Reinventing Health Care in 2023

aAfter a year defined by record inflation and double-digit health care premium increases, I hope that a few years down the road we can finally look back on 2023 as the year that ignited change in American health care and the future. led to a new system. Generations proud.

I will do everything I can to make that happen.

When I think about re-inventing health care, I see two distinct problems that need to be addressed: How can a more sustainable long-term system be created? And how can cost barriers be overcome and patients put first?

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not quite durable

Do the math and it’s easy to see that reintroducing health care incentives in the US is inevitable.

The average family insurance premium in 2000 was $6,348. By 2020 it had grown to $21,342, an average increase of 6.25% per year. The average salary in 2000 was $30,846, increasing to $58,130 by 2020, or an average increase of 3.22% per year. Put another way, health premiums in the US have grown at almost twice the rate of wages.

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If nothing is done and health premiums continue to rise at the same rate, the average family premium will exceed $100,000 by 2046. If premiums and wages continue to grow at similar rates, the average family premium will overtake the average wage in 2055. A little over age 30, a family will need the entire adult income to pay for health insurance. Imagine the stifling effect on the economy and American life.

Reshaping health care for the long term

Here’s a simple question for the leader of every organization in the health care industry: Do you serve the best interests of the patient? Naturally, they would all answer, “Of course!” But that’s not true unless people should pay for care that’s part of what the organization thinks is in the best interests of patients.

Health care is unaffordable for many Americans and medical debt is a leading cause of personal bankruptcy. More initiatives should address this directly. A person can get the best clinical care possible, but if the cost of that care is too high, you’ll still have a person – and a family – who is suffering.

I’m a health care entrepreneur, so I wholeheartedly agree that health care organizations need to be profitable. But not at the cost of financial ruin to the patients. A fraction of the annual profit of a health care giant (choose a major insurance carrier or pharmacy benefit manager) could wipe out most of the medical debt in the US.

As this finally becomes a focus, Americans and their employers will increasingly seek health care partners committed to financial wellness. Companies that make every interaction between humans and health accessible, affordable and seamless will win the future of healthcare.

reinvest for now

To refocus the health care industry around the reasonable cost of care, there are several steps employers and employees can take to reduce costs immediately. When such solutions become more widely known and implemented, it will begin to turn the tide on rising health care costs.

Expand use of the Health Care Benefits Navigator. Much to the surprise of many, the cost of care is not an indication of quality. The same procedure with the same surgeon can cost many times more than a surgery center run in a hospital. People don’t realize that they can pay $16,000 in one place versus $4,000 in another with the same provider, How would they know this? Employers can provide a health care benefits navigator on top of health benefits, so their employees are able to make cost-effective care decisions.

Make hospital financial aid more easily available. Nonprofit hospitals are required to offer free and subsidized care based on an income scale that often reaches well into the middle class. But these programs lurk in the shadows. People who would qualify for financial aid are often unaware that these programs exist and do not apply for them, leaving them vulnerable to medical debt. Surprisingly, it is more cost-effective for hospitals to offer charity care than to chase bad debt. Anyone who is eligible for this assistance should not miss out on it.

Advance self-insured business. Self-insurance or self-funding once only made sense for companies with more than 1,000 employees. Things have now reached a tipping point where companies as small as 25 workers can afford to pay their own claims, protect themselves against risk with stop-loss insurance and cost-control programs, and protect their organization and their teams. can produce savings for I took my 87-person company, Goodroot, down the self-insured route on January 1st and significantly reduced costs for our business and our employees, while improving our benefits.

Embrace sensible drug pricing. The high cost of drugs contributes to ineffective health care. As new treatments enter the market with price tags in the millions, the time has come to rethink how drugs are priced and paid for. There should be fewer steps — and fewer profit-taking companies — between the makers and the people taking the drugs. There is an opportunity for a new generation of healthcare innovators to design better.

Let’s make 2023 the year of innovation in healthcare. Although it is highly profitable, the industry cannot continue on the path it is on. Things must change, and those who see that now will have the honor – and the reward – of creating the new order.

Michael Waterbury is the CEO of Goodroot, a community of companies that is reinventing health care one system at a time. Goodroot companies operate in some of the locations described in this essay.


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