are not really interested in it, I'm not going to put that forward. One good example is tap and go. You take your badge and you tap it to log in. Emory has not rolled that out yet. I'm doing that immediately, because I know from previous experience that everybody loves it. It's easy to do. Other things are much more complex. In terms of home-based care, it is going to take a lot of logistics so that is in the out years. But it's still on the list.”
— Alistair Erskine, M.D., M.B.A., Emory Health’s chief information and digital officer
“As long as we're hospital-centric in all of our processes and approaches to deliver supplies and resources and labor, it’s very hard to pivot to a different setting and to actually think about that setting as being the cornerstone for care as opposed to thinking of the hospital being the cornerstone for care. So this is a big paradigm shift. I do think there is a growing recognition of the feasibility of it and and increasingly, the value of it.”
— Christine Ritchie, M.D., M.S.P.H., professor of medicine at Harvard Medical School
“Once we started doing telehealth-only, over 30 percent of all new patients coming into our program had never been in an in-person [opioid use disorder] treatment program before. We were finally tapping into that invisible 90 percent that other programs don't serve. And that's just everything for trying to truly address this public health crisis.”
— Brian Clear, M.D., Bicycle Health’s chief medical officer
“Labs have been very slow to come on board, even though they are an actor under the information-blocking prohibitions, and it's a little crusade of mine to try to help the labs understand that they need to come on board. All the labs are federally required to share data today, without delay, without special effort in the form and format that's been requested and they're just not doing it. If I need to get all of David's labs from every lab that has seen him in the last 10 years because I want to see his longitudinal lab record, that's not possible because people are literally breaking the law.”
— Steven Lane, M.D., M.P.H, chief medical officer at Health Gorilla
“Part of the reason why I came to the VA from the private sector, beyond feeling honored to have the privilege to care for our nations Veterans, is that I thought that the VA can serve as a beacon of what care and payment models should be for CMS and the private sector. The VA has an amazing opportunity and flexibility to do this. That's why the VA was a leader in telemedicine well before the COVID pandemic. What we can effectively demonstrate could be a part of conversations on what changes should happen in the private sector. We're achieving the outcomes and measuring the things that matter critically to our Veterans and achieving the cost avoidance that is necessary for long-term sustainability.”
— Cole Zanetti, D.O., M.P.H., the acting director for value-based care in the VHA’s Center for Care and Payment Innovation (CCPI) and a senior advisor to the VHA Innovation Ecosystem
