Dear Congress: Here’s How You Can Create Healthcare’s Future

Antiquated policy is holding back innovation. Here at 10 things lawmakers should keep in mind as they rewrite the rule book

Over the last 12 months, we’ve seen the start of a true revolution in healthcare. As the pandemic has turned our worlds upside down, health systems and consumers have embraced new ways of delivering and receiving healthcare. In both large cities and remote rural areas, telehealth visits have spiked since last March, and there’s been a growing enthusiasm among patients and providers for virtual care.

Such changes were already on tap, but the pandemic has sped up the arrival of digital healthcare exponentially. And there’s no turning back. Over the next two decades, the two of us believe that the organization of care online is the greatest opportunity that exists.

But one thing that stands in the way of this revolution — which has the ability to give people better care while significantly bending the healthcare cost curve — are the policies and regulations that govern our healthcare system. Too often those rules favor the status quo and incumbent institutions — and inhibit consumers and innovative companies trying to serve patients better.

That needs to change. We need to move away from the expensive “sick care” model of healthcare that dominated in the 20th century and clear the way for health assurance, a new approach that focuses on keeping people healthy; embraces responsible use of data and technology; and truly puts the consumer first.

As a new Congress and a new presidential administration come into power, here are 10 principles that should guide them when it comes to healthcare policy.

1. Reward health, not sickness.

The best healthcare policy would make people healthier while driving down the use of healthcare itself. What we all really want is to stay as healthy as possible and spend as little time as possible in doctors’ offices and hospitals. Over the next couple of years, as societies everywhere try to get past Covid, that will be important. We should think of healthcare the way we now think of energy: we want to reward using less.

The old healthcare industry was set up to reward everyone in the system when people used healthcare more. Insurance has always paid a fee for service — for an office visit, a surgical cut, an X-ray, an IV drip. Insurers rarely pay for health.

Over the past decade, policies have nudged the industry toward paying for quality and outcomes rather than fee-for-service. Most healthcare industry leaders know that’s the right direction. But progress has been slow. And that has taken its toll on companies developing health assurance services intended to keep people healthy instead of just treating them once they’re sick.

If we’re to reinvent healthcare and bring health assurance to life, policies must curtail fee-for-service healthcare and favor practices, products and services that keep people healthy and out of the “sick care” system.

2. Create an environment conducive to open innovation.

The healthcare system has long thrown up enormous impediments to innovations that might reinvent care. Yes, technology has always brought near-miracles to medicine, whether it’s the MRI, robots for precision surgery, or artificial body parts. But the way patients access and interact with the system hasn’t changed much in 30 years.

Across the country people are now inventing technologies that can transform the very model of healthcare — the way it’s delivered, the way it’s consumed, the way people work. Yet it’s been too easy for the healthcare system to reject such change.

Our two organizations — Steve runs Jefferson Health, Hemant is a managing director at VC firm General Catalyst — have partnered in a venture called Commure, whose goal is to build a platform for healthcare apps, something like the app platforms for Apple’s iOS or Google’s Android. If you think about those platforms, developers can build an app once for anyone to use. Data can migrate between apps — your GPS location data, for instance, can move into the Uber app; an appointment set by email can automatically populate your calendar.

Nothing like that exists for healthcare apps. Data about patients or outcomes or anything else usually is locked up inside a healthcare system or a stand-alone electronic medical record system, blocked from being shared with other apps. If an app is developed for one healthcare system, it’s often incompatible with the technology from other systems. Developers can’t independently build an app that all systems can easily adopt.

If policy is to aid innovation, it must prevent health systems from hoarding or blocking data. Policy must encourage the kind of openness we see in software elsewhere. It’s already moving in the right direction. The 21st Century Cures Act, signed in 2016 by President Obama, includes provisions that push for greater interoperability of software and more open data. But lobbyists and entrenched interests still try to derail some of the provisions. Entrepreneurs and innovators must help policymakers and health professionals embrace open innovation and strengthen rules that support it.

3. Put consumers in charge of their data.

Data is the fuel that drives health assurance. Data about users is key to helping them stay healthy, predict problems and spend less money and time on “sick care.”

All of that data must belong to users. Users must be able to decide what to do with their data, whether that means allowing an app to access it, sending it to a new doctor or allowing medical researchers to use it. Strong privacy laws must protect it.

Your records should be in the cloud, and the doctors you use can have a password to see them. If you want to change your cardiologist, you just change that password to grant access and block the old cardiologist. There is no reason your data shouldn’t be safely in your control.

Policymakers generally understand this imperative. In 2010, the U.S. Veterans Administration launched its “Blue Button” initiative — on the VA website, patients could click a blue button and download their medical records. The Centers for Medicare and Medicaid Services (CMS) started its own Blue Button initiative later that year. A Blue Button 2.0 is an attempt to increase adoption of data and API standards. The latest HHS rules giving patients the right to their data further this trend.

All that is a start, but awareness and usage of the data downloads remains narrow. Policy must continue in that direction in order for health assurance to work.

4. Give patients the power to be informed consumers.

Patients still have little ability to make informed choices about their care. Health systems and insurance companies guard information about pricing and outcomes. If you need knee surgery, you have almost no way to compare prices and quality around the country and choose where to go. You can find far more information about a flight on a site like Expedia than you can about the doctor who’s about to cut you open.

If today’s healthcare is to transform into consumer-first health assurance, we’ll all need the power to act like consumers. That means prices must be transparent to all of us, and we must have access to data about the quality of care provided by doctors, clinics, hospitals and so on.

That doesn’t mean just publishing price lists so we know that an Advil given in an emergency room costs $40. Policy should demand that patients can understand what to expect and what they’ll pay for it. If you are considering knee-replacement surgery and you like 10K runs, you want to know from each hospital: what you will pay out of pocket; the chance of you running that distance in six months; the hospital’s complication rate: and what other patients have said about that hospital and surgeon. After all, it’s what you’d expect when assessing contractors to renovate your kitchen.

5. Support responsible innovation and assure everyone access to good, affordable care.

Developing new treatments and new technology can take a lot of resources. That’s one reason that breakthrough innovations — TV, cell phones, genetic sequencing — often start out being too expensive for the masses before becoming cheaper as they scale.

As health assurance takes hold, we need policy that makes sure innovation doesn’t just make the wealthy healthier. Yes, we want to encourage entrepreneurs and innovators to develop advanced technology and premium services that, initially, may not be accessible to everyone. But we have a responsibility to make sure that those advances eventually benefit all of society.

Everyone should be assured of access to good healthcare that allows them to thrive and avoid bankruptcy. They should be able to see a capable doctor when sick, have access to services that will help them stay healthy, receive the medication they are prescribed, and have access to the procedures they need.

Health policy should assure good care for everyone.

6. Focus on safety, less on efficacy.

In medicine, most new products and services — pills, devices, procedures — must receive regulatory approval before being offered to the public. That’s a good thing. No one wants to go back to the days of snake-oil salesmen marketing a mixture of alcohol and molasses as a cure for gout.

Regulations demand that something new be both safe and effective. In other words, developers must prove their product or service won’t harm most people and will significantly help most people. Those requirements make securing regulatory approval — and offering new stuff to the public — much more burdensome than it has to be. It’s an impediment to innovation in health assurance, and to reacting quickly with new services when something like Covid rolls in.

We would never advocate that regulators let up on safety. But in this era of Google, social media and data, proving efficacy before going to market seems less important. We’ll all know soon if something works — especially once we move further into health assurance and much of the population has real-time data and digital medical records that researchers could study (anonymized, of course).

We need regulators to think of digital health assurance products the same way they would think about any other technology. Make sure a product is safe. Let consumers decide how good it is.

7. Don’t protect the status quo, and help health assurance emerge.

Health assurance is not meant to displace the legacy healthcare system — a $4 trillion industry in America. We’re not proposing destruction of what exists. The only way health assurance will happen is if the current U.S. healthcare ecosystem plays a role in building it.

Policymakers who embrace the development of health assurance must realize that the legacy healthcare industry needs help to move in that direction. Any policy that helps the current industry resist change will slow developments that will bring consumers a better care experience. The shift to health assurance is inevitable.

The best policies will help current healthcare players disrupt themselves and endure.

For example, well-meaning 20th century policy subsidizes hospitals that lose business, with the intention of keeping hospitals open in more communities. But that rewards costly physical hospitals when hospital systems must migrate to “hospitals with no address” — virtualized hospitals that might start with an online doctor visit and end with a patient directed to a nearby clinic or a specialized surgical center.

Similarly, policy should not protect insurance companies from losing their highly profitable role as middlemen. It should help them migrate to acting as valuable data suppliers or, perhaps, aggregators of health assurance services. Policy shouldn’t protect the profits of pharmaceutical companies, but instead help them become consumer-facing companies that compete transparently on price and value.

Importantly, policy should fan the embers of health assurance. During Covid, some insurance companies and Medicare began paying for telehealth and virtual visits, and such services exploded. Those changes should be cemented in place and built upon.

8. Reposition and retrain healthcare professionals and workers.

The U.S. healthcare industry employs nearly 20 million people. They became our heroes during the Covid crisis, and we must treat them as such as the industry shifts. But the truth is that almost all of them will see their jobs change dramatically or be eliminated in the next 10 years. Policy must address this, or the disruption will be devastating to families and the economy.

Artificial intelligence and other technologies are about to vastly alter the role of a doctor. Society — from medical schools to licensing regimes to professional organizations — must help transform how we select and educate physicians. Doctors in the era of health assurance will need to score high in empathy, communication and creativity — subjects not at the core of most med school programs. The best doctors will also know how to take advantage of the analytical power of AI.

The rest of the workforce will need a huge retraining effort because the hospital will no longer serve as the center of the healthcare ecosystem. Training for telehealth workers, providers who go to patients’ homes, genetic counselors, predictive risk managers, customer experience professionals and population health professionals will be imperative.

9. Get ahead of AI.

Artificial intelligence has enormous potential to change health and medicine. It is the key to building technology that allows professionals to deliver empathy at scale. Yet like any powerful new technology, AI comes with a potential to do harm. Good policy will get out in front of that possible harm, not react to it after it’s too late.

Companies typically use AI algorithms to optimize their businesses. For all their positives, what algorithms aren’t optimized for is doing the right thing or for displaying any transparency. From the outside, there’s no understanding of how decisions are made inside those software-driven black boxes, and no way to know if the companies are overtly or inadvertently behaving badly. The algorithms that manage internal operations strongly favor doing whatever is the most expedient, efficient and effective, even if that means, for instance, amplifying societal biases.

The last thing anyone wants is for health assurance AI to treat people differently because of the way they look, or their income, or where they live. Or for health AI to put patients at risk for the sake of profits.

AI technology is developing so quickly, we’re concerned that the usual processes for making policy or regulations will be too slow. One solution would be to adopt software-defined regulation, which can monitor software-driven industries better than regulations enforced by squads of regulation bureaucrats.

In the meantime, we encourage the health assurance industry to be intensely mindful of building ethical AI, or risk a public and regulatory backlash. AI can do its job only if it’s trusted. Loss of trust could derail health assurance.

10. Stop trying to pass a “Big Bang” solution.

Finally, even during this post-Covid strategic inflection point for healthcare, we believe that policy change should be constantly evolving, not the kind of major, all-encompassing legislation that often is proposed. The only certainty is that things will continue to change, often in ways no one can foresee. The technology that drives health assurance is still evolving. As the technology improves, new business models and new kinds of services will be imagined and implemented. That in turn will create jobs that don’t yet exist — and problems we can’t foresee

The best policies will put up guardrails that help make sure health assurance emerges the way we want it to and keeps the public safe, while allowing entrepreneurs and innovators to move the industry forward and leave the old, dysfunctional system behind.