Malcolm Gladwell, staff writer for the New Yorker magazine and author of “What the Dog Saw,” “Outliers,” “Blink” and “The Tipping Point,” offered an overview of “Cowboys Versus Pit Crews: How to Build a Sustainable Health Care Delivery System” at our start of Day 3.
Gladwell was introduced as “gifted” at interpreting new ideas in the social sciences and making them understandable, practical and valuable to business and general audiences alike. Gladwell did shed light on a few industry examples including self dialysis and remote health as no-brainers in a cost-conscious future state of the healthcare delivery system, yet we still see extensive pushback from less progressive distracters that have a vested interest in the status quo.
I’ll confess; I did sneak out a bit early to get in line for a signed copy of “Outliers”…
Gladwell was followed by a discussion of the “Doorway to Health System Change” with contributions from a distinguished panel including: Michael E. Chernew, PhD, Professor of Health Care Policy in the Department of Health Care Policy at Harvard Medical School; Daniel Kessler, PhD, Professor at Stanford’s Business and Law Schools and a Professor (by courtesy) at Stanford Medical School; and, Scott E. Harrington, PhD, Alan B. Miller Professor; Professor of Health Care Management and Insurance and Risk Management, University of Pennsylvania.
Chernew’s research examines several areas related to controlling health care spending growth while maintaining or improving the quality of care. His work on consumer incentives focuses on Value Based Insurance Design (VBID), which aligns patient cost sharing with clinical value. Chernew suggested that depending on the new health care budget and the extent to which it will rise, it will determine the scope of delivery system impact upon the under 65 demographic. Chernew suggests that the American public is expecting a “perfect government in an imperfect market.” The role of government will require clarity regarding who ultimately needs to make decisions considering taxation, willingness to pay and disparity.
Kessler has written numerous articles and books about health economics and health policy. His current research interests include how tax policy affects medical spending and how vertical integration and other shared ownership structures in markets for health services affect the cost and quality of care. Kessler suggested that a key consideration is within the tradeoff between an “expanded safety net and cost control.” Kessler further suggests that the root cause is in the “mis-set incentives” where plan decision ownership (employers vs. employees), transparency (competition amongst providers) and benefit design (latitude of coverage within a regulated plan) will require refinement in our future state health care delivery system.
Harrington has published widely on the economics and regulation of insurance and is a frequent speaker on health insurance reform, insurance markets, regulation, and public policy. Harrington has also testified before the U.S. House and Senate on insurance regulation and before numerous U.S. state legislative and administrative committees and he recently was appointed to the U.S. Treasury’s Federal Advisory Committee on Insurance. Harrington clarified 2 distinct approaches to Health System Change: Increased Government Control or Markets & Consumer Driven change. Where the current ACA places emphasis on increased government control, Harrington suggests that there must also be provisions to allow for competition and consumer choice.
Good news is that we won’t have to speculate on the Supreme Court ruling much longer…