Healthcare Innovators and Our $6 Trillion Burning Platform for Change

March 26, 2019
The only way to both bend the cost curve and at the same time provide high-quality care to Americans, is for providers—in concert with Medicare, Medicaid, and private health insurer leaders—to make dramatic strides in innovation

Though I’m certain they don’t think of themselves as such, the actuaries working in the Office of the Actuary inside the federal Centers for Medicare and Medicaid Services (CMS) have for years now been acting as the 21st-century version of some combination of the Oracle of Delphi and the mythical Cassandra.

As the Wikipedia entry on the Oracle explains it, “The Pythia was the name of the high priestess of the Temple of Apollo at Delphi who also served as the oracle, commonly known as the Oracle of Delphi…. The Pythia was established at the latest in the 8th century B.C., and was widely credited for her prophecies inspired by being filled by the spirit of the god…Apollo.” After undergoing very complex, highly ritualized purification rites, the Pythia would on the seventh day of each month be led by two priests, into the adyton, and would “mount her tripod seat, holding laurel leaves and a dish of Kassotis spring water into which she gazed.” In a heightened state, she would answer petitioners’ questions and give advice and essentially predict the future.

Meanwhile, as the Wikipedia entry on the subject notes, “Cassandra was cursed to utter prophecies that were true but that no one believed.” As with the historical Oracle, the stories about the mythical Cassandra are somewhat tangled. But of course, what Cassandra is most remembered for is predicting the destruction of Troy—and being disbelieved.

So what does all this have to do with the Medicare actuaries? Well, for at least two decades now, the Medicare actuaries have been foreshadowing the blooming cost crisis that threatens to engulf the U.S. healthcare system, as total U.S. healthcare spending has inched up from 12 percent of gross domestic product (GDP) to 15 percent, and soon, to 19.4 percent, as of 2027. Meanwhile, the dollar number—$5.963 trillion in overall U.S. healthcare spending by 2027—is truly a gobsmacking number: essentially, six trillion dollars, and nearly one-fifth of the entire U.S. healthcare GDP, will be spent on healthcare, within the next eight years. And yes, that absolutely is a burning platform for change.

Indeed, that cost cliff that we’re going to be going over in this country in the next eight years, has become a Delphic theme recently, with CMS Administrator Seema Verma becoming more and more emphatic about the coming cost cataclysm, referencing the one in five dollars that soon will be spent in our economy, on healthcare, in virtually every speech. Will she also prove to be a 21st-century Cassandra, or will the industry listen to her? More importantly, even with the right motivations, can the industry move forward quickly enough to bend the cost curve?

As leaders from across the industry agree, the only way to both bend that cost curve and at the same time provide high-quality care to Americans, is for providers—in concert with Medicare, Medicaid, and private health insurer leaders—to make dramatic strides in innovation. The good news? Leaders from across the country are doing so, right now. Our cover story package  provides profiles of the four winning teams in this year’s Innovator Awards Program, as well as capsule summaries of six runner-up teams (longer descriptions of the runners-up will appear on our website).

So the good news is this: amazing strides are being made in innovating across U.S. healthcare, on clinical, operational and financial fronts. Change is happening, and we’re thrilled to be able to showcase innovative organizations here. So in this case, it seems the Trojans are listening to Cassandra. And we’re glad to play our part in helping to encourage change forward.

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