Universal health insurance, a focus on the end user, and a change to healthcare financing systems are top priorities for Asaf Bitton, MD.
Asaf Bitton, MD, MPH, recently took the reins as executive director of Ariadne Labs. The Harvard professor, Brigham and Women's Hospital primary care physician, and veteran of Ariadne Labs, plans to use his background as a primary care provider and new position to influence the way healthcare is delivered around the world.
HealthLeaders spoke to Bitton recently to learn what changes he thinks need to take place in the American healthcare system, as well as the roles innovation and primary care play in devising solutions. This is the second of a two-part series. Bitton's comments have been lighted edited for space and clarity.
HealthLeaders: What are the top three things you would change to deliver healthcare more effectively in the U.S.?
- Asaf Bitton: The first thing I would do is ensure that everyone in the U.S. has effective insurance coverage. I think that there's a moral and human case for everyone having access to healthcare, but I also think that there's an economic and a financial imperative. It makes economic sense to have everyone covered, both because of uncompensated care that the rest of the covered people end up shouldering the bill for, but also because health insurance and lack of health insurance traps people in jobs and limits movement across economic systems. It's something that every other developed country in the world has figured out how to do, and I think that we can do so as well.
- The second area is to refocus the system on the needs of its users—patients and families. We have a system that's incredibly complex, and it's often built around the needs of providers, or bureaucracies, or just the complexity of fragmentation. When we redesign systems to meet the user's needs, to meet the patient's needs, that North Star can help us see our way through complexity. Too often we forget that the people who will give us the answers are often standing right in front of us.
- The third area that I would change is the financing system. We're already seeing some change happen there with the move to value—but not enough. One of our fundamental challenges in the U.S. is that we have a delivery system that's designed around the idiosyncrasies of a payment model that just happened to come into being, as opposed to having a payment model designed to support the delivery of a healthcare system [constructed] around the user's needs. There are ways that we could pay for healthcare in a more rational and user-centered point of view to get the outcomes that we want at a more reasonable price.
HL: How does innovation play into those solutions?
Bitton: We need an innovation engine to drive all three areas.
- In terms of [insurance] coverage, we actually have a variety of models at state levels. Right here in Massachusetts, we've shown how one could cover over 99% of the population and not break the bank and not have chaos in the employer-sponsored health insurance market. We can learn and better scale things that work across different states to meet the needs [of] this big, expansive country.
- Similarly with finance, there are all these tests of better models for paying the right amount and paying in different ways for the healthcare we want. We need to keep pushing those tests and pushing to scale the tests that seemed to work, as opposed to just sort of letting healthcare continue to gobble up more and more of the U.S. economy. If we don't, then one day as healthcare providers, we will see that politicians and other stakeholders just don't want to keep funding healthcare at the same level if they want to build roads and schools and other great priorities. We've got to do our part to innovate through these challenges of making healthcare more responsive and more efficient.
HL: How does primary care factor into the solutions that you enumerated?
Bitton: We know from great evidence, both in the U.S. and abroad, that healthcare systems built on a foundation of primary care deliver better care at lower costs. That's 45 years of research distilled into one sentence.
Asaf Bitton, MD (provided)
When we then think about what primary care is, it's a set of four functions that are linked together:
- It means that a healthcare system provides first-contact access: the ability to take care of most of your needs in one place and to do so in a way that's affordable.
- Primary care is also continuous. It provides long-term healing relationships with providers or provider teams that know you.
- The third part of a primary care system is that it's coordinated. It helps you navigate through the fragmentation and chaos of our current healthcare system, coordinate care with specialists, and [as you] leave hospitals or come back from rehab, helps orient it toward your end goals, not just the entropy of the healthcare system.
- Finally, [primary care] is comprehensive, which means that it sees you as a person in your entirety, not just a disease, organ, or a person who's episodically stick. It sees you for mind and body, but it also sees you as a person within your family system, your community, and your culture.
[Around the world and in the U.S.], we're finding we can deliver primary care in a better way through teams that are connected by health information technology and focused on the needs of their communities. But they have to be paid and they have to be operating in a system where people have insurance in order to get that value. So without that financial coverage and without health financing mechanisms that actually reward them, primary care sort of dies on the vine. That's why it's so important that we focus on value-based payments that actually double the spend, orienting toward primary care, as opposed to just paying hospitals to do more.
HL: What message do you have for hospital and health system executives who are interested in innovation?
Bitton: We have to think about innovation not only as a search to produce new technologies or medical treatments. Innovation is also desperately needed to build more reliable, safe, and patient-centered experiences to improve outcomes. We too often get distracted by the lure of technology, and it justifiably has its place.
We need to also recommit, in every part of the health system, to create and maintain innovation design and care redesign engines that can improve the quality of our work and the experience of our patients every day.
And we need to create innovations in payment [models to support] innovations in care delivery. That will take time, it will take coordination, it will take courage, and it will take the long view to make it happen. But if we are to match the rhetoric of value-based care to our current reality, this more expansive, long-term, holistic view of innovation will be necessary.
Editor's note: We invite you to read part 1 in this series, where Bitton shares details about what influenced his career path and his leadership style.
Mandy Roth is the innovations editor at HealthLeaders.