On #THCBGang today we have a special solo episode with Olympic rower for 2 countries and Digital Medicine Society CEO Jennifer Goldsack, (@GoldsackJen) joining Matthew Holt (@boltyboy). It’s at at 1pm PST 4pm EST on Thursday November 30. Find out about what DiME is and does, and what projects it is pushing forward in the future of health tech.

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

By KIM BELLARD

Larry Levitt and Drew Altman have an op-ed in JAMA Network with the can’t-argue-with-that title Complexity in the US Health Care System Is the Enemy of Access and Affordability. It draws on a June 2023 Kaiser Family Foundation survey about consumer experiences with their health insurance. Long stories short: although – surprisingly – over 80% of insured adults rate their health insurance as “good” or “excellent,” most admit they have difficulty both understanding and using it. And the people in fair or poor health, who presumably use health care more, have more problems.

Health insurance is the target in this case, and it is a fair target, but I’d argue that you could pick almost any part of the healthcare system with similar results. Our healthcare system is perfect example of a Rube Goldberg machine, which Merriam Webster defines as “accomplishing by complex means what seemingly could be done simply.”   

Boy howdy.

Health insurance is many people’s favorite villain, one that many would like to do without (especially doctors), but let’s not stop there. Healthcare is full of third parties/intermediaries/middlemen, which have led to the Rube Goldberg structure.

CMS doesn’t pay any Medicare claims itself; it hires third parties – Medicare Administrative Contactors (formerly known as intermediaries and carriers). So do employers who are self-insured (which is the vast majority of private health insurance), hiring third party administrators (who may sometimes also be health insurers) to do network management, claims payment, eligibility and billing, and other tasks.

Even insurers or third party administrators may subcontract to other third parties for things like provider credentialing, utilization review, or care management (in its many forms). Take, for example, the universally reviled PBMs (pharmacy benefit managers), who have carved out a big niche providing services between payors, pharmacies, and drug companies while raising increasing questions about their actual value.

Physician practices have long outsourced billing services. Hospitals and doctors didn’t develop their own electronic medical records; they contracted with companies like Epic or Cerner. Health care entities had trouble sharing data, so along came H.I.E.s – health information exchanges – to help move some of that data (and HIEs are now transitioning to QHINs – Qualified Health Information Networks, due to TEFCA).

And now we’re seeing a veritable Cambrian explosion of digital health companies, each thinking it can take some part of the health care system, put it online, and perhaps make some part of the healthcare experience a little less bad. Or, viewed from another perspective, add even more complexity to the Rube Goldberg machine. 

On a recent THCB Gang podcast, we discussed HIEs. I agreed that HIEs had been developed for a good reason, and had done good work, but in this supposed era of interoperability they should be trying to put themselves out of business. 

HIEs identified a pain point and found a way to make it a little less painful. Not to fix it, just to make it less bad. The healthcare system is replete with intermediaries that have workarounds which allow our healthcare system to lumber along. But once in place, they stay in place. Healthcare doesn’t do sunsetting well.

Unlike a true Rube Goldberg machine, though, there is no real design for our healthcare system. It’s more like evolution, where there are no style points, no efficiency goals, just credit for survival. Sure, sometimes you get a cat through evolution, but other times you get a naked mole rat or a hagfish. Healthcare has a lot more hagfish than cats.

I’m impressed with the creativity of many of these workarounds, but I’m awfully tired of needing them. I’m awfully tired of accepting that complexity is inherent in our healthcare system.

Complexity is bad for patients, bad for the people directly giving the care, and only good for all the other people/entities who make a living in healthcare because if it. Instead of making pain points less painful, we should be getting rid of them.

If we had a magic wand, we could remake our healthcare system into something much simpler, much more effective, and much less expensive. Unfortunately, we not only don’t have such a magic wand, we don’t even agree on what that system should look like. We’ve gotten so used to the complex that we can no longer see the simple.

I don’t have a Utopian vision of a healthcare system that would solve all the problems of our system, but I do have some suggestions for all the innovators in healthcare:

• If your solution makes patients fill out one more form, log into one more portal, make one more phone call, please reconsider.
• If your solution takes time with patients away from clinicians, making them do other tasks instead, please reconsider.
• If your solution doesn’t create information that is going to be shared to help patients or clinicians, please reconsider.
• If your solution only focuses on a point-in-time, rather than helping an ongoing process, please reconsider.
• If your solution is designed to increase revenue rather than to improve health, please reconsider.
• If your solution doesn’t recognize, acknowledge, report and act on failures/mistakes/errors, please reconsider.
• If your solution can’t simply be explained to a layman, please reconsider.
• If your solution adds to the healthcare system without reducing/eliminating the need for something even bigger in the system, please reconsider.
• If your solution steers care to certain clinicians, in certain places, rather than seeking the best care for the patient in the best place, please reconsider.
• If your solution adds costs to the healthcare system without uniquely and specifically reducing even more costs, please reconsider.
• If your solution doesn’t have built-in mechanisms (e.g., use of A.I.) to be and stay current on an ongoing basis, please reconsider.

 I’m sure all those innovators think their idea is very clever, and many are, but remember: just because an idea is clever doesn’t mean it’s not Rube Goldbergian.  They need to step back and think about if they’re adding to healthcare’s Rube Goldberg machine or helping simplify it. My bet is that usually they’re adding to it.

So, yeah, I agree with Mr. Levitt and Dr. Altman that health insurance should be less complex.   Just like everything else in the healthcare system. Let’s start taking the healthcare Rube Goldberg machine apart.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday October 26 at 1pm PST 4pm EST were delivery & platform expert Vince Kuraitis (@VinceKuraitis); author & ponderer of odd juxtapositions Kim Bellard (@kimbbellard); futurist Ian Morrison (@seccurve); and our special guest was Kat McDavitt(@katmcdavitt) President of Innsena.

The video is below. If you’d rather listen to the episode, the audio is preserved from Friday as a weekly podcast available on our iTunes & Spotify channels

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday October 5 at 1pm PST 4pm EST were delivery & platform expert Vince Kuraitis (@VinceKuraitis); author & ponderer of odd juxtapositions Kim Bellard (@kimbbellard) and policy expert consultant/author Rosemarie Day (@Rosemarie_Day1).

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday September 28 at 1pm PST 4pm EST are futurist Jeff Goldsmith: author & ponderer of odd juxtapositions Kim Bellard (@kimbbellard); and patient safety expert and all around wit Michael Millenson (@mlmillenson).

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday August 31 at 1pm PST 4pm EST are the small but mighty pairing of Kim Bellard (@kimbbellard); and patient safety expert and all around wit Michael Millenson (@mlmillenson).

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday August 17 at 1pm PST 4pm EST are futurist Jeff Goldsmith: medical historian Mike Magee (@drmikemagee); policy expert consultant/author Rosemarie Day (@Rosemarie_Day1); and patient safety expert and all around wit Michael Millenson (@mlmillenson);

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday July 27 at 1pm PST 4pm EST are Olympic rower for 2 countries and DiME CEO Jennifer Goldsack, (@GoldsackJen); patient advocate Robin Farmanfarmaian (@Robinff3); Kim Bellard (@kimbbellard); and medical historian Mike Magee @drmikemagee.

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday July 20 at 1pm PST 4pm EST are futurists Jeff Goldsmith; patient advocate Robin Farmanfarmaian (@Robinff3); Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune); and our special guest Investor at Bessemer Sofia Guerra (sofiaguerrar)

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.