Healthcare 2020: Some thorns, lots of roses

What’s the state of play in healthcare as we move into a new decade?

The title of this two-part article is a good summary of our opinion. Read the bad with the good or skip ahead to part 2, which includes quotes from many members of the Jarrard team.

Part 1: What’s not working

The shape of public dissatisfaction with healthcare has changed over the past year. Much of that is thanks to political debate, exposure of questionable practices across the industry and a general reduction in trust of institutions – which together have increased scrutiny on hospitals and health systems.

What makes patients dissatisfied with healthcare? Is it their doctor? Their hospital? The cost of meds? Their experience with their insurance company?

There’s plenty of blame to go around for Americans’ dissatisfaction with healthcare. But it’s worth asking whether that’s due to the actual medical care or the business of healthcare that surrounds the care itself.

Early last year, Gallup showed that only 48 percent of Americans are satisfied with “the quality of medical care in the nation.” Not even a third were satisfied by “the availability of affordable healthcare.”

Certainly, figuring out insurance coverage on a large scale could help – whatever form that takes. It goes further, though, as Dr. Freddy Abnousi pointed out on an episode of the podcast A Second Opinion:

“If you’re ill, this country is the greatest place to be. But if you’re well, there’s really not much for you.”

While there are certainly too many mistakes, readmissions and preventable complications occurring within the U.S. medical system, the quality of what science and medicine can accomplish is remarkable. Laparoscopic surgeries have replaced many procedures that formerly required inches-long incisions. Childhood leukemia is now a hurdle to overcome, not an automatic death sentence. Even straightening teeth can be accomplished with invisible plastic rather than bolting metal wires to your teeth.

As we were preparing this post, a colleague made the point with a profound example:

“I remember reading a story earlier this year about a patient in Chicago receiving a triple organ transplant. There are stories like this that happen every day in our U.S. healthcare system that get lost in all the noise.”

Still, if you’re just living daily life, health drivers (often referred to as social determinants of health) play far more of a role in your overall wellbeing and happiness. We as a healthcare system need to find ways to reassure people that they’ll be able to “exercise healthcare preferences when needed,” wrote the authors of a 2016 study in Health Affairs. That’s providing access to quality care, it’s streamlining scheduling, it’s helping people understand the quality and cost of the care they’re receiving. It’s helping people feel comfortable that they’re getting quality care in a timely and affordable way. It’s ensuring that people who pursue care aren’t caught off guard and potentially harmed by bills that show up after the fact.

Maybe most importantly, it’s helpful to not need those health services in the first place. Keep people healthy and the need for medical care decreases.

This is where we’re excited. There is incredible opportunity to improve existing healthcare delivery systems, helping provider organizations in everything from clinical improvement initiatives to partnerships and mergers. At the same time, leading providers can use their existing market share, clinical experience and operational framework to create powerful new programs for keeping people out of the hospital in the first place. Counterintuitive at first – “Why wouldn’t a hospital want people to need a hospital?” – it makes more sense once we recognize that so many other non-traditional healthcare companies like Amazon are getting in on the action. Vertical integration is doing the same thing, as payers and providers combine to create holistic, streamlined care for people – not just healthcare for sick people.

Rethinking an entire business model is a daunting prospect for any organization. However, it’s necessary in today’s healthcare environment, and it’s simply a good thing for the people our industry serves. If someone is comfortable in their home, has access to good food, can afford their insulin and has a great relationship with a primary care provider, they shouldn’t have to interact with the business side of healthcare nearly as much. They should have fewer – and smaller – bills coming in and lower insurance costs. On the other side, insurance companies will be providing more personal, health-focused services (covering food and housing, not just surgery and blood pressure meds). When that happens, how much happier will we all be with “the healthcare system” as a whole? And how much happier will they be in life in general?

Part 2: What’s working and what we’re excited about

The public narrative about healthcare is largely negative. We talked about it in Part 1. We cannot let the problems obscure the good that is happening, though. In our role as counselors to healthcare organizations across the country, we are fortunate to have a front-row seat to the hard, good work that is taking place. In some cases, the change is happening in response to specific problems. In others, it’s being driven by a proactive desire to avoid stagnation. But whether precipitated by an acute crisis or a long-term trend, many dedicated leaders across the industry are taking this moment for introspection and recommitment to create a better healthcare system.

With that in mind, we wandered around the Jarrard Inc. office and asked our colleagues about positive signs they’re seeing. We boiled down what they said below.


Healthcare is reconnecting to and celebrating mission and vision. This reconnects people to their core purpose.

Holistic care

Healthcare is still an industry that desires to do good. Hospitals and health systems continue to push advances in medicine and toward thoughts of wellness (mind and body, fitness and traditional healthcare).

Personalized care. Interventions and products can be tailored to individual patients based on their predicted responses and predisposition to certain diseases.

Prioritizing the wellbeing of physicians and other clinicians – the recognition that we need to care for them, so they can care for our communities.

Providers are driving toward intentionality with their patients, creating connections and forming relationships – and moving away from impersonal healthcare delivery.

Providers are thinking innovatively as they look to invest in underserved communities. As some disinvest in those areas, tremendous need remains. Those who have a core interest in actual service, as opposed to simply profits, recognize the opportunities to provide that in both urban and rural communities.


Making business work for patients, not the other way around

Transparency. For the first time ever, patients are starting to gain access to the cost of care and price for services. Still a long way to go, but it’s the first step in the right direction.

EMR interoperability. A lot of patient medical information can now live in one portal within a health system. Even disparate electronic systems are starting to talk to one another so your medical information can transfer and patients don’t have to repeatedly tell their history.

Movement toward outcome-based reimbursement models. As much as providers balk at this, attributing reimbursement to the quality of care in addition to the quantity of care is a good thing for patients. It will eventually lead to better outcomes.


Going on offense

With the status quo not sustainable, we’re seeing unique partnerships to find better ways to evolve delivery of care and access to it. The current landscape is bringing different minds together in ways we haven’t seen before. It’s inspiring and gives hope for what’s ahead.

The increased tensions between employers, providers and payers is driving some providers to tell their stories. This is a good thing, whether it’s about the power of their not-for-profit work, community investments, media relations or community relationships. Smart healthcare providers are recognizing the need to go on offense, to bolster what is inevitably coming from outside influences. They know that when they will most need a friend, it will be too late to make one.

David Shifrin