I well understand why clinicians in various segments of healthcare are quitting. A physician recently told me that he is not going to invest $50,000 in some new EHR system at this stage in his career, and so retirement, even before age 65, made sense for him.
Healthcare systems are buying physician practices for little money. Some doctors delay retirement and choose a guaranteed salary, along with payment for their accounts receivable and their furniture. That’s it. They agree, for no additional compensation, to hand over information on thousands of their patients to a large healthcare organization.
As a consultant, I have found this to be true for large behavioral healthcare group practices as well: Practice leaders are offered a buyout deal that treats the practice as relatively worthless, in exchange for the opportunity to draw a salary going forward. Depending on your perspective, this is either panic, or knowing when to fold in a high-stakes card game.
The successful operators of the day in any industry figure out how to survive in the circumstances they face. Making a profit within the constraints of that day’s environment will always be admirable, and there are healthcare executives who figure out how to manage the clinical needs, the funding streams, the regulations, and the billing gymnastics to sustain profitability. They are not innovators. They are successful at adapting to ever-changing business realities when few people can master this. Their success is grounded in either business acumen, scientific wisdom or luck.
Innovators are an even more rare breed, and they are not all successful. We desperately need innovators in science and business, and yet the aspiring innovator should be wary about the challenges they are accepting. Potential innovators need both encouragement and warning from us. Most fail. We very much need innovators to get us out of the rut of accepted wisdom, and yet they generally suffer on our behalf as they test out new ways of thinking and operating.
I will offer some ideas on what healthcare innovators might be thinking today, but I do not pretend to be a companion on the innovation healthcare highway. I am merely a reporter who values their work.
Let us recap the main options for healthcare leaders (and for clinicians/administrators at mid- to senior-level executive roles) in 2017, before attempting to understand the challenges for innovation today.
Panic: Sell, retire or just freeze. Wait for a minimal sales price, a decent salary or a miracle.
Adapt: Deliver traditional services where the funding is adequate today, if not for the future.
Innovate: Pursue many paths, not well-understood, including:
What should a healthcare innovator be exploring today? This has not changed over time. A successful healthcare innovator needs these elements:
Considerations for innovators
While I am not offering any blueprints for innovative healthcare structures here, I am proposing some ideas on how to get started. First of all, behavioral healthcare practitioners need to collaborate with other healthcare specialists to begin to see how innovation can occur across specialties. Silos are, justifiably, among the most maligned features of healthcare in the United States. People have healthcare problems that don’t exist in solos. There are many intersections for health and illness, and only a coordinated approach can help people truly lead healthy lives.
Agreement on this point is easy, and yet behavioral healthcare specialists should start from an assumption of professional equity with other healthcare disciplines, if not a position of primacy, based on the prevalence and devastation of behavioral healthcare disorders. At the very least, behavioral healthcare clinicians should recognize the importance of their specialty, both clinically and financially, as they begin inter-disciplinary discussions. Breaking down silos is not the same as treating every healthcare discipline as having an equal impact on the health status of a population.
Your primary care physician takes your blood pressure at each visit, and your mental health status should also be taken at each visit. We don’t have a measurement tool today with overwhelming endorsement for mental health status. However, we are quite close to this scientific goal, and the impediment is simply the lobbying by for-profit and not-for-profit entities for their preferred tools. Let science decide, and we will clear this hurdle.
One’s health is dependent on diet, exercise, and the avoidance of harmful substances like tobacco and alcohol. Yet it is even more profoundly dependent on the thoughts, feelings and behaviors of people as they strive for optimal health and wellbeing in their lives. There is a strange business dichotomy today between entities trying to get people to eat right and exercise often, and those trying to get people to relax, reduce stress, and increase their resiliency and sense of wellbeing. We need to break down these walls and just focus on health, however we get there.
On the professional side, we must clarify who should be leading the clinical team for any given patient. A cancer patient needs an oncologist in charge, but probably not in the final days, and a bipolar patient needs a psychiatrist in charge. However, since people with a serious mental illness die 25 years earlier than others on average, we should be sure to get non-psychiatric clinicians to focus on the deleterious effects of obesity and tobacco use. Since 70% of primary care visits originate in psychosocial stress, it would be important to have behavioral healthcare clinicians lead many frontline primary care teams.
Clinical programs of the future will not be defined by a single diagnosis. Chemically dependent people have long struggled with depression and anxiety, independent of, or in combination with, their addiction. People with chronic pain may be dealing with an addiction to opiates, or disabling depression, and any number of other conditions. We need holistic programs that understand the intersections of various conditions. We must demand that insurance reimbursement understand these complexities and then adjust on a financial level to these realities. The changes needed are both at a program development and business billing/reimbursement level.
Adapt or innovate
Let me revise the categorical distinctions I have offered above and admit that a bright line between successful adaptation today and inspiring innovation tomorrow may not really exist. Only talented executives find a way to successfully adapt to the fluid, unpredictable healthcare environment we live in today. Their adaptation today may be a precursor to tomorrow’s game-changing innovations.
Executives must push themselves for honest answers about their tolerance for risk, the personal investment dollars they will advance, their understanding of the consequences of accepting venture capital or private equity funding, and the range of success that would meet their personal goals. An entrepreneurial executive recently told me that cashing out down the road for around $10 million is preferred to $100 million with many more years of all-consuming work. This is an important piece of self-understanding—family time is a powerful contender to dollars in the bank account for many.
There is a time to quit the big entrepreneurial game of healthcare innovation and survive with more modest ambitions. Here is the strange transition that I see occurring today: Professionals are taking guaranteed salaries to pursue the noble healthcare calling to which they responded years ago, and they are not greatly troubled by the economics of this transaction since they are still well above middle class and still performing rewarding healthcare services.
The economics of any industry will ultimately determine its course, for better or worse, and I want our best and our brightest to be fighting for the clinical and economic success of the healthcare industry. But forget the dry clinical and economic arguments—your grandchildren will appreciate a more effective and efficient healthcare delivery, along with the associated improvements in health status. Grandchildren tend to sharpen one’s focus. We need to live in a country where everyone is pulling in the direction of greater health and countervailing forces are rebuffed. Let’s cheer those wading into this complicated battle at the same time that we thank those leaving the arena for their many years of service.
While I would prefer to end on that mildly uplifting note, I will instead end on the more prosaic message that we need to train our future leaders, plan for leadership succession and continually prepare for healthcare crises that are sure to recur. Let’s continue to cultivate people who can adapt and innovate.
Ed Jones, PhD, is senior vice president of strategic planning for the Institute for Health and Productivity Management.