Rohit Khanna of Catalytic Health: In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System

An Interview With Luke Kervin

We need to get control of overall cost and wastage within the system. This is not an argument for lower drug prices only. Yes, we can certainly do with lower drug prices, but we can also do with lower administrative costs that eat up a big chunk of the overall healthcare budget. And we have to look at the waste within the system — 20% of our GDP goes towards healthcare and there is certainly a couple of billion dollars of waste in there!

The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.

In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.

As a part of this series, I had the pleasure to interview Rohit Khanna.

Rohit Khanna is the founder and president of Catalytic Health. He earned his MBA from Queen’s School of Business, his MSc from the London School of Economics and Political Science, and his MPH from the Harvard School of Public Health. He is the author of Misunderstanding Health: Making Sense of America’s Broken Health Care System, out October 19, 2021, from Johns Hopkins University Press.

Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?

I began my career in the pharmaceutical industry progressing through various sales and marketing roles and eventually started my own healthcare communication and education agency after seeing a massive gap and unmet need in the industry. With a Master of Science in Health Economics from the London School of Economics and Political Science and a Master of Public Health degree in epidemiology from Harvard

T.H. Chan School of Public Health, I realized that my academic background along with my practical experience in the pharmaceutical industry was a natural fit for this new endeavor. We’ve been fortunate enough to grow over the years and we have a great team that brings new products to market for our clients and helps them communicate the benefits of their medicines to patients and clinicians.

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

One of most interesting stories in my career is that our firm was tapped by a small company back in 2014–15 to help launch medical cannabis in Canada. That firm turned out to be Tilray, who would later go on to become one of the largest players in this emerging industry, and, as a result of that work, our agency was actually one of the earliest pioneers in creating the medical cannabis space in Canada.

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

There are so many, but I particularly like this one from Thomas Jefferson: ‘If you want something you have never had, you must be willing to do something you have never done.’ This has been relevant in my professional and academic life in almost every way because it has forced me to realize that achieving the things I want to achieve requires me to do things differently (i.e. in ways I have never done before). It is a great reminder that one must be willing to stretch oneself outside of one’s limits to achieve great things.

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

Fortunately, we are always working on exciting new projects that involve launching new medical devices and medicines which will help hundreds of thousands of patients achieve their health goals and improve how they live with various diseases and illnesses. Our role in the launch of these new devices and medicines is to help our clients educate clinicians and anything we can do to make that happen puts us closer to better health outcomes for patients.

How would you define an “excellent healthcare provider”?

To me, an excellent provider has a number of qualities but the one that, perhaps, stands out the most in my mind is that an excellent healthcare provider doesn’t just treat the disease; he/she treats the patient who has the disease. This is, of course, a subtle recognition that a holistic approach to disease management incorporates more than just the physical and recognizes the mental, emotional and spiritual components of good health.

Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID- 19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?

Well, when I think about the struggles of the American healthcare system as a function of COVID-19, I jump to three key areas. Let’s start with inequities in care delivery and access to care. What COVID-19 exposed in shockingly stark terms was that there are large swaths of the American population who suffer greatly from a lack of access to immediate and urgent care and that these inequities are concentrated in communities of color and low-income communities. Secondly, on a more practical level, the system struggled with communication. Whether it was the government agencies (CDC FDA, HHS, etc.), the public health units, the epidemiology community or the individual hospital, we did not do a good job (by and large) of communicating risk and benefit in a number of areas related to COVID-19. This resulted in confusion, anger and, most importantly, a lack of trust. Lastly, at the most basic level, the American healthcare system struggled with simple operational efficiency. Whether it was ordering PPE or figuring out how to get patients in and out for vaccinations, there were massive operational gaps exposed that should have been ironed out a lot quicker than we saw actually happening on the ground.

Fixing these specific issues is no easy task. For a problem like societal inequities, this is a long-term fix that requires government intervention and involvement and a paradigm shift that can take decades. For the other 2 issues (communication and operational inefficiency), the solution might be more achievable in the near-term but no less difficult. We need to invest in better systems and hire more people. We need to re- allocate wasted dollars in the health system to these high priority areas. And we need to learn important lessons from the COVID-19 pandemic because there will definitely be another pandemic in most of our lifetimes.

Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.

I totally agree. The obvious place to start would be with the development of vaccines themselves in less than a year from bench to patient. It would not be an understatement to compare this with some of the greatest achievements of the 20th Century including sending a man to the moon and the invention of the telephone. It was really that incredible and we have the bench scientists and researchers and manufacturers to thank for this along with a federal government that was willing to invest and invest with the knowledge that failure was a real possibility. Beyond this, the system excelled because of the frontline healthcare workers and their willingness to stretch themselves to the point of physical and mental exhaustion. There is no way that we would have made it to this point in the pandemic without the collective effort and selflessness of millions of healthcare workers across the country.

Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

1. We need to get control of overall cost and wastage within the system. This is not an argument for lower drug prices only. Yes, we can certainly do with lower drug prices, but we can also do with lower administrative costs that eat up a big chunk of the overall healthcare budget. And we have to look at the waste within the system — 20% of our GDP goes towards healthcare and there is certainly a couple of billion dollars of waste in there!
2. We have to find a way to train more clinicians (doctors, nurses and pharmacists) in general and we certainly have to train more clinicians of color and with more ethnic diversity so that our healthcare workers truly represent the communities they serve.
3. We need to approve drugs faster so that medicines can get to the patients who need them. There are countless examples of patients who have died waiting for drugs or for whom entry into a clinical trial or compassionate use of a therapy has been denied.
4. We need to better deal with pharmacy benefit managers (PBMs) and insurance companies who have an inordinate amount of control over what drugs get listed and reimbursed.
5. We need to improve health literacy in America. Research shows that people who are better informed about their health status are more likely to have better outcomes. In fact, let me be far more precise: differences between high health literacy levels and low health literacy levels have been consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality in those individuals who have lower health literacy

Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?

There is not an easy, one-size-fits-all solution to this problem. Of course, there are some obvious levers we can pull. We can start by admitting more people to medical school. I don’t have the exact statistics at my fingertips but somewhere less than 10% of medical school applicants actually make it to medical school. That means 90% of applicants go on to do something else. We can also make medical schools free to those who qualify or greatly reduce the tuition fees as large numbers of individuals are discouraged from entering the profession due to the high tuition costs (and eventual student debt). We can make it easier for foreign-trained physicians to meet the practice requirements in this country instead of having to go through onerous re-qualification and certification that is both time consuming and expensive. These are just a few of the ways we can immediately address the issue of physician shortages.

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

As a matter of record, I think that close to 60% of active licensed physicians in America identify as Caucasian and, so, we need to do a better job at understanding the underlying drivers that contribute to the lack of physician diversity. That’s the first place to start. After that, as I mentioned earlier, we need to make medical school more affordable for the underprivileged and we need to ensure that they are not saddled with debt coming out of medical school because simply shifting the debt burden to 10 years in the future doesn’t address the underlying issue in my mind. We need to address the number of medical school spots that are available. I think we can also get more diverse practicing physicians out into the communities, speaking at schools and mentoring young high-schoolers who are thinking about a career in medicine. There are ~250,000 physicians from visible minority groups (e.g. Asian, African American and Hispanic) It will come as no surprise to anyone reading this article that good role models can be a major source of career choice for young people.

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

This is a tricky question and one that requires some careful thought as the problem is multifactorial. In some situations, we can hire more physicians which will alleviate the immediate burden of physicians who are over-worked. In other situations, we need to be more creative with our recruitment strategies so that physicians in rural parts of America are not working 100-hour weeks and we are consistently attracting physicians to underserved parts of the country. In some instances, we might consider providing more training and ultimately clinical responsibility to physician assistants and nurse practitioners. In the end, all these issues are linked. By training more people and making sure we are reaching more diverse communities, we will naturally address issues of burnout. So, it goes without saying that there is a common thread running thorough all of these questions.

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

In order to bring about these changes we need all stakeholders to get involved which is part of the problem. There are so many stakeholders with differing views that it can be a daunting task to even agree on the problem and get everyone to the table! But, in a perfect world, we need governments, corporations and policymakers to provide the funding and the strategic vision to solve these issues. We need a 5–10-year plan that has tangible milestones and metrics to ensure we’re on the right path. And we need individuals and communities collectively to advocate louder and longer for change. As much as these are cliches, a lot of loud voices can bring about change.

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. :-)

If every publicly listed company on the NYSE and NASDAQ — ~6,000 companies at last count — could sponsor one medical, nursing or pharmacy student (especially those from underprivileged communities) by paying for their full tuition, we’d be able to address so many issues. This would be my moonshot idea that I’d like to see come to fruition.

How can our readers further follow your work online?

I love to hear from readers, and I can be reached for speaking/writing engagements or readers can access some of my select monthly columns on my website: www. rohitkhanna.com. Or they can read all my monthly columns at www.pmlive.com. And, finally, readers can also purchase my new book Misunderstanding Health: Making Sense of America’s Broken Health Care System at their favourite online retailer.

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