A healthcare renaissance?

At Rightway, we work hard to be part of the solution and are excited to explore what needs to happen to generate the change that is long overdue.

We hope you can join us at ReWork Health on September 14th to hear from medical experts like Dr. Sanjay Gupta, Dr. Leana Wen, and Dr. Zeke Emanuel as well as HR Leaders from Salesforce, Visa, BNY Mellon, SF Giants, Morgan Health, and others as we explore the unprecedented opportunity for generational healthcare transformation. Register now.

Written by Jordan Feldman, CEO and Co-Founder of Rightway.

A new chance to solve old problems.

I had just stumbled in late to a Zoom meeting when I heard Stan Dunlap, SVP of Total Rewards at Salesforce and panelist at ReWork Health, proclaim “we were in the midst of a healthcare renaissance.”

Surprised to enter the conversation on that note, my mind quickly began racing to find the points of intersection between 15th century Italy and 21st century America.

Then it clicked. The re-birth of Europe, a time that left behind the fixed ideas of the Middle Ages and created the beginnings of the modern world as we know it, may be the perfect prism for understanding the period we are entering for U.S. healthcare.

Just as the 14th century Black Death pandemic led to fundamental shifts in all aspects of life in the Middle Ages, the Covid-19 pandemic has catalyzed wide-reaching reform today. The invention of the printing press democratized knowledge and led people to challenge institutions, while today’s increased access to personal health information empowers people to drive their own healthcare decisions. We even have something akin to a modern patronage system, with the likes of Tiger Global backing healthcare entrepreneurs with the same vigor that the Medici family supported Italian artists, scientists, and writers.

Healthcare in this country is undergoing an exciting revolution, even as those on the front lines of Covid-19 continue to fight their toughest battles yet. The same way da Vinci first incorporated scientific principles into drawings and Brunelleschi advanced mathematics to design immense buildings and expansive domes, we are making extraordinary advances in biotech, gene sequencing, mRNA, CRISPR, and precision medicine. But even as our scientists and practitioners develop new innovations at a previously unimaginable rate, we must consider: can our healthcare infrastructure support them in these era-defining advances?

In his famous and profound Atlantic article, How American Healthcare Killed My Father, David Goldhill captured the “terrible and perverse results” of our healthcare system’s misaligned incentives. While the system still suffers from the same ills he decries—complexity, hidden costs, and a bias for treatment over prevention—I believe we are better positioned today than ever before to finally solve these problems.

So, why now?

We have in place all the ingredients—dedicated clinicians, entrepreneurs, healthcare leaders, and innovators—to make the next decade a transformational one for healthcare. But to truly capitalize on all this potential and emerging good, we need to be intentional. We must systematically rid ourselves of what has held us back from what we are all here to accomplish: better experiences, better outcomes, and lower costs. The masters of the Renaissance had access to emergent tools and conditions that allowed them to flourish. What is it about our time that makes it equally rich with potential? Here are some of the key components:

• The rise of dissatisfied healthcare consumers and trends that empower them—high deductibles, co-insurance, out of pocket increases, and opaque pricing. There is no greater force than a dissatisfied consumer to drive change and much-needed market convergence. The burden has been placed on consumers, and they are ready to start fighting back.

• Technology is making its much-anticipated debut in the world of consumer healthcare. We now have apps with useful tools, programs to scale accessibility, and information available at the fingertips of both patient and physician. Virtual care and digital therapeutics are ushering in a brand-new standard of care impossible before the smartphone. Consumer healthcare has long felt like the last frontier for technological transformation. It feels like it is finally being discovered.

• Specialization is broadening the realm of possibilities. It used to be that your PCP guided you on your healthcare journey. Today, there are hundreds of companies in categories like women’s health, diabetes, adolescent behavioral health, and beyond. While this has generally been helpful for consumers, it has also complicated and added noise to the landscape, so much so that we need apps to help us choose which specialty health apps to use. While the expansion of choice is good, we need companies to align on one common goal—helping patients access resources they need when they want at a reasonable cost.

• Tools for the rich are being democratized and made accessible to all: concierge medicine through One Medical, healthcare navigation through Rightway, and family planning through Progyny. These types of services used to be reserved only for those with privilege. Raising the standard of care is important, but it’s only meaningful when it’s raised for all, which is facilitated by technological advancements.

• Talent is flooding the healthcare and digital health space the same way it did in the finance industry a generation ago. Healthcare now offers a similar financial upside with a much greater opportunity to have a positive social impact. There is an emerging crop of talent that is hungry, diverse, and ready to disrupt in a way that healthcare has not experienced before.

• Money is flowing into emerging businesses. Healthcare was not an easy choice for investors for too long. Regulatory hurdles, reimbursement, value-based care, binary risk—healthcare has many of the risks that tend to make investors shy away. So they stayed on the sidelines, wary but fascinated with an industry that produces 20% of our GDP. While all the risks prevail, there are mitigants and approaches that now make investing in healthcare hot. Recurring-revenue businesses, risk and dollars shifted from the government to private companies, and technology overlays to complex conditions have all changed the investing narrative. Outcomes like Livongo, One Medical, and Doximity are all certainly helping the case.

• Rising costs for employers who are finally saying enough is enough. For a lot of companies, healthcare has become their second largest line item on the PnL and they know they need to get it under control or face significant consequences. This is a conversation that has been elevated to the C-suite, with the focus on trend and impact as pronounced as ever. With more attention, expertise, and buy-in, the conversation and strategy around the true economic stakeholders are as strong as they have ever been, and they are not going to keep perpetuating the status quo.

• The Covid-19 pandemic cannot be ignored, both for what it did to raise awareness around some of the inadequacies and inequities of healthcare and for the way it has started to tear down some of the bureaucracy that stymies innovation. In 18 months, we witnessed 30 years of progress in consumer behavior, telemedicine, and digital transformation. And there’s no turning back.

So, now what?

With an unprecedented set of conditions aligned to support a renaissance in healthcare, what are the necessary next steps? Technology needs to move faster, consumers need to be smarter, employers need to be more discerning, and insurers need to be more aligned. The list is long, but it doesn’t require extreme (and likely unactionable) moves like going to a single-payer system or ending insurance companies’ profits.

Here are seven foundational action items for the healthcare system—doable today—that will lay the groundwork for the healthcare renaissance:

1. We need to build and execute with the consumer in mind. We can no longer have a marketplace disconnected from the reality of every other capitalistic market in our country. Regulations around transparency will help, but the member needs to be front and center. This means personalized navigation, access to EMRs, condition-specific management, and a single, centralized place to do all things healthcare. Let’s get a healthcare app onto the home screen of someone’s iPhone for the first time ever. That’s how we’ll know we made it.

2. We need to better support the employer, a key stakeholder. While the employee/consumer/patient holds the keys to change, the employer is a crucial piece of the puzzle and needs more support. Big companies spend billions of dollars on healthcare and are starting to impose their will, which is a very positive step. But small companies often hold less leverage. We need to make tooling and strategy equivalent across the board, no matter the size, sophistication, or resources of a company. An employee shouldn’t get worse access because they work at a small company. Period. Employers negotiated to deliver healthcare to their employees in 1942. After almost 80 years, it’s time to deliver at the next level.

3. We need to find a way to pay for and reward preventative care. It doesn’t make sense that we don’t, and it’s leading to uncontrollable, catastrophic costs. Let’s pick the lowest common denominator of what must get done—i.e., annual wellness visits, age-appropriate screenings—and not let a year go by where the system doesn’t support and incentivize this level of care for patients.

4. We need navigation to help uncover and utilize innovation. We are rolling out a generation of innovation in one year. We need to help people make sense of it all and actually understand what is being offered. It is widely agreed upon that the missing link in healthcare innovation is engagement. One way to solve this is supporting the consumer with a tool that serves as air traffic control for the entire ecosystem. Expedia did it for travel, Waze did it for transportation—let’s do it for healthcare.

5. We need to make virtual care much easier. The Covid-19 pandemic helped us tear down some of the licensing and regulatory requirements. Let’s use this progress as a steppingstone to create permanent, positive change. Video calls were created by cell phone companies to visit with family anytime, anywhere. Now it’s time to support this level of access for all patients and doctors. Let’s not overthink this.

6. We need to get rid of misalignment. Yes, this is complex and multi-faceted, but there are some simple, impactful areas to start. For pharmacy benefits, there cannot be drug rebates or spread pricing. Period. This is the most backwards part of healthcare and is leading to prescription drug costs growing faster than any other part of the entire industry. The excessive power abused by pharmacy benefit managers needs to change. We need PBM transparency. The world of “my doctor diagnosed me, the TV told me what medication can save my life, but my local pharmacist told me my insurance doesn’t cover it and I therefore can’t afford it” should be a thing of the past.

7. We need more stakeholders working together. We have reached a point in technological sophistication where we have tools like APIs and enough data to make sense of what’s going on. Let’s start freeing this up to allow the right people to make the right decisions. Fight for progress, not for pride of authorship.

So where is the Sistine Chapel?

If we can get just a few of these right, we will start to see some real masterpieces emerge from the marble in health and healthcare. There is much work to be done, but there are many inspiring people and efforts ready to take on the challenge. It is essential that we continue the conversations about making bigger, broader, more sweeping changes. But we cannot allow the slow pace of systemic change to keep us from taking effective actions now. Let’s start by repainting the Sistine Chapel, not building a new Vatican.

Here is a scaffold for actions that employers can take now to begin reshaping the landscape:

• Find a great broker. Cherish them. Collaborate with them. And hold each other accountable. They are the strategists. The composers.

• Start with the foundational pieces. You need a good medical plan and pharmacy plan. The medical plan should be broad and reward consumerism. The pharmacy plan should be carved out and transparent.

• Don’t fear risk. Hedge out the catastrophic risk with great stop-loss but hold all your vendors accountable. Utilize risk-based contracts and shared savings. It’s time for all stakeholders to shoulder a share of risk.

• Get a chief medical officer. If it wasn’t clear during the Covid-19 pandemic, every company needs expertise and access to clinical and healthcare support. This doesn’t need to be a full-time role, but the CMO needs to be in the C-suite.

• Understand data. Every C-suite member should know the top five conditions driving their healthcare costs and what they are doing to right-size this. If you are in the C-suite, your job is to manage risk, and you need continuous, full visibility on this data.

• Wellness and well-being matter. This is probably obvious after the Covid-19 pandemic, but don’t let up. Budget for this should and will increase. Lead, don’t follow.

• Reward preventative screenings. Reward investments in individual health. A carrot or a stick. Just do it.

• A "doctor in the family," for every employee. It is our responsibility to provide a baseline level of support, advocacy, and guidance for members. We can’t roll out innovation without guiding members on what to do with it. Art during the Renaissance period was complex. Healthcare during its renaissance is no different.

Healthcare, like art, is not straightforward. At its core, the Renaissance was about new ideas overthrowing old views and customs; today, we need to rally around a set of ideals for a transformative new vision of what healthcare can and should become. The dialogue about what’s possible in healthcare never ends. It’s time to turn it from theory into practice.

We must support members with great technology, advocacy, and tools to become better, more empowered healthcare consumers. If we can do this, we can create a better path forward for outcomes, costs, and experiences. We can fully realize the golden potential of a true healthcare renaissance.