We need to change the way we pay providers. Right now, health systems get rewarded by getting you through their doors and doing more. And this isn’t their fault- this is the structure by which we pay them. They get paid to physically see you in clinic, to do the surgery, to scope you, to do more chemo, to do the c-section, they do not get paid to take the healthier less invasive route. And because of this we see increased spending but we do not see the benefit of good health outcomes. If we would pay health systems based on the outcomes of your care they would operate very differently. These types of financial incentives such as capitation and value-based payments do exist but any healthcare administrator will tell you they are not wide enough or strong enough to fully push providers to embrace this shift and change how they provide care.
Asa part of my interview series with leaders in healthcare, I had the pleasure to interview Meghan Nechrebecki. Meghan is a healthcare administration expert who has working to improve U.S. healthcare for over a decade. She is the CEO of Health Care Transformation, a healthcare consulting firm focused on strategy and implementation of the Digital Front Door and Digital Care Journey at healthcare organizations across the country. She is also the Founder of The Health Care Cube, the first-of-its-kind platform that crowdsources top healthcare expertise and curates the info into videos and tools you can stream.
Thank you so much for doing this with us Meghan! Can you tell us a story about what brought you to this specific career path?
I’ve been thinking about the market need for The Health Care Cube since back when I was earning my Master’s of Science in Public Health from Johns Hopkins. It has always been very clear to me that the general public does not understand how the healthcare system works and how to navigate their care. Most recently when I was managing value-based care and population health at the UCLA Health system I saw on the ground how the lack of patient knowledge lead to detrimental health outcomes and increased healthcare spend. Being in Los Angeles and watching every other industry use video, I saw this untapped resource and how it could be used to solve a great need in health care. And given that health care is incredibly complex and there are many different players on the ground who have useful expertise I knew we should crowdsource and curate that information for consumers. Given my background in analytics and operations improvement we would then support healthcare organizations to incorporate recorded videos in order to educate and empower patients to make the right decision.
Can you share the most interesting story that happened to you since you began leading your company?
You know, this isn’t a specific story exactly, but I think what has been so thrilling and rewarding to me has been the support that I’ve received from friends and strangers alike. Every time, and I mean every time, I have ever explained what The Health Care Cube is and what we have built they tell me “this is so needed”. And that’s incredibly rewarding when others can see and acknowledge the problem this solves. It is really special to me.
What makes your company stand out? Can you share a story?
We stand out because we are doing what’s right and what’s needed for consumers. The U.S. healthcare system is incredibly confusing so to give them a resource that will guide them through their situation- whether that’s a pregnancy or hospitalization or surgery or getting signed up for health insurance- we have crowdsourced the top expertise and given it to them in the format they want, which is short simple videos. We answer folks questions but we also give them the insider scoop that they wouldn’t even know to ask. We have incredible stories about our members who have gotten physically healthier, better understood how to manage their health insurance bills, and more. It’s been incredible and we love hearing how we have created positive impact in someone’s life.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
The huge pain point in the healthcare industry is lack of information to the patient. Right now, patients are only communicated with verbally or on paper. And you can imagine how this leaves the patient either hearing something wrong or forgetting what was said or simply not understanding. Recorded video acts as an extension of the healthcare team and it allows the patient to watch the videos at their own pace and place, rewatch them with their loved ones, and watch them in any language. The patient is better able to retain the information because it’s audio-visual learning. The videos are great because they take the work off the plate of the care team so they don’t have to have redundant conversations or maybe they didn’t even have the conversation with the patient because they didn’t have the time. There are so many benefits to using recorded video that will improve the patient experience and health outcomes and it will become a vital layer in their care.
What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)
- You will drink from a fire hose. When I started Health Care Transformation and The Health Care Cube I had to learn and do everything. I have always been a healthcare expert but now I feel confident that I’m an expert is so many facets of starting and running a company.
- Your resilience will be tested. Starting a company is incredibly difficult. Things will go wrong literally all the time. But attitude, passion, and work ethic push you along and will reinforce your resiliency.
- Find people who are also humble, hardworking, and smart. One of my mentors told me this after I learned my lesson too many times. It can be hard to find good people. Test them and ensure they are humble, hardworking, and smart. Otherwise they aren’t worth your time. Find those who are willing to give more than they get.
- The innovators are your first clients. I spent a lot of time reaching out and thinking that some of these old-school organizations would jump on the Health Care Transformation bandwagon. No- find your innovators and the others will come along once they have seen the social proof.
- Always work smarter not harder. Again, one of my mentors drilled this into me. I always thought I was working smarter not harder and then every time I look back I would think I was closer to the “harder” end of the spectrum. Truly analyze and critique what you are doing and what goal it is going to help you reach.
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?
Yes here in the U.S. we do in fact have one of the worst healthcare systems among the developed nations. We are incredibly high cost- we spend over $10,000 per capita and over 17% of the GDP. We have the worst health outcomes- for example, we have low life expectancy, high infant mortality, and high rates of unmanaged disease such as diabetes and asthma. About 27.5 million people don’t even have health insurance. We have terrible patient experience scores and levels of loyalty. The Net Promoter Score for healthcare organizations is typically in the teens. And our clinicians are burnt out with one physician committed suicide every day here in the U.S.
You are a “healthcare insider”. 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.
#1 We need to get everyone insured. #2 We need to change the way we pay our providers. #3 We need to change the way we provide care. #4 We need price transparency. #5 We need to better utilize our electronic medical records for communication and care.
Let’s start with #1: We need to get everyone insured. Right now, about 27.5 million people in the U.S. are uninsured. That’s about 8.5% of the population so that means about 1 out of every 12 people are uninsured. This leads to high costs and poor health outcomes so let me tell you a story that exemplifies why this is the case. There was a young man named Kevin who was uninsured. Kevin came down with an issue that probably could have been taken care of same-day in an outpatient clinic that would have cost maybe about $5,000. Due to this cost barrier, Kevin avoided seeing the doctor for his issue but then he ended up in a hospital bed and was there for weeks. This avoidable hospital stay cost the system over $100,000. This is what happens when we don’t have insurance coverage or we don’t have good insurance coverage- individuals avoid needed care and we all pay for it.
#2: We need to change the way we pay providers. Right now, health systems get rewarded by getting you through their doors and doing more. And this isn’t their fault- this is the structure by which we pay them. They get paid to physically see you in clinic, to do the surgery, to scope you, to do more chemo, to do the c-section, they do not get paid to take the healthier less invasive route. And because of this we see increased spending but we do not see the benefit of good health outcomes. If we would pay health systems based on the outcomes of your care they would operate very differently. These types of financial incentives such as capitation and value-based payments do exist but any healthcare administrator will tell you they are not wide enough or strong enough to fully push providers to embrace this shift and change how they provide care.
Which brings me to #3: We need to change the way we provide care in this country. Once we have the proper financial incentives in place, healthcare delivery will completely shift to focus on the consumer and their needs through what I like to call the Digital Care Journey. The Digital Care Journey is how you will receive high quality healthcare in the future that begins with inexpensive tools that reach the masses and works their way down to more individualized and expensive care. There will be much better technology to reach patients in their home through recorded and live video along with patient monitoring tools. Health systems will focus on keeping patients happy and healthy in their homes and stop avoidable ER visits and hospitalizations. Health systems will put resources towards teams and analytics that focus on population health management instead of the current volume-based care resources centered around billing improvement to increase revenue.
#4 We need price transparency. Until patients and providers have even the slightest understanding of what things cost we will struggle at reducing healthcare spend. A quick example relates back to a conversation I once had with a dermatologist that wanted to know the price of a lab that she was pulling quite regularly. When I told her we were charging over $200 per lab she immediately stopped doing it when not totally necessary. She probably reduced her individual provider spend by thousands of dollars in a single year.
#5 We need to better utilize our electronic medical records for communication and care. Right now they are based around billing and defensive medicine and are not truly developed to manage a patient’s care comprehensively. Also, we need a personal health record. Every healthcare system has their own medical record and we therefore lose continuity of care every time a patient goes somewhere different. This causes a lot of re-do of care. Think of it this way- it’s like moving to a new dentist and having them re-do your x rays instead of having the most recent dentist send over the xrays. It adds to the cost but doesn’t add value.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
I believe that our healthcare leaders need to continue pushing for change in the right direction. It is really difficult because many of the different players are entrenched in the current way of doing things. We need to keep advocating and pushing proposals forward that are feasible and create true impact. As long as we keep the patient and consumer at the forefront I believe we can do this. Consumers especially need to keep voicing their frustrations and learning more about how the healthcare system works. They actually have a lot of say- healthcare organizations are realizing more and more that they need to become more consumer-centric and do what is right for patients. I believe we can get there- we just need to keep fighting for what is right.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
My favorite books have been Being Mortal by Dr. Atul Gawande and Reframing Healthcare by Dr. Zeev Neuwirth. The main podcasts I listen to are Creating a New Health Care, also by Zeev, and Touch Point by Chris Boyer. I always follow the Kaiser Family Foundation for their reports and love whenever I find articles that link value-based care with the consumer experience and digital transformation.
How can our readers follow you on social media?
Definitely connect with me on LinkedIn and follow our company page at Health Care Transformation. I’m also personally on Instagram @healthcaretransformation and twitter @megh_nech_hct
We also have pages for The Health Care Cube so be sure to follow @thehealthcarecube on IG and FB and @thealthcarecube on twitter to get the insider scoop on how to navigate the healthcare system with fun videos and tips!
Thank you so much for these insights! This was so inspiring!