The system needs to make tort law reforms, in part because it is so expensive. Many examples could validate this, but malpractice cases should be focused on providers that make intentional mistakes. Taking legal action against a physician should not be a catch-all for something minor that happens or pursued just based on the idea of being able to gain compensation from a malpractice suit.
As a part of our interview series called “5 Things We Must Do To Improve the US Healthcare System”, I had the pleasure to interview Amel Hammad.
Amel Hammad is a managing director at Conway MacKenzie, part of advisory firm Riveron, where she leads client services for the healthcare industry. She is based in Chicago and focuses on developing financial, operational, and strategic solutions for both distressed and healthy companies. Her healthcare experience includes restructuring and turnaround, interim management, enterprise assessment, strategy implementation, revenue cycle management, payor negotiations, capital raises, and mergers and acquisition advisory for healthcare systems, single hospital engagements, physician and dental practices, and post-acute and senior living organizations.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?
Healthcare found me. I fell into it by working in corporate accounting for a home health company and found myself continuing to find opportunities in healthcare. Even when I was thinking about leaving to pursue a different career path, the industry continued to hold my interest because it is always changing, extremely dynamic. The healthcare industry has a lot of opportunities for improvement, which is probably why I transitioned into management consulting. It gives me the opportunity to work with many different organizations to try to impact change.
Can you share the most interesting story that happened to you since you began your career?
As a management consultant in healthcare, I worked on one compliance project for a hospital system in Texas that lost its privileges under Medicare. At that point in my career, colleagues wanted me to get exposure to clinical environments, and they tasked me with shadowing a nurse and a physician in the emergency room and the psychiatric emergency department. As a finance and restructuring professional who focuses on helping organizations with a turnaround, shadowing gave me different insights into what happens on the clinical side. During many intakes, individuals came in from the street, often brought in by law enforcement. It was eye-opening to see the access points in a hospital system and its emergency services — and what psychiatric and emergency medical professionals have to encounter — because processes happened differently than one might expect. There is a significant amount of volume that can be performed outside of an emergency service, but often that is the only entry point available for individuals needing care. From my point of view, that was the most interesting project to date and good for me to see at that time in my career, because — as much of my work today focuses on integrated care models — that experience gave me more appreciation for why behavioral and mental health are important, and how organizations can integrate that into traditional medical care.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
As an entry point to management consulting, I learned the opinions and varied communication styles of a large group of academic physicians who practiced medical services and also taught medical students and residents. The group had some compensation issues and had been asked by practice leadership to do a better job of tracking their time. Their responses were, “Others might be able to track time easily, but physicians like us who also research and teach, it’s virtually impossible to track. If I come up with a great work-related idea in the shower, how can I be expected to track my time there?”
The mistake I made was assuming that everyone was willing to be flexible and change the way they work or operate. I quickly learned by observing many physicians, home health care aides, and various other professionals that another person’s job-related expectations might not easily align to certain processes that previously seemed straightforward to me.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
Failure and success are typical themes for my favorite life lessons, and a related quote is: “failure is a lesson learned; success is a lesson applied.” The desire to avoid mistakes or uncomfortable situations will not allow for growth, and many people coast through life afraid of failure, but the most successful people I know are focused on growth.
How would you define an “excellent healthcare provider”?
Excellent healthcare providers care about their patients but also understand that there is a business aspect to what they do. Excellent providers know that while they are providing care for their patients that they also need to operate a viable organization.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
More than an awareness of the latest industry care topics, what makes me a good healthcare leader is a focus on self-growth and self-realization. Those factors have a lot of influence on whether an individual is a healthy human being. Podcasts and books by self-help experts like Tony Robbins or Brené Brown can help audiences to be introspective and figure out what is holding them back from their intended paths in life. This is important because people who are not healthy usually have various traumatic experiences that they just have not dealt with and may use destructive methods to cope. And, as individuals, it helps to realize that effective care is not just about the body and how it functions, but things people are exposed to and the environments in which they live. Beyond the body itself, often these other unaddressed issues fail to drive positive outcomes.
Are you working on any exciting new projects now? How do you think that will help people?
My current project focuses on creating new services aligned with models that ensure positive outcomes. It responds to a major imperative in medicine — the managed care model (which involves capitated payments). These payment models are reshaping health care because providers are taking on more risk related to their revenue while they focus more on driving positive patient outcomes. The project I am currently working on addresses one aspect of this managed care imperative by improving medication adherence.
In the past — based on the way revenues and incentives were structured — physicians generally would not have spent time following up with patients to ensure they adhered by taking all necessary medications. For patients, adherence often relies on things that we take for granted, such as having adequate transportation or money for copays. These factors are social determinants of health and sometimes present barriers to getting necessary medication and care. My current project involves a company that reaches out to individuals to see why they are not complying with their medication and finds ways to remove those barriers. This effort allows patients to get their medication and ensure a better likelihood of a positive outcome. This current engagement is really flexing my brain to consider new ways of looking at revenue and determining what resources are needed to meet those revenue goals to allow providers to continue to reinvest and grow, while improving positive outcomes for patients.
Ok, thank you for that. Let’s now jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
.The main issue is due to a focus on treating symptoms rather than providing preventative care. Because of this mentality, many people lead unhealthy lifestyles and only see a doctor when conditions are severe, or people avoid seeing a doctor altogether because not everyone has easy or affordable access. In some cases, people with chronic conditions — but no insurance — will live with the chronic condition until it presents an emergency then visit an emergency room, and that costs much more than non-emergency care. Often, expensive visits could be avoided with preventative care.
Second, the nation’s policies and infrastructure demonstrate an attitude that health care is not a necessity. For the healthcare system, the infrastructure and policies are structured in a way where only certain individuals have access to quality care. Not everyone has access or can afford to get access, a depressing reality. And, because the system is not designed to address the social determinants of health, it is designed for people who are already in a position to have health care needs addressed. For those without access, who may need more support, the social services support that is currently in place may not be robust enough to serve the needs of patients. For example, if an individual has Medicaid, fewer physicians may accept it. Then, after finding a physician, getting to the appointment can be a big hurdle. Accessing care is something many of us take for granted. For example, I grew up in a city and assumed that everyone could use public transportation, but that is not the case for everyone who needs care. Many people face long wait times or unreliable transportation, which can cause missed appointments. And patients may lack other personal or community resources that might otherwise ensure adequate care. Improvements to infrastructure and other policies could ensure everyone has access to necessary health care.
Next, we need to allow the market to work itself and deal with the current problem of the third-party payer. Through Medicare, this good and necessary concept was introduced many years ago, but it was exploited, and a lot of regulations emerged around it to prevent it from being exploited further. Today, a free market could address when a third-party payer should or should not be involved. This is similar — for those who have a vehicle — to having car insurance. That insurance is not meant for a minor, inexpensive car repair but for situations when costs get over a certain threshold and people need insurance to pay for it. Applying that concept to the healthcare market, an encounter with the physician becomes a service purchased over the counter. In the past, there were times when people did not have insurance, but they were able to get the care needed. Until changes are made, a few powerful companies will continue to direct how the healthcare system works. By instead allowing the free market to work, pricing will fix itself, and the current entities will not entirely control how care is given to patients.
And payment models dictate how care is administered, not the other way around. Today, there is a shift in control for how healthcare is administered, moving to this capitated payment model where the risk is falling on the provider. In the model, providers have a certain amount of money to do what needs to be done and are incentivized for positive outcomes instead of multiple procedures. This is reshaping how the healthcare system works.
As a “healthcare insider”, If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
Health care provider organizations need to establish creative ways to drive efficiency while still meeting regulatory requirements. In part, this means addressing the disconnect between clinical and business experts within an organization, because the acumen on both sides is necessary to provide health care. The disconnect that often exists within organizations is part of the reason why distressed organizations seek my consulting services and guidance. Ultimately, provider organizations want to shape a cohesive approach that profitably drives good outcomes, while being compliant to regulations. One story a lot of people can relate to: clinicians often focus on the patient and making sure they meet regulatory requirements, but the same clinicians might not view the organization holistically. So, the finance team might say, “based on all the ratios, we’re overstaffed.” While the medical practitioners say, “Staff levels are necessary to meet regulatory requirements and ensure patient safety.” If the parties work together to determine where patients are and why the numbers appear overstaffed, then it enables positive change. They can move patients to different areas and meet minimum staffing requirements. Often outside guidance can help streamline this, and parties can work together to identify and fix the issues at hand.
Second, looking at patient care, there is a large push for providers to generate a high volume of procedures, which sometimes leads to unnecessary or highest-priced treatments when a simpler intervention might be adequate. Back in my own early adulthood, I learned that I had gall bladder disease, and the doctor’s first recommendation was surgery. I asked if there was any other option other than having surgery and removing an organ. The doctor said, “No. You actually don’t need the gall bladder, and this recommended surgery is a common procedure.” Then, I searched and visited someone who practiced alternative medicine and seemed very unconventional. When I met with her, she noticed that I bit my nails during that time, and she responded, “How much sugar do you have in a day?” When I asked how she knew that, she said, “You bite your nails.” Then she suggested that if I started eating carrots and potatoes, I would likely stop eating sugar and biting my nails. This made me consider listening to her advice and evaluating alternative or holistic approaches to medicine. Upon returning to the original doctor’s office six months later, my gall bladder was found to be in good health, and I still have that organ today. This personal example is a case that shows the healthcare system needs to stop pushing people toward high-priced procedures that may be unnecessary and instead look to find and treat the root cause.
Next — and closely related — treating symptoms alone needs to stop. An example here is something that many people who are active encounter. As a runner, I have learned that many people develop runner’s knee — inflammation due to overuse. Many physicians recommend treating runner’s knee with a cortisone shot, which usually blocks the pain signal that says something is wrong and that a runner needs to stop running. So, often runners who take a cortisone shot continue running with an injury but feel no pain. In cases like these, people need to stop treating the symptom and focus on fixing the root cause. This is not to suggest people should avoid running, but there are ways health care professionals could approach easing the pain of runner’s knee through therapy, stretching, and different types of yoga practices, and also strengthening different parts of the body so that the runner uses all of the muscles in the leg, not just the one that is causing the overuse. To fix issues like this one, merely treating symptoms needs to stop.
Fourth, I think the industry is transitioning into a more holistic view of care, toward payment models that support looking at a patient from start to finish. Payment models help to drive well-rounded care as opposed to just what one care provider sees in a single realm of expertise. To see how payment models can support better care management along the continuum of care, look at a hip replacement example. Before, this might entail having the surgery to get the hip replaced, and the patient gets stabilized, then gets discharged to rehab (at which point the hospital is done with the patient), and the patient moves through rehab — usually for three weeks — then is discharged to home. But now, there is care coordination where providers are incentivized to ensure that this individual’s care is done in an appropriate and cost-effective way, centered on a positive outcome for the patient. One entity is almost responsible for the individual, monitoring all the way through the care as opposed to fragmented management. A bundled payment model forces the providers to work together across the entire continuum of care because there is one payment for the entire incident. The model aligns providers in following the most efficient and effective route toward patient health.
Finally, the system needs to make tort law reforms, in part because it is so expensive. Many examples could validate this, but malpractice cases should be focused on providers that make intentional mistakes. Taking legal action against a physician should not be a catch-all for something minor that happens or pursued just based on the idea of being able to gain compensation from a malpractice suit.
What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
Patients and physicians can work together to treat symptoms better, and this means patients need to take a more active approach in how care is administered to them, not relying on providers to be all-knowing. This does not mean physicians cannot be trusted, but some physicians are trained a certain way, and they look at each symptom as opposed to making changes to address symptoms. By contrast, we have to ensure care recommendations are based on relevant research and facts, as some doctors express frustration with patients relying on WebMD or other informal web searches. That should be avoided, but the health care community should also ensure that the studies that go out to the public are based on research and facts.
One positive emerging trend is that corporations and wellness programs — especially with self-insured companies — are highly beneficial. These programs are getting individuals on track to become healthy and stay healthy. I have a good friend who struggled to ensure a healthy weight, chalking the problems up to aging, until her employer provided a wellness program that helped her learn about lifestyle habits that can be maintained long-term. She learned how to feed her body properly as opposed to just following a trendy or inappropriate diet. The program also helped her understand her biometrics and some other health issues that she faced. So, corporations certainly need to invest in wellness programs. Organizations also need to position the right type of wellness professionals to teach employees or other stakeholders how to go about life and effectively drive better health outcomes.
Additionally, there are often a lack of community resources and support in certain areas of the country. Without support from the community, it is hard for people to get the help they need or thrive in general. Because each community only as successful as its weakest link, communities can do a better job of supporting health and wellness. This can happen through activities, healthy eating options — developing and improving access to restaurants, food markets, and stores that provide good nutritional options. Communities can support health research and education, making sure that people have libraries and technology to educate themselves and take part in their own health care.
The COVID-19 pandemic has put intense pressure on the American healthcare system, leaving some hospital systems at a complete loss as to how to handle this crisis. Can you share with us examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these issues moving forward?
The pandemic put a financial strain on the system, in part because the higher-margin cases were considered to be elective procedures, and those cases were deferred. Hospitals also had to spend a lot more on supplies and address staffing shortages. Some organizations could cope with this, while others could not. On the one hand, there are many large, sophisticated health systems that have access to endowments and donors that can compensate for declines in highly profitable cases and increased cost, but regional health systems were struggling as they did not have the margin cushion and access to other funds that larger systems had. Struggling hospital systems needed more support from governments related to the pandemic and a playbook to ensure ongoing operations.
Also, in the United States, hospital systems now have to face the requirement of an electronic medical record (EMR), which was mandated by the government with good intent. The problem is that larger health systems were sophisticated enough and had the infrastructure and the capital to make an investment in technology in order to properly implement an EMR. But other organizations struggled, such as the single-site hospitals, smaller regional health systems, and especially the rural health systems that lacked the capital or infrastructure to implement electronic record systems. If such organizations were not at a stage sophisticated enough to do that but implemented anyway, it resulted in a botched implementation, causing a lot of working capital and financial issues. So, the system is struggling with faulty implementations of the EMR. The solution and any related legislation must address how to support those organizations in the system without the capital to invest. Some attempts have been made to address this through different types of programs, but those programs alone may not be enough.
How do you think we can address the problem of physician shortages?
We need to address needs and pay gaps in the lower-paying specialties such as primary care, internal medicine, and pediatrics. Here, physicians need better pay and limited liability regarding the costs of medical school. And part of this means offering scholarships for medical school or some type of student loan relief. A lot of individuals who want to help people by becoming a doctor come out of school with more than a half-million dollars in debt. Finding a way to limit that liability would generate more interest in the career path. A related issue for any practicing physician involves figuring out medical malpractice lawsuits. If physicians are not paid adequately, they will not be able to afford higher premiums associated with malpractice coverage.
How do you think we can address the issue of physician diversity?
I think everyone is struggling to understand why it is difficult for diverse candidates to not only be in the medical field but a lot of other fields, including finance. Many types of diversity issues impact professional fields, and socioeconomic diversity, in particular, is a key issue in health care professions. Some of the key factors include high costs of schooling, which is a barrier to entry, especially for groups of people who do not have a large financial safety net and might be especially risk-averse. The high cost of education often requires student loans, and loans may deter risk-averse individuals from entering the field. Beyond the cost of education, educational pedigree and background impact the ability of many students to enter top-tier schools that ensure career success. This is another barrier for many individuals from diverse backgrounds who often face a primary school structure that may not adequately equip aspiring students to attend top medical schools. And, while care organizations and patients all want the top candidates, everyone needs to understand that there are financial barriers to being able to get a medical degree. And if organizations can provide additional educational support or incentive programs (especially in primary care, or internal medicine, or pediatrics, which currently pay physicians comparatively low), then the incentives and higher pay may also be able to attract more diverse candidates.
I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
There is a strong connection between mental and physical issues; better outcomes will result from addressing both. That is why something like an integrated care model — which integrates primary care together with mental health — would benefit society greatly. From a mental health perspective, people who do not handle stress very well have a high tendency to have physical issues such as high blood pressure. And lots of people who lead very stressful lifestyles will have heart attacks or strokes. We need to be able to address people’s mental and behavioral health and stress management to avoid some of those physical issues that happen without proper stress management. Similarly, someone with a physical issue such as diabetes may then become depressed because their body is trying to fight off the physical imbalances, essentially meaning the physical complications could be causing the mental health issue of depression. And if providers are not addressing a patient’s depression while addressing the same patient’s diabetes, then patients like this may have diabetes-related complications for an entire lifetime as opposed to controlling diabetes as the mental health issues are addressed. An integrated care model that looks at physical and mental health holistically, seeking to improve overall patient health, will have great benefits rather than addressing issues in siloes.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
Lately, I have recently written and spoken about home health care as an emerging trend, and in-home care is becoming an important element ofwhat is next for the industry. This is part of the notion that health care and ensuring a healthy lifestyle does not just happen in one setting, such as a single visit to a doctor’s office, nor is it just for sick people, as it also involves preventative care. Because of this, health can be approached in a more holistic way. And developing convenient and effective ways of offering health care services within people’s homes — not just for older individuals with critical issues but for all types of patients — is a big part of a well-rounded approach to health.
How can our readers further follow your work online?
For healthcare industry insights as well as broader topics about management consulting, business turnarounds, business value creation, and more — several of my written articles, as well as highlights from events or podcast interviews are available at Riveron’s website. You can also connect with me or follow the company on platforms such as LinkedIn, where we post upcoming speaking engagements and other thought leadership on a regular basis.
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.