OPINION: How Government Can Cure Its Sickeningly Expensive Approach To Health Care

In 1960, we spent 5 percent of our GDP on health care. Today, it’s about 18 percent.

That growth has been wonderful for all the suppliers — like physicians, hospitals, laboratories, drug companies, health-tech companies and insurers — but very bad for the rest of us.

To mitigate the agony of these expenses for patients and companies, our government’s focus has been on the insurance end of things, which is basically how the costs are (re)distributed. But it is much more important to figure out how to lower these excessive costs while increasing both health care access and overall quality.

Health care is currently not a system. It’s a profit-driven industry, albeit with heavy government regulations and financing.

If we can convert it to a system, or at least bring system-like attributes to the industry, we will be able to continually enhance the system’s design to increase both efficiency and effectiveness. This will steadily lower costs and increase quality. Continuous Quality Improvement (CQI).

The most powerful potential tool for systematizing health care is triage. Whenever someone has a health problem, that person should immediately interact with a trained triage professional over the phone or via the Internet. This will tend to result in an intelligent action plan, connecting the patient with the resource that is most likely to bring about the optimal clinical outcome.

Perhaps the problem is of an emergent nature — in which case the patient would be referred to an emergency room, or 911 will be contacted to send an ambulance. Maybe the problem can be handled by guided self-care, saving unnecessary expenses. Or it could be a simple and common problem for which a particular medication is the clear remedy.

The triage professional will be able to transmit the appropriate prescription under the auspices of a physician or nurse practitioner. If the condition requires a primary care physician’s evaluation, an appointment with that office would be made. Or if this is clearly a case requiring a specialist, that realization would save the patient from a wasted and costly visit to a primary care provider, which will only come up with that same referral.

If it’s determined that the patient should see a doctor (in person or by telehealth), it might be obvious to the triage person that lab work and/or imaging is required before a doctor can definitively diagnose the condition. So that would be requisitioned, to ensure the availability of results in time for the appointment — again saving a mostly wasted clinical encounter, which would result solely in requisitioning the test(s).  Initially, triage would be handled by humans.

But by applying machine learning to all those triage interactions and correlating the triage decisions with clinical outcomes, AI (artificial intelligence) will eventually be capable of delivering this essential service.

We should develop this health care “system” to run in parallel with what we have now as an option. It would incorporate the technologies and systematic processes that are known to optimize care, such as: preventive care, screening for risk assessment, telehealth, devices for monitoring chronic disease, web-based patient-provided medical history, a totally integrated electronic health record across all providers and a personal health record.

Also, we would perform rigorous analytics on the clinical big-data set, to identify what are actually early signs of dangerous conditions and to discover what treatments are most effective for specific diagnoses and under what circumstances.

The cost for this new alternative health care system will surely be far lower than current offerings. Thus, its insurance premiums would plummet well below those of the traditional model. It will therefore unceasingly metastasize and replace much of our high-cost care.

Since health care would be provided at the right time in the right place with the right resource, access and quality will be substantially improved. The time has come to start trending down from 18 percent. The time has come to make health care all that it can be.

Joe Weber has served as the CEO or vice president of several health systems companies. Early in his career, he managed the emergency room and outpatient department of Cook County Hospital in Chicago. Joe holds three U.S. patents, including one for the invention of predictive typing. He has an MS in biostatistics from Columbia University and an MS in management from MIT.