For Robert Goldberg, technology is making healthcare more personal, but it’s also making a certain comeuppance possible. Or, maybe a better word would be fairness, at least in how we bill for medical treatments.
Healthcare providers, after all, get paid whether their treatments work or not. But even if those treatments work most of the time, they don’t work all of the time, meaning a certain subset of patients are laying out real money for services that are doing them no good.
This intersection of consumerism, medical data, and technology is what Goldberg, vice president and co-founder of the Center for Medicine in the Public Interest, will discuss on his panel at BioNJ’s “Continuing the Conversation … Seeking Solutions” conference on Thursday, October 11, from 8 a.m. to 1 p.m. at Amicus Therapeutics in Cranbury.
Joining Goldberg will be Debbie Hart, president and CEO of BioNJ; Andrew Pecora, chief innovations officer at Hackensack Meridian Health; Don Sawyer, vice president of U.S. Market Access at Celgene; Leigh Anne Leas, vice president and U.S. country head of public policy at Novartis; Ellen Miller-Sonet, chief strategy and policy officer at CancerCare; Kevin Rigby of Rigby Consulting; Bob Gold, CEO of GoMo Health; Steven Peskin, executive medical director of population management at Horizon Blue Cross Blue Shield of New Jersey; and Terry Wilcox, co-founder and executive director of Patients Rising and Patients Rising NOW. Cost to attend: $295. Visit www.BioNJ.org.
Goldberg grew up in upstate New York, where his father started out as a comedy writer until a letter from CBS humorist Garry Moore advised him to “stick with the booze business,” Goldberg says. So his father ran a liquor store; his mother was an administrator on an educational co-op board. Goldberg studied political science at Brandeis, where he eventually earned his Ph.D.
Goldberg found himself in the pharma industry and moved to New Jersey to be closer to it. In 2005 he co-founded the Center for Medicine in the Public Interest in New York. Nine years later he co-founded Transforming Medicine: The Elizabeth Kauffman Institute, a Boston-based nonprofit designed “to use precision medicine to help people with life-threatening diseases find the most effective treatments more quickly,” according to the organization’s stated purpose.
Goldberg says he helped form the institute to counter the broad-swath approach to treatment, which he says only works for some of the people some of the time. Think of it like the 80-20 principle.
“Eighty percent of diabetes patients will do fine on the meds you give them,” Goldberg says. But when it comes to that 20 percent, the reasons it’s not working can be plentiful and unclear. “We’re looking to pinpoint where the problem is — is it the medicine or is it someone not taking the medicine?”
The 80-20 principle filters into other areas of healthcare as well, Goldberg says. One area is the fact that “a drug is part of a healthcare solution,” not the full solution — even though people in and outside medical fields tend to think of drugs as the sole treatment option.
So if drugs are only part of the healthcare management picture, there are other factors to weigh in as much or more: diet, exercise, stopping smoking, stopping drinking, stress management. The better approach than to “take two of these and call me in the morning” is to find what’s working and build a more rounded healthcare plan on more individualized bases. And this, Goldberg says, is where technology and commerce intersect with data.
“Consumerism is finally penetrating healthcare in a fundamental way,” Goldberg says. The same technology that lets us customize our online shopping experiences or lets Netflix figure out what it thinks we’d like to watch can “let us personalize our healthcare experience and see how well we’re doing.”
Part of what this brings into play is accountability. While most people will do well on a drug or treatment plan, not all will — but those who won’t do well are getting stuck more than once. It’s not just that they’ll get billed for services rendered, they’ll get more than one set of services as doctors try to whittle down (based on broadstroke treatments) what the problem and solution might be. That, of course, means they get billed throughout this process, and this way of doing business, Goldberg says, gives healthcare providers no motivation to take individual patients’ issues into consideration.
“If you go to a restaurant and your steak isn’t cooked the right way, they’ll say ‘We’ll get you another steak,’” he says. Does anyone expect to pay for that first steak? Doubtful. “Yet in healthcare, it’s, ‘Well, here’s a new bill for the new visit and the new meds.’”
The culture of healthcare needs to change from this old model of “as long as I get paid,” Goldberg says, to one in which treatments are honed to an individual through data sharing and more real-time measurements of how a patient is responding to a treatment. And if doctors and hospitals need to make sure people are getting the right care before they bill those patients, there will suddenly be a lot more motivation to get things right, sooner.
Another cultural change needs to happen in the pharma sector, “Drug companies have to realize they’re just selling pills,” Goldberg says. “We need to provide real results and that requires changing the view of taking care of serious illness.”
Part of the overall treatment approach needs to be monitoring, and another part needs to take into account the behavioral nature of a patient — something else made possible by data. In other words, if you’re a doctor who knows your patient is just going to forget to take her pill once a day, technology as straightforward as a text message could remind her, while the data on these behavioral cues can be shared among the range of providers your patient might see. That way they too know that they have a patient on their hands who needs extra help.
The entire business model, says Goldberg, changes to reward good care, rather than the attempt.
“Instead of fee-for-service,” he says, “it’s paying for episode of care — if you get these results, you’ll get paid more.”
Goldberg says that pharma and biotech are the logical places to start looking at how to change the business model, mostly because they have such good margins and can best absorb the risks associated with figuring out the quirks. A lot of new meds, he says, will have to be fairly expensive to offset the trial-and-error phase, but if healthcare providers and pharma companies can remember to “provide people with more than a pill,” things should find their level in good time.
“If you help doctors manage their money to better care for patients,” he says, “then we can have more money to look at analytics.”
He likens the idea to how analytics have changed baseball. Beyond Moneyball and Sabermetrics, we now know the speed at which a ball comes off a particular player’s bat after a 98 mph fastball. We know the angle he tends to hit such pitches, which direction it’s most likely to head, and how fast it’ll take him to make it to second base, so managers employ subtle shifts to compensate.
Even if you hate what that’s done to the game, you can’t deny that technology has given managers the ability to analyze data and customize how to play each batter, as opposed to a broad-swath approach to the game overall.
None of this will take money from healthcare providers, Goldberg says. In fact, managed well, it could boost some bottom lines, as long as everyone from insurers to pillmakers to country doctors with a shingle outside keep one thing in mind.
“The best way to save money is to keep people healthy,” he says.