Betting on the ‘complexity business’

Chad Michael Van Alstin,
Features Editor

Like many of you, I traveled to fabulous Las Vegas for the annual HFMA-ANI conference at the end of June (and to donate my paycheck to the craps table at the Luxor, but that’s our little secret). While this conference is certainly mostly for hospital systems and providers looking for ways to enhance the revenue side of their business, talking with folks about the human side of healthcare finance was inspiring. There are unsung heroes in this industry who really do want to fix the myriad of problems healthcare faces, and to some degree I’m still very optimistic that technology can allow that to happen – that is, once the innovators are free to innovate, as opposed to react.

To put it mildly, there are so many facets to the revenue side of the healthcare business – properly identifying patients, dealing with different insurance programs, cleaning and clearing claims, understanding the true cost of care, and so much more – it’s miraculous to me there are people out there with the knowledge and skill to make sense of it all, let alone develop solutions to help ease the burden.

But even with great minds and cool technology hard at work, the quest to automate this complexity seems like a never-ending battle, particularly as we continue moving toward a reimbursement system that is becoming entangled in the strings of corporatism, with the policymakers reactively reworking their programs in an apparent effort to ease the expanding financial burden placed upon government coffers, consumers, and providers.

In my view, healthcare is a bubble that will inevitably pop as the prices begin to overtake the reactive solutions, and that spells something very bad for the average person who is already having difficulty paying for their care – or even insurance for their care. And on that note, it also means less business for providers and systems that are – despite all the money that seems to flow through the incentive and reimbursement programs – often barely able to stay afloat.

Something Mark Frisse, M.D., MS, MBA, Accenture Professor of Biomedical Informatics and Vice Chair of Business Development, Vanderbilt School of Medicine, said stuck with me: “We’re not in the healthcare business, we’re in the complexity business.”

And he’s right. Whether by design or a series of reactions, we have created a complicated and convoluted system. For now, technology and public policy seem hellbent on making that complexity less complex – the irony being that the ability to make healthcare less complex through the adoption of automation is inspiring more complexity. That’s a system that cannot possibly last forever. Eventually, something has to give. We have to find a better way to manage and pay for healthcare resources, not simply make the complexity easier – otherwise, we, as a collective whole, are never going to get off this giant metal wheel.

I think history shows that problem solving is less about complicated public policy and more about simple ideas and market demands. Someday, healthcare is going to see a serious paradigm shift, but I doubt it will come until the technological advancements are free from the restraints of incentive programs, undue regulation, and an insatiable insurance scheme. For now, it seems technology is a double-edged sword, where one side of the blade is continuously adding resources to a seemingly autonomous system that is locked into the mindset that more resources will fix the problem.

I imagine the answer is going to come from simplifying this system, either by choice or because we’re no longer able to react and keep up with the problems being added into the mix every day. As consumers continue to struggle, the demand for life will motivate them to find creative workarounds. And in turn, the new paths they carve will inspire innovators to continue putting health and wellness into the hands of everyday folks, as opposed to a proprietary few. At least, I hope that’s the case.

Thank you for reading HMT. As always, I welcome your comments and questions – [email protected].