Health Care Summit speaker: Parallel integration can address crisis

Tim Sagers gets straight to the point: We’re spending more in the U.S. on health care than at any point in history, yet we’re less healthy than we’ve ever been. But Mr. Sagers says he has a potential solution – and it centers on cooperation. Mr. Sagers, medical director of MercyCare's Business Health Solutions and president and CEO of employee health solutions startup Captive Health, delivered the morning keynote address to an estimated 200 medical professionals at the Corridor Business Journal’s Health Care Summit Feb. 10 at the DoubleTree by Hilton in downtown Cedar Rapids. As a frequent attendee at previous CBJ health care events, Mr. Sagers said he’d “love” to talk about health care reform as it’s been discussed in the past. “It was easy,” he said. “You either bashed Obamacare or you supported the (Affordable Care Act). But things have changed a lot. I would argue that what we're facing now, with health care costs associated with customer care and delivery, continues to be a crisis. And I think there’s some new ways to think about that.” As an example of a troubled single-payer health care system, Mr. Sagers cited the United Kingdom’s National Health Services, a longstanding system that is now struggling with physician shortages, lack of access and disparities in patient outcomes because it “has confused inexpensive with efficiency.” “I think they’re starting to pay for that,” he said. “And I think there's some real lessons to be learned (from them) on how we deliver the products we deliver today.” Mr. Sagers said he recently conducted a small survey with health care peers, asking a simple question: What do you want from your health benefit programs? He said responses indicated that people are sicker, employees are less healthy than ever and we’re spending more than ever, and technological advancements aren’t moving the needle. ”My favorite response was ‘Dude, seriously?’” he said. “This is a really remarkable time for our health care. Big systems are struggling, small systems are struggling. The financial headwinds right now facing American health care are absolutely unbelievable.” Industry research shows that 60% of the nation’s workforce have a chronic disease, and 40% have two or more chronic diseases – a 40% increase in just the past five years. “There’s never been an inflection like that in the time that we’ve tracked chronic disease,” he said.

Access presents problems

Access to care remains an issue, Mr. Sagers said, noting that the U.S. is expected to face a shortage of at least 120,000 physicians in the next 10 years. Access to mental health services is especially critical, he said, as Iowa already has a shortage of 120 mental health care providers. “I feel like we're spinning our wheels in some ways,” he said. “We've had the same conversations for a decade now. We’ve made some headway, but things are just slow to move.” One key issue to address, Mr. Sagers said, is consumer preferences about the provision of health care services. “I used to joke that patients wanted Walmart,” he  said. “They don't. They want Amazon. They want it now, they want it cheap, they want it in their living room. And we have to find a way to meet the consumer head-on.” Health care systems continue to vertically integrate, based on the concept of providing all patient care on one network, as the British system has done. That movement has continued, driven in part by 53 large mergers and acquisitions across the health care landscape in the past year alone. Some positive trends are emerging, Mr. Sagers said. The decentralization of health care, based on the concept of delivering care where people are, is exemplified by recent announcements of new emergency care facilities in Marion by both Mercy Medical Center and Unity Point Health - St. Luke’s. Mr. Sagers said he’s also a “big fan” of telemedicine, not only for primary care and urgent care, but also for specialty care – but the system is largely underutilized now that the pandemic’s impact has waned, partly due to obstacles from state and federal regulations, as well as expense reimbursement.

Large-scale reform efforts have failed

A few trends have attempted to address health care’s challenges, Mr. Sagers said. IBM Watson was touted as a source for initial cancer diagnosis, and an outreach trend resulted in the movement of health care clinics into retail settings. Most prominent, he said, was the ill-fated Haven Healthcare concept, founded in 2018, that sought to marshal the financial might of Amazon, Berkshire and JP Morgan to make health care better and more affordable. The initiative had an immediate and dramatic effect on the health care market, but failed in less than three years. Why? Amazon has a $322 billion economic engine that touches 75% of the American population, Mr. Sagers said, but they, and Haven, failed to understand the concepts of personal relationships and engagement in the health care ecosystem. “They just couldn't crack that shell,” he said, “because it's not the way they work, it’s not the way they think. (Health care) isn’t your typical single-channel customer behavior. That's not what health care is. And that's why they struggled.” The fundamental problem with American health care, as Mr. Sagers sees it, is a “functional silo syndrome” that puts payers, providers and patients in individual silos. “It’s not a clean ecosystem,” he said. “It’s not that effective at times. It's inefficient at times. It’s indiscriminate at times. It's adversarial at times.”

Parallel integration can improve care, communication

Doctors are making decisions in one silo the types of care they provide, while patients are deciding where and how to seek care using separate criteria. To demonstrate that essential dichotomy, Mr. Sagers displayed a chart that showed widely divergent costs of care for a patient seeking treatment for a rash, depending on whether they sought care through telemedicine, primary care, urgent care or emergency care channels. “What it comes down to me is the fact that there's a fundamental disconnect between the benefits and the programming you provide as part of your package and the patient's existing health care,” Mr. Sagers said. So what needs to be done? Mr. Sagers’ new venture, Captive Health, has built its entire program on the concept of parallel integration – working with health care payers, providers and consumers on issues such as data liquidity between providers and improving access to care options. Such initiatives, he said, can provide cost savings and improved patient outcomes, as well as behavior modification for patients that can lower the rates of chronic disease. But change on such a monumental scale, Mr. Sagers said, is an evolving process and won’t happen overnight. “Health care is a big ship with a tiny rudder,” he noted. “It does not turn on a dime. I think we're all aware of that. This parallel integration step is a really important move forward. And it only happens with conversations like this. The solution to make this better will gain traction when the people in this room keep talking, when we sit down at tables at your business and we keep meeting and talking about how we do this. You have tremendous power.”