Must-read book for everyone “Unraveled: Prescription to repair a broken healthcare system”

My neighbor Tom and I often discuss various topics such as society, politics, environment, and sometimes work. Tom is into the landscaping business and he maintains my yard. This spring, while Tom was working on my yard, we started discussing the latest move from GOP and Trump on Healthcare. Tom and his wife bought their health insurance from the state Health Exchange and were worried about its future. There is certain coverage under the current affordable care were must for him and his family and any changes to those care would be a severe financial impact on them. Soon our discussion moved from Obama Care, Ryan Care, and Trump Care to how we reached this situation.

He was telling me how his father, who had experienced healthcare prior to the computer age, blamed the technological advance on the ever-increasing cost of care. Healthcare in his word today is test, test and more test and very less physician and patient interaction. In his younger days, doctors used to spend at least 30 minutes discussing his issues and complaints, which now had gone down just 10 minutes while the doctor was busy looking at the computer screen. In his younger days, for a hospital stay, they used to get one lump sum hospital bill that included all the cost; but now for similar stay, they get multiple invoices – Physicians Invoice, Hospital stay invoice, laboratory invoice, and whatnot. His father being in his eighties, had a hard time keeping track of the invoices and some of them even landed with collection agencies. We continued to discuss how we reached this stage in Healthcare and the whole discussion was very thought provocative. For the rest of the week, I kept on thinking about our discussion and what ailing our Healthcare system. There are a number of articles, seminars, and discussions around “Patient-Centered Care” and it has become a buzzword in Healthcare
industry.

He was telling me how his father, who had experienced healthcare prior to the computer age, blamed the technological advance for the ever-increasing cost of care. Healthcare in his word today is test, test and more test and very less physician and patient interaction. In his younger days, doctors used to spend at least 30 minutes discussing his issues and complaints, which now had gone down just 10 minutes while the doctor was busy looking at the computer screen. In his younger days, for a hospital stay, they used to get one lump sum hospital bill that included all the cost; but now for similar stay, they get multiple invoices – Physicians Invoice, Hospital stay invoice, laboratory invoice, and whatnot. His father being in his eighties, had a hard time keeping track of the invoices and some of them even landed with collection agencies. We continued to discuss how we reached this stage in Healthcare and the whole discussion was very thought provocative. For the rest of the week, I kept on thinking about our discussion and what ailing our Healthcare system. There is a number of articles, seminars, and discussion around “Patient-Centered Care” and it has become a buzzword in the Healthcare industry.

Are we trying to define Patient-Centered Care from the viewpoint of Payer, Provider, and Pharma companies, ignoring the fact that the patient should be the driver of his or her care? Is this the reason, that despite all these technological advancements and healthcare acts, Medical bills continued to be one of the major contributors to bankruptcies? As per consumer report 2017, there is a big reduction in personal bankruptcies due to medical bills since the introduction of the affordable care act, primarily due to the mandate on a preexisting condition. But still, there is approximately more than half a million personal bankruptcies in 2016 for medical reasons. While exploring all over the internet, trying to gather some insight, I found a gem, a book written by two doctors who had experience from both sides of the healthcare system in the USA as a provider and as a patient. I found a small internet review of a book titled – “Unraveled: Prescription to repair a broken healthcare system” written by Dr. William B Weeks and Dr. James N Weinstein. Not wasting time, I ordered the book on Amazon and received it the very next day.

Author Dr. James N Weinstein is the CEO and President of Dartmouth – Hitchcock Health Systems in New Hampshire and his co-author Dr. William B Weeks is a senior researcher and Professor in Geisel School of Medicine at Dartmouth. Dr. Weinstein had seen and experienced the healthcare system from both sides – as a provider and as a patient and he was very successful in explaining the broken pieces from both sides. Dr. Weeks is an MD, an MBA, and a research scholar was not only poured in his medical experience but also provided critical analysis and management insight to the healthcare system. Both Dr. Weinstein and Dr. Weeks were able to deliver a very well-thought-out book that is meant for everyone in the United States. The healthcare system consists of 4Ps – Patient, Provider, Payer, and Pharmacy. And this is the first book I read that comprehensively analyzes and connects all these 4Ps for a better healthcare system. The whole book is like a flow or a journey of a person through the healthcare system. The authors very systematically managed the flow starting with access and initial encounter with the healthcare system to the management of dying; very articulately narrating the issue, how we got there and what should be done to fix it.

As I mentioned, this book is probably the first book that is a must-read for everyone whether you’re a doctor, a patient, someone at a payer organization or pharma company, a Healthcare IT professional, or a health administrator. In other words, whether you’re actively involved with healthcare or just receiving care, this book is a great read.

The book enlightens the patients with tools and techniques to make an informed decision for their own healthcare. As the author stated – “patient-centered care means the patient to be in the center of and in charge of his care because no one else is”, the healthcare system will be successful only when the patient is aware of his conditions and options, and has access to the necessary tools and techniques to decide what is best for his care. The authors used real-life patient scenarios to explain the broken pieces of healthcare very effectively. This book is a very good educational and awareness tool to empower patients in taking better care of themselves. Most importantly, the people who find it difficult to understand the healthcare jargon will be able to understand those often used healthcare terminologies very easily.

“Prevention is better than cure”, but to ensure prevention, we need more Primary Care. In fact, the success of the Affordable Care Act is based on the success of Primary Care. Today the country is going through a shortage of Primary Care Physicians and they are even more scarce in rural areas. It takes several weeks, even months for a new patient to get an appointment with a PCP, whereas the waiting period for an appointment with a specialized doctor is much less. This shortage is causing the existing Primary Care Physicians’ schedule overloaded with patients. As Dr. Weinstein and Dr. Weeks rightly pointed out, the financial system of healthcare, the reimbursement model that we have today is the reason behind the shortage of Primary Care. Financial reward is much higher for Specialized Care than that of Primary Care. In fee for service model, an endocrinologist prescribing metformin gets more financial reward than the PCP prescribing the same metformin to a diabetic patient. This is not to undermine the endocrinologist, but to emphasize that more and more medical students are preferring higher specialization as opposed to becoming Primary Care.

Healthcare IT professionals are consistently working on delivering technology to enable better and foster care, but still, the patients need to fill in lengthy forms and paperwork with the same information again and again in their patient care journey from one doctor to another, or one facility to another. We are successful in creating the most sophisticated Electronic Health Record, which is resulting in doctors looking at the computer screen more than talking to the patient. Where is that trust and bond in the provider-patient relationship? A type 2 diabetic patient was prescribed Tradjenta by her physician. She had a good job and very good health insurance from the employer. Her liability for the medicine was $15 a month. Last winter she lost her job and joined a smaller company that provided her a High Deductible plan, and now her liability for the same Tradjenta, under 5 tier pharmacy benefit is $385. Every time she visited her physician, she thought of bringing it up with him and asking for other options. But that 10 / 15-minute discussion with the physician during her visit went on discussing other priority items. And by the time she was able to discuss this with him, already 5 months went by. If the in-person discussion is difficult, this could be easily reported through electronic media and be included in the patient record, thereby ensuring action from the physician on the request.

Our healthcare system is very well regulated and controlled by robust protection and privacy laws. While the intent of these laws is very good, the implementation of the laws to an extent contributed to the broken healthcare system and high cost of care. The direct result of the not so well-planned implementation is the repetitive documentation that the patient experiences all the time. The provider tends to over diagnose by ordering additional tests, scheduling interventions; which is not only increasing the healthcare cost but also induces unnecessary fear and anxiety. The payers and providers are using Rack Rate to give a false assurance that the member is getting a great discount by choosing their plan and saving a lot of money. But in reality, no one would pay that rate even without insurance. It is just a tool between provider and payer negotiation and false savings for patients.

This book “Unraveled: Prescription to repair a broken healthcare system” has something thought provocative for everyone to act upon and work towards a better Healthcare system. For Healthcare IT professionals, this book provides a lot of food for thought and seeds for ideas to leverage Information Technology for better Patient-Centered Healthcare. Finally, Dr. Weinstein and Dr. Weeks rightly said that America needs a healthcare revolution that is similar to the industrial revolution which dramatically enhanced production and transformed the worker’s life through new technology and process. This new Healthcare Revolution should be built around improving the health of the population drawn from within and outside medicine in a consumer-friendly fashion leveraging new technology; a healthcare system that works for the patient, not for the sky-high profit margin of the payer, provider, or pharma companies.