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Recap from the 17th Annual HBS Health Care Conference

So… I just returned from the 17th Annual Harvard Business School (HBS) Health Care Conference. The running theme of the conference was moving from healthcare to whole person care. Despite the frigid temperatures, the event warmed my heart with attendees full of promise for the healthcare industry. I will admit, it was a bit of a lovefest for Harvard alumni and students, but who can really blame them? They all got into the Michigan of the East… joking. Shout out to the conference organizers, Olivia vonNieda, Bhumika Agarwalla, Jay Thaker, Soltan Bryce, and many others for planning the event! But since many of you could not attend, here’s my breakdown of the conference takeaways.

Medicare Advantage for All (MA4A)

I was honestly surprised how often the topic of MA4A came up. The cynic would argue that it protects the interests of health plans, even though I’d argue it could disproportionately hurt regional and state-specific BlueCross BlueShield health plans. Here’s what they said.

  1. Medicare for All (M4A) will never pass the U.S. Senate. For political aficionados, you really want a 60-vote majority in the Senate to avoid filibuster, which is impossible in today’s political map. Currently there are 47 Democratic-leaning Senators and 53 Republican-leaning Senators. With the 2020 elections upcoming, most predictions believe Democrats will retain 46 seats, Republicans will retain 50, and only 4 Senate seats are legitimately up for contention (e.g., Arizona, Colorado, North Carolina, Maine). Further, there is fear that even if you could miraculously pass a M4A bill, the Democrats would need to use up all their political capital so that nothing else could get done.
  2. Medicare Advantage (MA) is viewed as the most flexible and innovative line of business in terms of shifting reimbursement to reflect value-based care initiatives. Throughout the day, MA received much praise from primary care startups, technology companies, and investors. There seemed to be a prevailing belief that given provider payment flexibility, supplemental benefits option, and higher cost, more complex patient populations, the future of true healthcare innovation remained in MA.

Doctors Want to be Doctors

Most of the panels I attended were heavily dominated by physicians. Across the board, I heard calls for physicians to return to practicing at the top of their license. Too much time is spent in the electronic medical record (EMR) and RVU-based compensation forces physicians into a hamster wheel reality. This is leading to widespread burnout among the medical community. In addition, the most interesting comments related to how the social determinants of health (SDOH), albeit undoubtedly important for creating better health outcomes, should not be the responsibility of the physician to learn and manage. The point being, physicians would like to focus on deep clinical expertise and create enough cost reductions to allow other institutions to provide resources like transportation, nutrition, or housing.

The status quo physician industry was not left unscathed. There were repeated calls for new and improved medical schools that teach medical students about the business of healthcare, not just the scientific aspects of disease states. It was mentioned that very few physicians understand the real implications of cost for each test and diagnosis, leading to the potential of unnecessarily high medical spend. This is addition to optimizing physician workflow would be paramount to success in better managing cost and improving patient outcomes.

Do, Don’t Just Complain

In healthcare it is easy to call out a million things that are wrong. I could write a blog post about every stakeholder type in the ecosystem who somehow contributes to high costs, poor outcomes, or resistance to new innovation. That even includes members of the media, both amateur (like myself) and professional journalism. The really difficult part is taking a step forward and building a service that addresses complicated issues with strong enough economics that allow the solution to scale. If you are a leader who is pushing change and innovation, you are standing in the arena and therefore allowed to throw stones. Everyone else should sit down.

One of the inherent challenges faced by healthcare startups is the difficulty in solving the multitude of social and clinical issues faced by complex patients. It is oftentimes cheaper and easier to focus on point solutions that address a smaller, more specific problem. What you end up with is a bunch of super sophisticated pieces, but a Frankenstein-like puzzle that doesn’t efficiently fit together. This leads to further frustration and and provides the fodder for incumbents to maintain the status quo. This is no better evidenced by Judith Faulkner and the hospitals who signed her letter. These institutions certainly have fair concerns about data privacy and security, but also very selfish interests to protect and limit access to their information for competitive reasons.

On a slightly unrelated note to the conference, I did receive a few messages questioning the proliferation of super-talented MBAs focusing on healthcare over the past decade. If you’ve been around healthcare policy long enough, much scrutiny exists over the rise of administrative costs. Given the fact that I am one of those non-clinical professionals who wants to reduce spending in healthcare, I understand this concern from both perspectives. According to the HBS website, there are 938 MBAs total in the 2021 class. Of those students, only 7% of them worked in healthcare or biotech prior to their MBA. Business school is a time of career change and exploration, which I believe lead to the HBS Health Care Club becoming one of the largest and most active student clubs on campus.

Now to hit the question head on, all the students I met this weekend seemed genuinely interested in improving healthcare for the right reasons, not just job security. They also don’t care about the status quo and are willing to start new companies, join high-growth startups, and invest into businesses that disrupt the incumbents. Rather than complain about the situation, I wholeheartedly believe we need as many smart people as possible to fix the $3.7 trillion system. Healthcare touches everyone in a variety of amazing and awful ways, and I would like to believe that is what drives so much interest in joining the fight.

In closing, I sincerely want to thank the speakers, attendees, and organizers for letting me be a part of the event. And if anyone else has an event or conference that would like to partner with me and the blog in the future, please email me at andy@healthcarepizza.com. The team is super selective with the partners we actually agree to work with, but open to start a conversation.

Andy Mychkovsky is the creator of Healthcare Pizza. Follow him on Twitter (@AMychkovsky) and LinkedIn for future thoughts and updates.

Andy
 

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Natalie Davis MD - February 11, 2020

Thanks for insightful post! Will put my thinking cap on for you. Best, Natalie

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