The Affordable Care Act and the cost of healthcare

Washington is in a grand debate this week about the Affordable Care Act (ACA) and its proposed replacements. The non-partisan Congressional Budget Office (CBO) has estimated that the proposed change in legislation would reduce healthcare benefits to over 22 million people and save more than $300 billion in the next decade.

As I process the debate, it is really around the constantly rising expense of healthcare and the need to curb the cost curve, as currently healthcare spending is approaching 20 percent of our federal GDP by 2025 (projected to be over $5 trillion dollars/year).

This needs to be balanced with the necessity to care for our vulnerable population – pregnant women, those with chronic and acute disease, children, the indigent, addicted and those with mental and behavioral health issues.

At the same time our spending is surpassing 1.5 times more than the next country, our outcomes are among the worst in all westernized countries. As I have previously blogged, the Dartmouth Atlas suggests that the more a state in the U.S. spends on healthcare, the worse its outcomes.

How can we change this slope of spending and improve health outcomes?

I think it gets back to supporting a healthier population.

In many ways, our healthcare system is backwards.

We are rewarded financially for rescuing people from failure – the sicker the patient and the more procedures done, the more reimbursement to our healthcare delivery systems. That has become our business model, and we are very good at it.

But what is our purpose model? It is to prevent failure, stay healthy and live long and great lives.

How do we do this?

We have to align our business model to our purpose model.

This is accomplishable by following the lead of Tom Friedman, who states in his book, "Thanks for Being Late: The World in the Era of Acceleration," that cooperation, communication, creativity and coding is the fuel of the future.

My interpretation of Tom Friedman's approach is that in the age of rapidly activating networks (via internet, social media, computer-generated communities), we need to cooperate and communicate with each other. That being closer to networks of influence is the new capital of success.

It also tells me that balancing precision analytics (coding) with individual creativity is the key. Google taught us that an environment of psychological safety is the key for great creativity.

This is the delicate balance of precision and fun that make great companies great.

Fun is what you like to do, work is what you have to do.

A workplace can be fun or drudgery for its employees and to the business domain.

Too many successful healthcare delivery systems and academic medical centers are threatened and scared to focus on the purpose of health. Their environments are not fun or very creative. They are circling the wagons and trying to protect their revenue streams by stringent support of our current system.

I think this is misguided. Great organizations are guided by their purpose.

Think about NASA. When NASA was purpose-driven, it put the first man on the moon. After that, NASA was motivated by fear of losing their funding and decided to put the Challenger in the air, even with engineers from Morton-Thiokol worried that the "O" ring would fail on a cold January morning where seven astronauts lost their life.

Their purpose model had become disconnected from their business model.

I think healthcare delivery systems are in danger of the same thing.

I think the answer is to change the model of healthcare to connect the business and purpose. While this may seem threatening, I think this is the leadership needed in healthcare.

That is what we are trying to do in West Virginia. Cooperating with each other. Seeing a world where payment is not the central driver of healthcare, but serving, helping, loving and caring for others is.

Where our work lifts others. To invest in love and safety of our children, families and communities is a prescription for health, while still creating the ability to care for the most complex acute and chronic illnesses.

By bringing healthcare providers together and having them work with state government, academic leaders, educators, business leaders and with insurers, we can take risk for our state's population and change the healthcare model to one of purpose – keep our citizens healthy.

In this model, healthcare providers, legislators, policy folks, social workers, educators, businesses and community leaders are inextricably linked in a new healthcare and community-building system to realize health.

This system will lead us to all invest in better infrastructure, education, jobs, well-kept communities, safety, love and hope for our citizens (particularly our children).

This builds strong communities.

Strong communities are usually healthy ones.

Better health in this model means less spending on sick care and encouraging healthier citizens that can build a strong future for West Virginia.

Basic human connections, purpose, hope, jobs, education – believing again in a limitless future – is the best medicine for health.

Thus, I believe the only answer to spending less on healthcare and realizing better outcomes is improving the health and resilience of our population, families, communities, states, countries and world.

Together, in partnership, as a state of strong people and strong communities that builds a strong future for West Virginia and the world.