Yesterday, I had the honor of hosting University of Illinois Jeff Margolis as a guest speaker in my Employee Benefits course here in the Illinois College of Business. Jeff Margolis may not be a household name, but he ought to be. Jeff just recently retired from the TriZetto Group, the company he founded in 1997 to provide the knowledge and the tools to help power “Integrated Healthcare Management.” His company’s software touches the lives of over half the U.S. population. He is also author of the book “The Healthcare Cure: How Sharing Information Can Make the System Work Better,” which is due out later this month (which is an extended and updated version of an earlier book, The Information Cure, from which I am drawing my post for today.) Jeff understands the U.S. health care system inside and out.
Jeff’s talk to my classes yesterday had several really important take-aways. Of these, perhaps the most important is the need to carefully define the problem that one is trying to solve. I often point out to my class that there are many ways to define the problem with health care in the U.S., and each has a different set of solutions. For example, if one simply wants to reduce health care spending, there are lots of easy ways to do that – restricting access, limiting innovation, reducing insurance coverage – but we probably would not like many of the outcomes! Similarly, if one simply wants to increase insurance coverage, we can do that too. But then don’t be surprised when health care spending rises as a result.
Jeff Margolis focused on a more clearly-defined problem – one with which economist like me tend to agree is right way to think about health care policy. In my words, he was fundamentally focused on how do we get the right care to the right people at the right time? At its essence, this is a question of resource allocation, and the only way we are going to get it right is if all the relevant actors (doctors, hospitals, patients, payers, etc.) have access to the information they need. Information about patients. Evidence-based information about which treatments work for which types of patients. Information about costs. And so on …
To give but one illustration, in Chapter 3 of Jeff’s “Information Cure” book, he has a great chapter (the title of which I have borrowed for this post), called “The Lexus and the Human.” He starts with the provocative question – “which would you rather be: a Lexus or a human being?” He then goes on to point out that when a Lexus is “ill” (i.e., something is wrong, and it needs to be diagnosed and fixed), there is a very rich, thorough, and transferable set of maintenance records that are easily communicated to the right mechanic in the right garage at the right time. In contrast, when a human being shows up at a Doctor’s office, the information is often incomplete, fragmented, and out of date.
As Jeff states, “in stark contrast to Lexus’ systematic way of maintaining and repairing its cars, the U.S. healthcare system lacks the coordination to care for humans as reliably and comprehensively … the Lexus enjoys a much higher degree of precision regarding its care. For starters, our system does not reliably enable providers and consumers to access medical records wherever and whenever we need them.” He talks about the inefficiencies this creates in the form of duplicate tests. But he also notes the much more serious consequences, such as being improperly treated because an emergency room doctor was unaware of your drug allergy.
He also points out that the information exists. But the overall system needs re-engineered to optimize the use of this information. He points out that health plan providers – such as Cigna, Aetna, United Health Care, and others – may be in the best position to help us get there because of the role they play in the health care supply chain. Unfortunately, our politicians are so busy villain-izing these health care companies that we may be overlooking an enormous opportunity for increasing the efficiency and efficacy of our health care system.
It is worthwhile food for thought. There is much, much more to say on this topic – and hopefully I will return to it in future posts. But for now, thanks to Jeff Margolis for lecturing at his alma mater, and for helping to educate the next generation about ways to productively identify and solve problems.