Michael Swartz of Health Karma: 5 Things We Must Do to Improve the U.S. Healthcare System

Boost the quality of care — As we go through these different changes, it should help improve the quality of care. One of the biggest things in healthcare is that every experience is unique, so we need to create more personalized guidance to help patients direct their care in coordination with their other providers.

As a part of our interview series called “5 Things We Must Do to Improve the U.S. Healthcare System,” I had the pleasure to interview Michael Swartz.

Michael Swartz is the president of Health Karma. He founded the company with the goal of raising the bar in healthcare and empowering people to understand and navigate their own healthcare journeys — regardless of whether they have insurance.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?

In my career, I always wanted to be in investment banking or venture capital. After a year of trying, I got a job in New York City at an investment bank for the security industry. About a year or two in, I was no longer eligible for the family insurance plan, so I lost my insurance.

I began looking and trying to find doctors who had publicly available pricing and weren’t doctors at urgent care because I wanted a relationship with my primary care physician. I didn’t have family nearby, and my friends weren’t able to steer me in the right direction. I felt lost on how to search for doctors, and it hit me that there wasn’t a site or platform for people without insurance to shop.

While going through that process to find a doctor, it led me to think that there has to be a better way, which truly ignited my passion for healthcare. After three years of searching for something out there for healthcare, I started building the team to create Health Karma. Our mission is to raise the bar of the healthcare experience by empowering people to understand and manage their healthcare anywhere, anytime, and regardless of whether they have insurance.

Can you share the most interesting story that happened to you since you began your career?

When we launched our first marketplace, we focused on helping healthcare consumers find doctors and pay for services similar to the way they do on Priceline or Expedia. We assumed that because people were paying more out of pocket, they were ready to be healthcare consumers. User feedback from the launch of the marketplace showed that patients’ obstacles during their healthcare journey were not initially in booking appointments — the issue was confusion and a lack of understanding of healthcare costs and which doctors to visit.

We found people did not know enough about healthcare, especially when they had no insurance, to act as a consumer. This confusion led to hesitation regarding interacting with the marketplace as well as with healthcare as a whole.

This new knowledge drove my passion for the health literacy crisis. Healthcare illiteracy can result in individuals being robbed of thousands of dollars because they don’t know how to ask the right questions, shop around, or compare the pricing of services.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

In the early days of my career in healthcare, we thought we could fix healthcare by developing a platform to make shopping for specific healthcare services as simple and easy as booking a flight or hotel. We assumed that we could ask doctors for a list of services and the cash price for each item, and they would give us exactly what we needed. We found that cash-type practices would provide us with the exact pricing we needed, but most primary care providers didn’t know the pricing — so we would have to figure it out.

I learned from this mistake that I could not be attached to my original idea or believe my assumptions. One of the funniest parts of this mistake is that it’s hard to understand healthcare unless you’re in it and you see it daily — and even then, there is so much to learn that you probably still don’t understand some of the things that are going on.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“We are what we repeatedly do. Excellence, then, is not an act, but a habit.” — Aristotle.

This quote has always struck a chord with me. I truly believe success and excellence come from the habits you create as opposed to simple acts.

How would you define an “excellent healthcare provider”?

An “excellent healthcare provider” is someone who continually tries to raise the bar of the healthcare and patient experience. This means constantly looking for areas of improvement to do better. The best providers treat patients how they, as the provider, would want and expect to be treated.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

A book that not only inspired me but also had a significant impact in shaping me into the healthcare leader I am today is “Hacking Growth: How Today’s Fastest-Growing Companies Drive Breakout Success” by Morgan Brown and Sean Ellis. The book provides great insight into diving into growth strategies and implementation and how I, as a leader, use those strategies today.

Are you working on any exciting new projects now? How do you think that will help people?

Since the outbreak of the COVID-19 pandemic in the U.S., telehealth has become a tool to ease the burden on traditional healthcare systems. Last year, Health Karma introduced the Health Karma for Employer program, including Virtual Primary Care, to address employers’ needs to cut healthcare expenses while providing safe, affordable, and accessible healthcare for all.

Health Karma’s Virtual Primary Care is perfect for small to midsize businesses that either are not offering any healthcare benefits package to their employees or are opting for a high-deductible plan. It can be used by anyone, regardless of whether they have health insurance. It is perfect for those who need access to care but lack insurance, those with high-deductible/catastrophic plans, and for employers who are self-insured but looking for ways to keep claim costs down.

Ok, thank you for that. Let’s now jump to the main focus of our interview. According to this study cited by Newsweek, the U.S. healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the U.S. is ranked so poorly?

1. The astronomical cost.

Healthcare in the U.S. is absurdly expensive. Simply going to the doctor for a routine visit costs more in the U.S. than it does anywhere else. Whether it’s prescription drugs or imaging scans, it costs more in America than anywhere else. The driving factor is that many different people are in the middle of that healthcare transaction. With everything that goes on — you have insurance, networks, the middlemen — and then you can’t even find the actual price of the service because it could have 10 different prices.

2. Lack of insurance coverage.

Decent insurance coverage is expensive and hard to come by. The U.S. healthcare model is a direct-fee system with private health insurance. This model is why we see such high healthcare costs and high rates of uninsured people.

3. Health insurance is confusing.

Most Americans are confused about their health insurance. Many people think they’re paying for healthcare coverage, but they’re getting no value out of it because they don’t understand where to go or how much anything will cost. For example, the U.S. healthcare system is structured in a way where you could go to get surgery at a healthcare provider in your plan’s network, but the anesthesiologist is not in the network.

As a “healthcare insider”, If you had the power to make a change, can you share 5 changes that need to be made to improve the overall U.S. healthcare system? Please share a story or example for each.

Change №1: A bigger focus on the patient experience

In our current healthcare system, there has been a lack of patient-focused treatment. When the U.S. created the healthcare system, it focused on the insurance company or the provider as the end user. The first fundamental change we need to address is at the center of the different ways the system works, starting with the patient. Many patients pay out of pocket, so the first step is understanding and creating a personalized experience.

Change №2: Use technology

There needs to be a change in the type of technology we use to interact and communicate with providers within the healthcare system. When we first started Health Karma, we spoke to our credentialing company that helps credential providers. It said, “The best way to get in touch with a doctor is to use the fax machine.”

As a Millennial, I couldn’t remember the last time I had used a fax machine. This outdated technology alone is causing barriers to communication in our healthcare system; we have to update our technology to create a more connected experience for patients. To fix this, we need more apps and platforms to improve the communication and interactions between patients and their providers for in-person or virtual care.

Change №3: More focus on primary care

Traditionally, healthcare is very reactive; we get sick or are in pain, so we visit the doctor. It wasn’t until the past few years where there was more emphasis on taking a preventative and proactive approach to healthcare by keeping yourself healthy and well. This change starts building a strong relationship and connection with a primary care provider that focuses on end-to-end health and wellness to avoid waiting until the last minute to deal with an urgent health issue. This idea of healthcare focuses on medical, wellness, mental health, vision, and dental as interconnected specialties to create a better standard of care. Plus, once everything is interconnected, patients have the power to decide where their medical data goes.

Change №4: Improve access to care

To create the best quality of care, we must improve access to care. The COVID-19 pandemic has been a tragedy that forced innovation in the healthcare system via digital health solutions. Telehealth has been in the works for years, but adoption was challenging until COVID-19 forced patients and providers to use digital health solutions as their primary care option. Previously, virtual primary care used to be similar to urgent care, where you would click a button to speak with a doctor — but you didn’t get to pick the doctor unless your provider was already using a telehealth platform to meet with you. Over the past year, COVID-19 accelerated the rollout of these virtual primary care solutions, especially in rural areas.

Change №5: Boost the quality of care

As we go through these different changes, it should help improve the quality of care. One of the biggest things in healthcare is that every experience is unique, so we need to create more personalized guidance to help patients direct their care in coordination with their other providers. Once everything is connected, patients will own their medical history, and technology can help patients find the right doctor with the right experience that can provide the highest-quality care.

What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

Individuals: When it comes to the individual, we need to take responsibility and be more proactive about our healthcare journey as patients. The first step is becoming more educated on healthcare in general, and there are plenty of resources out there that can help us navigate the U.S. healthcare system. Individuals also need to be proactive and decide to live a healthy lifestyle by staying active and taking care of themselves.

Corporations: There are two ways to look at how corporations can manifest these changes:

In the United States, employers drive the majority of healthcare coverage and health insurance decisions. An employer has a unique position to encourage and provide the tools and resources for their employees to navigate their health benefits better. Many employers are introducing virtual primary care providers for telehealth and telebehavioral to help their employees control their health and well-being.

The second way is many healthcare companies are becoming more innovative and putting patients first through technology and tools that personalize the patient experience and allow medical professionals to save time on paperwork — and instead use that time to provide care to the patient. Corporations working to improve medical technology will need to make it a point to think about how to focus on the patient as the end user.

Communities: Communities can focus on accelerating access to care by opening up clinics, focusing on wellness initiatives, and working with local organizations and companies through outreach. Outreach will be essential to understand the needs of individuals in each community and find ways to create more proactive healthcare experiences. Each community can develop resources on wellness initiatives and determine what resources, such as new facilities, citizens need in the area.

Leaders: Regardless of industry, we are all consumers of healthcare. Leaders can inspire change by making the decision and investment to say they will be proactive toward creating a better experience for employees, community members, or families. As leaders, we can work with individuals, corporations, and communities to implement the changes to improve our healthcare system. It’s going to take every single one of us to make that investment — whether it’s through time or money. In all, it’s not going to be a small change that will happen overnight. We will need to work together to do something that will fundamentally impact the healthcare structure now.

The COVID-19 pandemic has put intense pressure on the American healthcare system, leaving some hospital systems at a complete loss as to how to handle this crisis. Can you share with us examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these issues moving forward?

Our healthcare system has struggled because we’ve stopped people from coming into medical facilities when they need care. COVID-19 impacted many healthcare facilities because they didn’t adopt technology to provide virtual care to patients. During the pandemic, there were rising numbers of people coming into a hospital with COVID-19. Hence, hospitals had to turn away people with other conditions — this created a major lack of trust.

To correct this, the healthcare industry cannot be afraid of technology or trying something new regarding patient care. Some ways I saw changes included implementing new regulations that opened up access to coverage for telehealth as a way to alleviate overwhelmed hospitals that were low on supplies and had overworked staff.

How do you think we can address the problem of physician shortages?

One of the best ways to address physician shortages includes having medical school systems encourage people to join the medical profession by providing reduced or free tuition costs. For example, schools like New York University announced giving away free tuition to their medical school. This type of medical school program is great for the healthcare system as it will reduce the amount of debt these future doctors will face when they graduate. These programs will also allow doctors to go into any specialties they want instead of focusing on high-paying specialties that will help them pay down their debt.

How do you think we can address the issue of physician diversity?

To address physician diversity, we need to make medical school more accessible. It starts with medical schools providing reduced or free tuition to students who want to apply but maybe can’t afford to attend without taking on significant student loan debt. Another way to make medical school more accessible is to work with community leaders to take charge of community outreach and determine what medical needs people have.

Typically, people who live in rural areas of the country don’t have access to the same level of healthcare as residents of cities or suburbs, so communities and their employers need to create more opportunities to educate everyone on navigating the U.S. healthcare system. The more everyone can take a proactive approach to healthcare, the better the healthcare system can become for everyone.

I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?

Like the rest of the healthcare industry, I think the status quo for this needs a major shakeup. We need healthcare consumers and providers to understand that the healthcare system needs to merge physical and mental health to be general health.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

The movement that I want to focus on is helping people take control of their healthcare journey. As a healthcare leader, I can inspire and help educate others about navigating the healthcare system, improving healthcare literacy, and using my platforms to share people’s stories.

How can our readers further follow your work online?

You can visit Health Karma’s blog, For the Health of It, for educational content. You can also reach me on LinkedIn or Twitter.

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.