Friday, April 3, 2015

Do You Have the Business “Cure” for Healthcare?


This audience has so many sharp business minds. I have been looking at the “business” model for healthcare, and it seems that it is out of sync with what most of us have to work with every day.

I have been married to a nurse for 24 years and she has been a nurse for nearly 30 years (amazing that she is still just 29!). I have had the opportunity to watch this industry evolve and recently become the center of the political universe. I want to be clear and state this is NOT about politics. I wanted to see if I asked all of you really smart business minded leaders - could we come up with a “cure” for the healthcare industry?

I hope you will share your thoughts in the survey I have attached at the end of the article. Remember I am looking for business solutions not political solutions.  

The first thing I think about is a clear vision for what great healthcare looks like. This may be difficult to get agreement on but if you were the CEO in charge of a healthcare organization, and could make the changes necessary, what would your vision for healthcare be?

Vision: To deliver the best healthcare solutions, to the most people, in the most efficient, and profitable manner. Every patient would receive the most comprehensive care to achieve a successful outcome.

This is where I think many of us get caught up in the current paradigm: Health insurance = healthcare. It doesn’t. Health insurance is a method of paying for healthcare, reducing the risk of being bankrupted by expensive medical procedures, but it is not healthcare. So put the insurance to the side and think like a business that delivers healthcare.

The Product: Our product is providing health services which means we need: doctors, nurses, facilities, equipment, and the necessary policies, pricing, and delivery models needed to serve the market. Do we focus on one type of healthcare like pediatrics, geriatrics, oncology, or a combination of services?

The Market: Our market is sick people. It is sick people in a specific geographic area, unless we decide some sort of virtual model which would include the sick people we can serve virtually.

Delivery: Do we deliver these services via house call, hospitals, neighborhood clinics, virtually, or all of the above.

Pricing: Do we price our products aggressively and target the most patients? Do we focus specifically on high income customers and price our services higher as to make better margins?

I started this exercise to demonstrate how I believe most business oriented people might approach the industry if we utilized a basic business model.

Could the current system benefit from a proven business approach?

If we approached healthcare in this manner do you believe we would see better healthcare? In the current system what has happened are a number of things that have prevented simple business models to take hold. The first is the limitation of MD training in this country. The system of training our future docs limits the number of docs that can be trained, therefore making their services more expensive. Would increasing the number of doctors improve the system?

The Price: The current system is heavily influenced by price charts created by government agencies. The office of Medicare lists the price they will pay for specific services. So if a patient has Medicare, doctors can only charge that patient x$ for the service even if that service costs more or less to produce. Would it be better to price our services according to market conditions? Would that raise or lower prices?

The Market: The current practice relies almost exclusively on the health insurance provider. They set their limitations of payment based on Medicare and prices of premiums, deductibles etc… If you were the CEO would you accept this insurance or price your services so that more people could access them even without insurance?

Delivery: Currently hospitals costs are excessively high due to many factors. Are there ways to reduce the costs of running a hospital? Why is an aspirin in a hospital $20 per pill and more? The price includes the additional costs hospitals can’t charge due to regulation. What could we do to reduce these costs?

Conclusion: I have just sprinkled a few ideas for you to consider in your solution for the problems in healthcare. I know this is a very complex issue. Are there simple solutions? Can we make small changes that will make a big difference quickly? I am interested in hearing from you. Do you see ways to apply business practices to the current healthcare system to improve services and bring down costs?

Can we do healthcare more effectively through a market based business model or is the government better suited for delivering quality services at lower costs? Is there a combination that works best?

I believe there is a business solution here. I also know that there are self-interested parties that may be protecting their “markets” as well. But what if magically we had the power for a short time to create a better model without injecting politics? Could we succeed?

I believe this audience and most business people if given the mission to fix the system would be able to do it with proven business practices. The caveat is that we would have to keep politicians a million miles away from the process. But I want to hear from you: Is there a business “cure” for our healthcare system or am I just wearing rose colored glasses? Take the survey…

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