As he climbed to the stage, Paul Keckley – who predicts a sort of “Occupy Healthcare” movement thanks to rising pharma and hospital costs – tested out his $77,000 knee.
Keckley, a policy analyst and managing director of the Navigant Center for Healthcare Research and Policy Analysis, spoke at this week’s Mid-America Healthcare Venture Forum in Chicago on some of the holes in the healthcare system – and the efficacy of the Affordable Care Act to date.
And when it came to that costly knee: Keckley found that the hospital bill went straight to the insurance company instead of to him, and when he – an industry expert – reviewed the charges:
“Four of the 11 line items were things I’d never even heard of,” he said.
So things still aren’t all rosy in America’s healthcare system – shocking, right? Five years into the ACA’s genesis, there have been things that work, and others that just don’t (read: ACOs). Here are some of his observations:
- “The delivery system has to become fully integrated, where we don’t have fiefdoms of post-acute, acute and sub-acute. There are nine subsectors of post-acute alone. All have different technologies, all have different business models, all have different regulations around quality and safety. We’ve got to somehow create Sam’s Clubs that compete with Costcos that are fully integrated across the healthcare system. And defragment the system.”
- The implementation of patient-centered homes is highly variable, even if the theory is sound.
- Outsider companies – like Microsoft – aren’t intimidated by the quagmire of awful that is the healthcare system. They see it as opportunity. Entrepreneurs will use analytics to associate patterns of care – and find unnecessary care. “Anywhere I drive the cost curve down is where I make my bet,” he said.
- “We’re finding that bundled payments might be promising, but bundled payments that involve drug spend, and post-acute spend, are really problematic,” he said. When bundling cancer costs, for instance, things like medication management, formulary design, medication adherence, and even the “grey zone of alternative health where science isn’t very strong” all come into play. So while bundles seem to be promising, but are getting increasingly more complicated, Keckley said.
- Investor-owned hospitals “are the bright light” – they don’t manage different populations, they’re very efficient and can move resources.
- “We’ve had a lot of pandering to the fears of both sides,” Keckley said. “You can use all kinds of code words if you wish to inflame the base.”
