Healthcare’s Blame Game
Before he dies, Romeo & Juliet’s Mercutio cries out "A plague o' both your houses!" Unfortunately, all too often this defines today’s healthcare marketplace.
Healthcare is rapidly approaching 20% of the U.S. economy, and for American families it’s a threatening financial burden where costs far outpace wages. Whether it’s providers, payers and employers engaging in contract disputes finger-pointing over network configuration and payment formulas, or big pharma trading accusations about who’s to blame for the country’s health care cost crisis, engaging in a ‘it’s your fault or you’re not playing fairly’ argument accomplishes little. It’s time to stop the healthcare blame game.
Hospitals are blaming value-based payment models, high deductible health benefit plans and competition from alternative sites of care for empty beds, rising expenses, deteriorating margins, and increasing levels of uncompensated care.
Pharmaceutical companies are blaming hospitals for rising health care costs claiming price manipulation of prescription drugs, alleging many hospitals charge patients and payers more than double the acquisition cost of medications.
Physicians are blaming their new-found status going from private practice owners to hospital employees as well as Electronic Medical Records for increased job dissatisfaction and ultimately, professional burnout.
Payers, while enjoying their ‘darlings of Wall Street’ status with record setting earnings, are blaming legacy infrastructure and administrative inefficiencies for their nagging problem of rock bottom scores when it comes to customer experience and member service.
Employers, many relying on self-funded insurance plans, are fed-up with rising employee health care costs and declining health status indicators, particularly when compared on the global stage; they are looking a combination of payers, providers and pharma to place blame.
Consumers can’t escape either. Their ‘blame game’ is health inertia…when confronted with a health condition or simply taking preventive actions to maintain good health, all-too-often nonaction, noncompliance or nonadherence wins the day…don’t have time, didn’t remember or can’t get there.
Healthcare industry insiders need to come together to figure out how to align interests, balance cultures and create incentives to sharpen an approach for better care and better access…all at a better cost. It takes collaboration, not "A plague o' both your houses!"
Rules of Collaboration
Collaboration among so many different parties with different interests and business drivers isn’t easy. Meeting shareholder expectations, balancing operational and financial goals, and servicing customer demands takes extraordinary discipline internally, let alone across health care’s coalition of players. However, the recent blitz of vertical and horizontal integration is reshaping the business of health care. Collaboration is successful because the parties involved are driven by common vision, trust and transparency. Potential partners must assess cross-functional compatibility and remain disciplined around the value exchange of collaboration.
5 Rs of collaboration
1. Rationale: primary objective, business case, staying-power
2. Resources: who brings what, talent & skills, brand equity
3. Risk: downside exposure, scalability, cultural alignment
4. Return: up-front investments, pay-back targets, ROI hurdles
5. Reward: success benchmarks, short/long-term performance metrics
As consolidated hospital systems and national mega-insurers build dominant market positions, and retail behemoths storm the market, we’re also seeing alliances never before thought possible…some are competitors playing defense, others are seeking scalability, and still others simply want to take advantage of a perfect storm of an industry in transformation. As a result we’re seeing retail giants acquire insurers, providers morphing into payers, pharmacies partnering with laboratories and primary care clinics, ride-sharing companies providing medical transport, tech giants aggressively move into consumer health services, and pharma driving convergence of drug, device and diagnostic lines of business.
Blame Game Exposed
The health care community can step away from the blame game. Collaboration needs to become a cornerstone business practice in today's turbulent health care sector. For those willing to make the right investment, these arrangements can yield big rewards: open-up new markets, extend product offerings, expand customer base, accelerate innovation, and reap collective financial gain. For health care consumers, motivating and empowering people to manage their health is an obvious place where the industry can join together to break the chronic cycle of health inertia.
Most importantly, a cross-industry collaborative approach can broaden access to care, enhance customer experiences, improve patient outcomes, and bring efficiencies that lower overall cost. Go forth and collaborate: "A win o' both your houses!"
Lindsay Resnick is executive vice president of Wunderman Health. He can be reached at
email@example.com and followed on Twitter @ResnickLR