Consolidation of medical records is needed (though privacy should be maintained). Improved standardization of hospital/surgery center billing practices is also needed. Telemedicine should be utilized to improve access to care. Also, medical case management (which is voluntary and based on patient consent) is needed to coordinate care better and to eliminate lack of coordination and communication among the providers and systems involved.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Paul Roberts.
He is the director/producer of a health care reform documentary, “Diagnosing Healthcare”. He has been involved in cost savings and the case management industry as a nurse case manager for over 20 years. In that time, he has developed a broad understanding of medicine and health care practices. Paul is also a health care reform activist and the owner of consulting firm, Roberts Consulting, PLLC.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
It was a day like any other in the summer of 2015, as I sat watching my daughter playing with her friends on the play equipment at Busch Gardens in Tampa, FL. Inspiration suddenly struck from nowhere as it often did. Though as soon as it came, it was also quickly dismissed. The notion of radically altering the face of health care in the nation was at once too daunting to seriously consider. Still, the ideas would revisit me time and again over the next year. I understood the merits of coordinated care as a nurse case manager. It is, after all, what we do. Far too often, complex medical care is uncoordinated and disheveled, which leads to inefficiencies and lack of communication as well as elevated costs. I knew that medical case management would be a prime solution to the problems facing our healthcare system. My idea, therefore, was to expand medical case management (which is mostly used in 5–10% of medicine, mostly in the Worker’s Comp. sector) to the wider healthcare arena. Ultimately, I took it upon myself over the next four years to more carefully and thoroughly develop an alternative health care plan utilizing case management as well as various other features.
In May of 2019, I began working with congressman Gus Bilirakis in order to introduce a bill to congress, featuring my alternative to health care plan. The frustrations of trying to move the plan through Congress led me to make a documentary on the subject, entitled “Diagnosing Healthcare”, in order to inspire a grassroots movement intended to place pressure on congress to enact the needed changes.
Can you share the most interesting story that happened to you since you began leading your company?
Working as an independent nurse case manager in the case management sector is not for the faint of heart. The current industry is quite niche, meaning that there are few suppliers of medical case management in an industry that is composed of about 95% Worker’s Compensation related claims, with only a couple of giant industry leaders. This makes for a jungle-like scenario for the few who risk going independent. I would be lying if I didn’t say that the first six months were very challenging. Not only do you have bills to pay, but you also have to survive in the jungle on your own. Fortunately, a combination of perseverance and fortitude ensure the survival of my company.
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?
I’m going to show what a novice filmmaker I am. While shooting on location at a local hospital in order to shoot a scene and to get B-Roll, I overlooked the fact that we needed pre-approved security clearance and approval for the location. It didn’t take long for security to intervene, and I soon heard from the administrator. It doesn’t take many lessons like these to learn from your mistakes.
What do you think makes your company stand out? Can you share a story?
Most people have heard of case management in the social services context, though they are usually unfamiliar with medical case management, which is the focus of our company. The company is also developing an artificial intelligence (AI) software platform which incorporates medical status with genetic information (to identify risk) and dispatches telephonic and field case management according to certain criteria. The system also focuses on prevention, education and medical records consolidation. The system, which will be licensed, was developed by the founder, Paul Roberts, and was featured in the documentary. Once fully implemented, the cost savings realized should be about 40%, relative to the current costs without the system. In the United States, this translates to a 1.4 trillion dollars cost savings per year and also improves the quality of care delivered. The plan, dubbed “Coordinated Care for All” was endorsed by the Case Management Society of America (CMSA) as featured in their industry publication, “CMSA Today”.
What advice would you give to other healthcare leaders to help their team to thrive?
Most importantly, believe in yourself. Rejections will happen, but don’t lose your focus. Remember who you are and what you stand for. There is a lot of noise out there — haters on social media and bold opinions. You have to quiet the noise and listen from within. I would say that the same advice applies both for the negative as well as the positive attention. It’s important to maintain balance.
Ok, thank you for that. Let’s 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?
As addressed in my movie, there are several reasons why the U.S healthcare system is flawed. As cited in the study, the U.S. ranked worse with equality of coverage. This primarily refers to people being left out in a system without universal health coverage. I am an advocate of universal healthcare. Currently, the cost of healthcare premiums often exceeds the cost of a mortgage. This is not acceptable. There is also a lack of access to care, either caused by the cost of medical care without insurance or a lack of access to qualified providers in a geographic area. Furthermore, special-interest lobbying among lawmakers and large institutional conglomerates formulate “closed-door” agreements (back-scratching) similar to cartels. All of this leads to price-setting, lack of transparency and ultimately inequality in the care delivered to Americans. Additionally, lack of oversight and uncoordinated care, particularly with complex cases, also contributes to rising costs in the healthcare system.
You are 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.
- Risk Prediction — The prediction of risk is based on genetic predisposition for a disease of condition (voluntarily submitted), as well as family history and current medical status. Example: A patient submits their sputum voluntarily for genetic analysis. Knowing their medical history and current status, our system identifies them as being 80% at risk for developing Type II Diabetes by age 52. This information and related educational materials are automatically dispatched to the patient to prevent the development of the related condition.
- Education — Our AI system disseminates free educational materials based on the medical risks identified, with an emphasis on prevention of a condition or the deterioration of a condition.
- Prevention — It is important to focus on prevention of a condition or disease, thereby reducing the burden on the healthcare system as well as the economy, and to promote overall health. Prevention should be holistic in nature, utilizing the most accepted principles in Western and Eastern medicine.
- Pharmaceutical legislation — We have all heard of the dramatic price increase, seemingly overnight, with the epi-pens, as an example.
- Improved Efficiency — Consolidation of medical records is needed (though privacy should be maintained). Improved standardization of hospital/surgery center billing practices is also needed. Telemedicine should be utilized to improve access to care. Also, medical case management (which is voluntary and based on patient consent) is needed to coordinate care better and to eliminate lack of coordination and communication among the providers and systems involved.
Ok, its very nice to suggest changes, but 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?
In terms of concrete steps, I will be going on a word tour for about 6 months, starting in September of 2020, in order to promote my movie on health care reform, as well as to promote the merits of the free market healthcare system and my alternative health care plan, “Coordinated Care for All”. Additionally, Roberts Consulting, PLLC is implementing the concepts of health care reform as featured in the plan. Furthermore, I regularly network with other leaders in the health care reform space including attendance at regular webinars and conferences. My plan is to continue working with Congress in order to implement the ideas in the plan.
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?
Concerning general health, there is too much emphasis on the management of symptoms, including medication. The focus should actually be more on prevention and the avoidance of a particular condition or disease. It’s similar to going over Niagara Falls. Once you have gone over the waterfall, you have to pick up the pieces. Additionally, I would say that mental health is vastly underserved and needs a great deal of attention.
How would you define an “excellent healthcare provider”?
When thinking about “centers for excellence” and the providers serving those centers, it seems to me that quality is much more important than quantity. Excellent providers, in my opinion, are well-informed of current trends and educational training but are also patient-focused and show empathy and understanding for their client, the patient. Furthermore, excellent providers collaborate well with other professionals in order to serve the common goal, which is patient care.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
It is a quote from my movie, “Healthcare is not a political issue, it has become one”. The quote speaks to me because of the political climate, affiliations and obstructions to achieving health care reform.
Are you working on any exciting new projects now? How do you think that will help people?
I think that implementation of the ideas supported in the alternative health care plan I have developed will significantly improve the quality of health care delivered, while at the same time easing the burden on the economic resources currently funding the healthcare system, not only in the United States but around the world.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
Yourfreedomhub.com is an advocate of the free market health care system and offers a weekly webinar which I regularly attend.
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. 🙂
My hope is that my alternative health care plan, “Coordinated Care for All”, will be embraced by the general publ and that this inspires a grassroots movement.
How can our readers follow you online?
I have a blog (paulroberts.blog) as well as presence on Facebook, Linkedin, YouTube, Twitter, and Instagram:
Instagram page: https://www.instagram.com/diagnosing_healthcare/
Thank you so much for these insights! This was so inspiring!