How Might U.S. Healthcare Be Reimagined? That Depends on Your POV | AHIP 2024

The keynote session this morning at the AHIP meeting in Las Vegas was called “Reimagining American Health Care: A Bold Vision for the Future.” But it might have been called the Rashomon of healthcare as the three panelists had very different perspectives and portrayals of the state of U.S. healthcare, its shortcoming and how they should be addressed.

Sachin Jain, M.D., MBA

Sachin Jain, M.D., MBA, CEO of the SCAN Group and SCAN Health Plan, a Medicare Advantage plan in Southern California, painted a bright picture about SCAN but a broadly critical and quite dark one of U.S. healthcare overall, the way it treats physicians and the self-congratulatory denial of problems at AHIP meetings,

“Every single one of one of these conferences is just full of happy talk about how amazing things are and how great things are and how we're promoting access and promoting quality,” Jain told the AHIP audience. “And then we're all privately talking about how freaking hard it is for us to get care for our loved ones and for ourselves. And so I think we have to stop having two separate conversations and start having one conversation, which is like, ‘Hey, we're in a bad place with American healthcare right now. Lots of things are messed up.”

Andrea Walsh, J.D.

Andrea Walsh, J.D., president and CEO of HealthPartners, an integrated, nonprofit healthcare system and insurer in the Twin Cities in Minnesota, wasn’t Pollyannish; “navigation is a mess — people are on a medical merry-go-round” that Walsh said has led to disjointed care. Walsh also spoke public’s distrust of science having a demoralizing effect on people who enter the medical profession and “brutal reality” that either Medicare or Medicaid in many markets cover the cost of actual care. But she trumpeted the success of a hybrid model of virtual and in-person healthcare that HealthPartners launched this year that she compared to the way Target, the Minnesota-based retailer, integrates online and in-store shopping.

Walsh also said COVID-19 vaccination efforts had led to changes in how HealthPartners works with the increasingly ethnically diverse population in the Twin Cities. “We’re trying to change the lens and do more with community — co-design with community — as opposed to doing things to community,” she said. She gave as an example a program called Open Faces that works with leaders in Somali community.

Dan Mendelson, M.P.P.

Dan Mendelson, M.P.P., CEO of Morgan Health, a business unit at JPMorgan Chase that invests in healthcare companies with a focus on employer-sponsored healthcare, wasn’t as scathing as Jain but had critical observations about the current state of U.S. healthcare and health plans in particular.

“We’re here at AHIP, and I'll say this very, very plainly that employers in the United States are not getting what they need for most health plans,” said Mendelson, citing double-digit cost increases and erosion of quality.

AHIP speakers tend to take up the accomplishments of their organizations, and Mendelson was no exception. He spoke enthusiastically about Morgan Health established an on-site primary care in Columbus, Ohio, where JP Morgan has 40,000 employees. Mendelson said that care navigation is “layered on top” of the clinic services to steer employees to low-cost, high-quality providers. Mendelson said he disagreed with the belief that broad networks of providers are better for employees and that “curated networks of high quality providers” are preferable.

Jain and Mendelson had different takes on value-based care. Jain expressed frustration that value-based care was an available but unpicked choice. “We’re not almost 15 years post-ACA and we’re 25 years-plus into Medicare Advantage. The ability to do value-based care has existed for a long time. There’s just a lot of organizations that have chosen not to do that.”

Mendelson countered that in contrast to Medicare and Medicaid, only about 10% of the payments in the employer-sponsored sector of the health insurance market are value-based and “it’s because of the products being offered to employers” by insurers. When value-based models are offered, Mendelson said, “when you dig into the details of any of those models, you see stuff that you don't like,” such as providers networks that are not optimized for cost or quality, hidden fees and “denial rates that are so high that they just don’t make a lot of sense.”

Walsh, Jain and Mendelson also differing views and emotional valence on workforce and physician issues. Walsh expressed concern about the number of older physicians and nurses. “When you look at the age of the workforce, whether it's doctors or nurses, as we look ahead, there aren't going to be enough caregivers for the increasing and aging demographics in the community. So we're going to have to innovate and change the way we do provide care,” she said.

Jain painted with a darker palette: “I think the people who used to be super valued for their work now feel more and more like their work is commoditized, devalued and underappreciated.

He added, “I think the work we need to do, collectively, as an industry, with a lot of clarity is to stop having yoga classes, stopped doing wellness hours and meditation retreats and doctors’ days with lots of tchotchkes that we give to lots of people [and],instead, actually go to work on fixing the workplace and make them make it places where people actually feel truly empowered and feel like they want to do their jobs with a kind of passion that they came to the profession with in the first place.”

Mendelson spoke the inefficiency of primary care being deliver by physicians and “leveraging” other a range of different providers to provide care. “That's going to be more efficient, is probably going to be a little more fun environment for the doctors and it's going to be better care for the patient.”