HIStalk Interviews Todd Park, athenahealth Co-Founder

Tim HISTalk | HISTalk | September 15, 2008

...I think healthcare is incredibly broken. I can’t think of a word that does justice to how broken it is at so many levels. I think we all intellectually understand that, but it was really eye-opening for me in my walkabout when I talked to these 150 leaders, to understand just how broken it is looking at the underlying data in terms of cost and quality and access. So I think it is actually broken.

I think the silver lining is that everyone knows it’s broken. It’s hard to find people in any position of responsibility that believe it’s not. There was a Commonwealth Fund and Modern Healthcare that was done recently. It surveyed leaders specifically in healthcare and it found that 9 of the 10 leaders in healthcare say that not only is change required, but fundamental transformation of the healthcare system is required. And that is certainly what I learned about on my walkabout as well.

There’s also a pretty surprisingly broad consensus about why it’s so badly broken at the end of the day. The consensus that I heard on my walkabout is that it’s fundamentally the massive misalignment between payer, provider and consumer. A key to actually healing the healthcare system is to realign those incentives between payer, provider, and consumer such that savings from smarter care and better health are shared with provider and consumer so they are incented to move in that direction through a variety of different means. So that fundamental incentive alignment problem is at the root of the issue and we need to address it in order to heal the healthcare system...

Len Nichols, who is a great healthcare economist at the New America Foundation, has a great sound bite he uses to describe this. He says, “Fee-for-service payment for providers plus low cost-sharing by consumers plus a very small effective evidence base on what works and what’s cost effective equals number one in the world in healthcare spending and 37th in the world in outcomes behind Slovenia and Costa Rica." I think that was a great sound bite that kind of puts it in a nutshell.