Dr. Kevin Tabb, MD, Beth Israel Deaconess Medical Center, will be keynoting the ACG Northeast Industry Tour: Healthcare Conference in Boston on November 5. Click here to learn more & register.
As one of a number of leaders in health care, the foremost challenge we face is ensuring we're part of the solution to a problem that is widely acknowledged in health care in the United States: health care is inordinately expensive in this country and yet, in aggregate, fails to deliver the outcomes patients deserve. When we look at health care spending as a percentage of GDP, we are by far the most expensive. But, when it comes to outcomes, we are ranked only slightly above Cuba. I firmly believe that it's our responsibility to change that trajectory -- to provide better care and do it in a way that is ultimately less expensive.
Any CEO in an industry that's in the midst of great change also faces the challenge of calibrating an understanding of the fact that business models are changing under our feet and we need to get out ahead of the curve -- but not to get too far our ahead of the curve. That calibration – understanding when the change will come and how far out ahead to get – isn't something that lends itself to a spreadsheet or an algorithm or an absolute answer. It’s far more an art than a science.
The third challenge is a personal one for any CEO. As a leader of a large complex institution on the cusp of getting even larger and more complex, I need to remember to focus on the small number of things that are fundamental to our existence and remembering to spend time and energy on those things that will make a difference to us as an institution for the next generation -- and not just those things that are clamoring for attention in an hour’s time.
While my view happens to coincide with the philosophy of investing more in value-based care, what really matters is that the market itself and state and federal governments believe we should. That’s where health care is going. The sooner we recognize that and get with the program, the better it will be for us as institutions and, more importantly, the better it will be for patients. Today, we face the proverbial challenge of one foot on the bank and one foot in the canoe, in that health care is moving toward value-based care, but we haven’t fully transitioned. That, in some ways, is the most challenging and dangerous time for an institution. I think many of us in health care believe that if that’s where we are headed, let’s just do it.
When the issue of the use of IT in health care comes up, we are frequently stymied by the fact that the solutions presented are very expensive and not particularly user-friendly for providers that use them, and not even what patients are looking for. Many of the “innovative IT solutions” I hear about seem to be solutions looking for problems. Here at Beth Israel Deaconess Medical Center, we have an innovative health IT history of bucking the trends. We are one of the few major academic medical centers that has chosen not to implement an electronic medical center that almost everyone else uses. We have led with new ideas that are not based on an expensive new feature or different piece of software but rather based on thinking differently about ways that we interact. OpenNotes is a great example of a tool that isn’t dependent on a new "whiz bang" piece of software but has to do with a fundamental belief that a patient's medical record is ultimately owned by the patient, and that access to anything and everything written about a patient in the medical record should be available to that patient. It's the right thing to do and has positive impacts on health outcomes. Beth Israel Deaconess Medical Center is among a small number of institutions in the country that has taken the lead in doing just that.
We are seeing two significant M&A trends in the United States and here in Massachusetts specifically. The first is the significant consolidation of providers pretty much everywhere we look. There have been some that postulate – perhaps with a small amount of hyperbole – that we are no more than five to 10 years away from there being only a handful of health care systems in the country. I think that’s an exaggeration, but I don’t think it’s impossible to imagine that within five years we will see no more than, perhaps, 100 systems, and we won’t see independent hospitals or independent providers. There’s good evidence to suggest we are moving in that direction. The other change we're seeing is vertical consolidation across traditional boundaries in health care. Look at the recently approved CVS/Aetna deal and Amazon’s acquisition of PillPack here in Boston. And, one of the largest payers in the country, UnitedHealthcare, and its Optum arm are now the largest employer of physicians in the country. As much as the wave of mergers of hospitals has the capacity to affect change in health care, this kind of vertical integration is different from anything we've seen before and may prove to be more disruptive and bring about more change than other types of consolidation.
Of course, there’s a long list of individual innovations in our understanding of specific disease states and types of treatment. Ultimately, though, I think that the innovations that will have the most profound impact on health care are those that redefine how we think about health care – away from the traditional model of simply taking people when they are sick to thinking about the provision of health care in non-traditional settings and thinking about health care as inclusive of wellness and preventative treatment.