The Future of Healthcare: “Why we need price transparency” With Jeff Gorke of Stout
Pricing transparency. It would be nice if consumers knew the price of their care before their visits. Sounds easy but it’s a bit prickly. With so many variables, this may take a while. However, the federal government is trying to get hospitals and clinicians to post their “costs” (allowables) to patients. Consumers do not necessarily “know” the cost to them of care. For a variety of reasons, an office visit at Dr 1’s office might cost the patient $100 where that exact same office visit at Dr. 2’s office might cost the patient $175.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Jeff Gorke, the Managing Director of the Healthcare Consulting Practice at Stout. Jeff has been in healthcare for 30 years with a focus on strategy and operational improvement in hospitals and medical practices. Jeff is a nationally recognized healthcare speaker and thought leader and is a contributor to Forbes.com. He began his healthcare career running medical practices.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
My undergrad was in Finance and International Business so I thought I’d end up banking in New York City. However, I started my career at an insurance company that managed the Medicare Part B contracts in several states and fell into healthcare from there. The good news is thatI love what I do. There is change on a daily basis which keeps things interesting.
Can you share the most interesting story that happened to you since you began leading your company?
I lead Stout’s healthcare consulting practice and one of the biggest lessons learned is that right when you think you’ve seen it all, something else pops up!
For example, someone recently reached out to me regarding the rebuild of the healthcare delivery system for a country. The goal is to change the country’s entire delivery model over the next 10 years. That’s such an amazing, once-in-a-lifetime opportunity that I am really excited about.
What makes your company stand out? Can you share a story?
Stout is a global advisory firm specializing in Investment Banking, Valuation Advisory, Dispute Consulting, and Management Consulting. In my humble opinion, Stout “stands out” due to its culture and persistent dedication to relentless excellence and delivering the highest quality outcomes to our customers. Our dedication to client success and proven track record is what keeps our clients coming back to Stout. In fact, more than 60% of our engagements involve repeat clients.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
Certainly “disruptive” is talked about too often and loosely in the current business climate. But, candidly, that term does apply in the new healthcare delivery models that are being fomented. Innovations in healthcare include remote care (telehealth), new technologies on different areas of the healthcare delivery model, and tighter clinical integration to deliver high quality, lower-cost care with repeatable quality outcomes.
Moving forward, healthcare will be disrupted nearly daily, but the “the value add” question will need to be answered. If we deploy the newest and greatest healthcare widget when the dust settles has it a. solved a care problem, b. aided in the delivery of quality care, and c. made life better for our patients and clinicians?
“Pain points” in healthcare are what they’ve been for years. As healthcare delivery has morphed over time inefficiency and disparity have leached in. That is, our current delivery model has been built on a series of disparate, but inter-related, constituencies that have evolved or, arguably, devolved, over time. System disparity, generally, may be the significant “pain point.”
What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)
1. Remember that comp-sci major you bailed on? Bad choice.
I started my undergrad as a comp-sci/finance dual major. By the very nature of healthcare, I’ve developed a pretty good IT background. But, had I kept that comp sci concentration, I might’ve landed further up on the IT curve.
2. Beware of all of the moving parts. There’s so much disparity.
As I moved from the practice world into the hospital model and witnessed how those two are intertwined (and for profit, not-for-profit, and academic medical centers), I’ve learned a ton regarding the good, and bad, in our healthcare delivery model. These touchstones have bolstered my “education” on all of the moving parts.
3. Be patient…change takes time
When I pitch a solution to a client, I’ve learned to let the idea germinate and grow within the parameters of their center; their delivery model, geography, clinician mix, payer mix. Early in my career I considered that the right answer was there, right in front of folks. But nothing is ever that simple nor one-dimensional.
4. The healthcare model is unnecessarily complicated.
See the answer to #2.
5. As I mentioned earlier, right when you think you’ve seen it all, something else pops up!
Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US 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 US is ranked so poorly?
Our care in the U.S. is terrific. Nonetheless, let’s stipulate that the U.S. has plenty of room for improvement. Many items, if “fixed,” would go a long way to improving our “rankings” among western, high-income nations, mitigate care variation, and reduce costs to the system (and consumers). For example:
1. Healthcare in the U.S. is expensive. Most data elements support that assertion. Some of that expense lays in redundancy of care (e.g. different clinicians/different practice order the similar tests on the same patient), administrative burden, and IT outlays.
2. Historically, hospitals and medical practices have been paid on volume and visits and the system has both rewarded physicians on volume and clinics (in many instances) have been built to optimize that delivery model (e.g. increase volumes).
3. Our clinicians are burdened by required administrative function. Arguably some of that is good and makes sense but a fair bit does not.
I would tend to agree with what Newsweek suggested in the report: “ These could include strengthening primary care, supporting organizations that excel at care coordination and moving away from fee-for-service payment to other types of purchasing that create incentives to better coordinate care. These steps should ensure early diagnosis and treatment, improve the affordability of care, and ultimately improve the health of all Americans.” These are all laudable goals that would deliver financial efficiencies and should help deliver better patient outcomes. As I write this, the federal government and many commercial insurance companies are working to incent clinicians to better coordinate care therewith delivering higher quality outcomes. In fact, health systems are being penalized (by Medicare) for “controllable” issues in care delivery such as patient readmission. And, new paradigms like Accountable Care Organizations (ACOs) that better coordinate care and help patient manage their care with the delivery model are showing promise.
In summary, I would argue that our “care” is terrific, but our process, cost, and inefficiency can be arduous and expensive.
You are a “healthcare insider”. 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.
· Coordination of care
Healthcare continues to be, in large measure, a fee-for-service delivery model. That is, Dr. 1 sees a patient, performs an office visit, and bills for that visit. The more patients he sees in this model, the more revenue he generates. But coordinating care with other clinicians can reduce redundancy and bundled payment models (e.g. paying one fee for the treatment of a disease state like congestive heart failure) may help reduce inefficiency. In some of these models, clinicians have financial “downside” if costs go “outside” the bundled reimbursement. For instance, if a bundle pays $100 and the cost to deliver care is $110, the clinician might eat that extra $10 in costs.
· Pricing transparency
It would be nice if consumers knew the price of their care before their visits. Sounds easy but it’s a bit prickly. With so many variables, this may take a while. However, the federal government is trying to get hospitals and clinicians to post their “costs” (allowables) to patients.
Consumers do not necessarily “know” the cost to them of care. For a variety of reasons, an office visit at Dr 1’s office might cost the patient $100 where that exact same office visit at Dr. 2’s office might cost the patient $175.
· Adoption of tech and new modalities
Remote patient monitoring (for patient adherence to clinical protocols), greater use of data analytics and predictive analytics, more data science. The expansion of networks via 5G should provide broader reach to consumers for better e-health and, theoretically, keep patients “managed” outside of hospitals.
These tech components need to deliver value. These can’t simply be one-offs that bolt on to an IT system and return limited value to patients.
· Patient participation
Consumers must take an active role in their care. Diets of processed foods, limited exercise, and other sub-optimal lifestyle choices conspire to create “sicker” patients. Care is only as good as the patient’s adherence to their own well-being.
· Gene therapies and “customized” care
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
As the saying goes, “it takes a village.” The constituents in healthcare are many and often times have competing priorities. However, embracing the goal of delivering quality care, reducing costs, and system interoperability, efficient technologies can go a long way to improving care delivery.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
- Kevin Pho (“KevinMD”)
- Health Financial Management Association
- Medical group Management Association
- American Medical Group Association
- I follow the goings on at Alphabet, Amazon, and others to get a feel on how they are approaching the healthcare conundrum from an AI/Predictive and blockchain perspective.
How can our readers follow you on social media?
Thank you so much for these insights! This was so inspiring!