Imposed maximums for pharmaceuticals. I just filled a prescription and the retail price was $450. My insurance brought it down to $80 and I asked the pharmacist if there was anything he could do since I normally pay $15 for a prescription (this drug was not on my list of approved medicines). The pharmacist applied a ‘coupon’ that brought the price down to $15. How can it be that something is discounted 97% and still acceptable/profitable by both the pharmacy and the pharmaceutical manufacturer? This only corroborates my point above on price transparency.
Asa part of my interview series with leaders in healthcare, I had the pleasure to interview Suzanne Garber, Co-founder of Gauze. Gauze is a comprehensive database of international hospitals that informs and connects the 1.3 billion international travelers annually with appropriate care anywhere, Suzanne Garber also directed and produced “GAUZE: Unraveling Global Healthcare” an award-winning, PBS documentary that highlights her journey to 24 countries, 174 hospitals and interviews with 65 healthcare experts. Her work as COO, International SOS and Managing Director, FedEx South America has taken her to 100+ countries and all 7 continents. Holding degrees from the University of Pennsylvania and Rutgers University, Suzanne has been featured in US News & World Report, The New York Times, Businessweek and hundreds of other media outlets / conferences that focus on globalization, risk mitigation, and international healthcare.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
Mycareer initially began in logistics at FedEx but, fifteen years in, I was recruited to do a different kind of logistics relating to healthcare, pharmaceuticals and emergency evacuations. Literally, people became, “what was in my box” as I ferried patients in the most expeditious and medically sound manner from point of illness to center of medical excellence. Fast forward another five years and I found myself on the patient side, in a foreign hospital, dealing with a congenital heart issue I never knew I had. That gave me the impetus to start Gauze, the world’s most comprehensive digital network of hospitals outside the United States that connects patients via API/web app for when they get sick outside their home country. Our software matches patients based upon criteria they determine important to them such as language, hospital accreditation, 24 hour ER, location and a number of other options. Gauze takes the guesswork out of international healthcare. In the meantime, I filmed an award winning, PBS short documentary on the subject of international healthcare that’s been shown at film festivals around the world, highlighting the importance of learning from healthcare systems in other countries.
Can you share the most interesting story that happened to you since you began leading your company?
We catalogue data so I’m not sure people would find that very interesting but I can share that we helped a US hospital determine which international markets could best benefit from their lifesaving work in pediatric oncology. Because we have the largest database on international hospitals, we knew exactly which hospitals around the world also had a focus on childhood cancers, which ones were engaging in groundbreaking technologies, and which countries would be most open to an ‘open border’ alliance. Because of the data analytics supplied, we were able to help save the lives of children in other countries by bringing a US solution to them that they might not otherwise have known about or been able to take advantage of.
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?
Early on, we would manually input data on hospitals into our system. We noticed that an unusually large number of hospitals were coded in Afghanistan. After analysis, we realized that unless someone doing data entry specifically selected the correct country, the system would automatically default to the first country alphabetically — Afghanistan. Needless to say, the number of hospitals in Afghanistan in our system has balanced out to where it should be. What we learned from that is to build in checks and balances along the way within the system to ensure information being added — whether origin of blood supply or number of board certified doctors or any one of our 50 line items — is verified at each entry point. It just took a little extra coding but we didn’t know it was a need until it became one.
What do you think makes your company stand out? Can you share a story?
Prior to Gauze, there was no database for hospital information anywhere. If you look in university libraries, you see a lot of databases for economics, diseases, population and for many other industries and metrics but nothing for hospitals specifically. Further to that, there is no definitive source, guide or standard for the actual number of hospitals around the world and how they are accredited or ranked. Gauze will be the definitive source on global hospital rankings through our scientifix and data backed algorithms that are able to objectively match patients with appropriate healthcare options around the globe. You will also be able to know, that while one hospital may be ranked 47,215 globally, it may be ranked #1 in that country.
What advice would you give to other healthcare leaders to help their team to thrive?
A team is made up of people and we look at our team as a collective unit of diverse and powerful individuals. In fact, empowerment is a key term at Gauze and for us, that starts with recruiting the right people with the skills we need. From there, we give our people the proper tools to perform their functions effectively and we actively seek their input into continually updating and improving our product. I know I don’t have all the answers and I’m proud of the fact that our team looks like our customers — they come from every corner of the globe, speak multiple languages, span from 19–76 years old, and are all passionate about healthcare and/or travel. Give people the tools, resources, and freedom to do their jobs well and they will.
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?
- Rising costs of care equating to patients avoiding care and/or declaring bankruptcy to pay for it (Source: https://www.pgpf.org/blog/2019/03/why-are-americans-paying-more-for-healthcare
- Lack of preventative care coverage and/or options (Source: https://www.newsmax.com/health/health-news/preventive-care-services-health/2018/06/12/id/865557/)
- Inaccessibility of care — either through prolonged wait times or untenable out of pocket costs (Source: https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-amenable-mortality-measured-by-healthcare-access-and-quality-index-2016)
- Rising mortality rates for specialties considered ‘safe’ or ‘routine’ in developed nations (Source: https://www.nationalgeographic.com/culture/2018/12/maternal-mortality-usa-health-motherhood/)
- High rate of medical error leading to premature death (Source: https://www.bmj.com/content/353/bmj.i2139)
In our film, we learned the criteria for high ranking in any nation was grounded in these 3 areas: Quality, Affordability, Accessibility. Dr. Steven Ullman, Deparment Chair of Health Management and Policy at the University of Miami equates it as “Price + Quality = Value”.
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.
- Price transparency. Most other nations have mandates or just good business practices to have all hospitals publish not only price lists but real costs of procedures. While the recent announcement by the President is a good start, it doesn’t go far enough to create true transparency. Thailand is considered a leader in this area as are the United Arab Emirates, Costa Rica and Colombia.
- Imposed maximums for pharmaceuticals. I just filled a prescription and the retail price was $450. My insurance brought it down to $80 and I asked the pharmacist if there was anything he could do since I normally pay $15 for a prescription (this drug was not on my list of approved medicines). The pharmacist applied a ‘coupon’ that brought the price down to $15. How can it be that something is discounted 97% and still acceptable/profitable by both the pharmacy and the pharmaceutical manufacturer? This only corroborates my point above on price transparency.
- Reward healthy eating. What we put into our mouths has a corrolary effect on our health. While there are many options to eat unhealthy foods, if organic, wholesome foods like fruits, vegetables, nuts and whole grains were incentivized to be eaten, that could curb our obesity epidemic which would have a direct relation to a decline in diabetes, hypertension and orthopedic issues. Asking a family to purchase an organic cauliflower that would be an accessory to a meal at $5.99/lb versus an entire KFC meal with full sides for slightly higher, is counter intuitive. We also see Frito Lay and Pepsi recording a $5.3B tax break and the state of New Jersey giving M&M Mars a $31M tax break to further reduce their costs, thus further marketing their products to consumers (while padding their profits). To counter this, I propose curbing tax breaks on unhealthy food manufacturers and removing junk food from government sponsored food plans while stepping up efforts to educate and delight children with the joys of healthy eating. These are easily enactable remedies that can have a direct effect on healthcare costs, life expectantcy and quality of life. This carrot/stick program has already seen positive restuls in England.
- Accessible and Immediate Electronic Medical Records. Not only is it an inconvenience to give your entire medical history to every doctor you see, but it can also create major issues if not entered correctly into the system. While filming our documentary, “GAUZE: Unraveling Global Healthcare,” we visited France, which has a nationwide system for medical records storage and retrieval. Each French citizen is given a “Carte Vitale” with a barcode on it that is unique to them. Their records are encoded into that barcode which follows them wherever they go. So, if they are having a mammogram in Marseille, the information recorded from that visit will be automatically housed in a central repository that can be accessed by the patient’s cardiologist in Cannes or neurologist in Normandy. Plus, the patient has access to the infromation as well; there is no need to dicker with a hospital to please, please, please send over the films to a specialist at a different health center without a charge or delay. Everything was automatic. I’ve heard American hospital administrators say that the patient does not own their records; the hospital does. That’s not the case in France, where information and ownership are co-joined.
- Overhaul the insurance industry. A few countries we visited have interesting insurance schemes that could work here in the US. Switzerland is one where all citizens are mandated to have private medical insurance. Each household is allotted a stipend for the most basic of coverage; individuals or families wanting to purchase more are able to do that and costs are capped for each household. Japan also employs an interesting system of “points” that is afforded to each citizen. Using up additional points for certain elective procedures incurs out of pocket costs. Healthcare in both countries is rated in the top 10 worldwide and life expectancy rates are both superior to those in the US. We could learn a lot by looking outside our borders…and paradigms.
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?
The recent announcement by President Trump that all hospitals must publish their price lists does not really get at the heart of the matter with regards to true transparency. What would be more appropriate is if hospitals published actual prices that they have been paid by consumers and insurance companies. This would give us a baseline of what procedures actually do cost, instead of publishing some nonsense number. I’ll give an example.
Hospital X publishes a price of $58,048 for a hysterectomy. On the invoice sent to the insurance company, it says that they gave a discount of, say, $43,103.50 leaving insurance to pay $13,450.50. The out of pocket cost to the consumer, in this instance, would be $1494.50. In another example using the same medical procedure, let’s say the published cost is still $58,048 but the insurance this time was given a discount of $22,918 and insurance then paid $35,130. So, instead of the published cost of $58,048 being what is required to be posted, the actual published price would be $13,450.50 — $35,130, since those are the amounts the provider was actually paid. Knowing that is being accepted as payment by the provider is a better indicator of the true cost of a procedure than some pie-in-the-sky number that has no substantiation or validity to it. In this example, a facility is willing to discount their “published” price between 39–74%. Pity the person who does not receive these in-network discounts.
As a case in point, I had gone in for a preventative colonoscopy a few years back. When I asked how much the procedure would cost, I received mixed messages from the staff with one saying she didn’t know and the other telling me not to worry about it as it was covered by my insurance. I checked twice prior to going under and in both cases, no one knew how much it would likely cost since they didn’t have a published price for that. Six months after the event, I received a bill for roughly $14,000. Were they kidding? Did they really think I would pay them $14K to have a tiny camera shoved up my behind? I was told I was out of pocket and responsible for the whole amount. When I protested to the billing department saying this was three times the national average for colonoscopy, the woman on the other end of the line told me that I was an anomaly as most people did not pay that much and I would be the unfortunate one to bring up the average for the ones who received better discounts. This billing fiasco was the impetus for my film.
Truly understanding and publicizing proper costs would also foster healthy competition in an industry where competition does not really exist at a consumer level. As patients (consumers) are corralled into networks mandated by insurance companies, their options can be very limited — especially for those not living in major metropolitan centers. What most patients (consumers) fail to recognize is that insurance company networks are not built with the patient (consumer) in mind but their own wallet. Networks are heavily dependent upon those facilities and providers that will offer up the highest discount — as evidenced in my first example of a 74% discount for the hysterectomy. In fact, if all healthcare providers extended the same type of discounting to every patient (consumer), there would be little need for insurance companies at all. But, that would dictate that each provider and facility have a solid understanding of their finances to begin with. And that, my friends, is another story for another day.
As a mental health professional myself, im particularly 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?
A few weeks ago, UK PM Teresa May announced that she was expanding services to treat mental health as seriously as physical health. And, why not? The two are inextricably conjoined and yet, in the United States, every single part of the body is separated into a medical specialty. Yes, great advances in science have been discovered by specializing by organ or body part but think of how many medical mysteries we could solve if we dealt with the body holistically. As an ovarian cancer survivor myself, my symptoms did not start in my ovaries but in my gut. How much wasted time I spent trying to figure out what was wrong with me by visiting various specialists who had no experience with female reproductive organs or cancer. The US is one of the few developed countries that sparingly acknowledges the benefits of integrative care for patients. We see some progress being made in this area as autoimmune diseases are becoming more prevalent and cancer centers may employ one integrative specialist on their team of dozens or hundreds. But, we don’t see widescale acceptance of holistic health to the degree we see in Asian countries. Furthermore, most insurances will not cover the cost of visits to integrative care providers, whether they are following a drug-free, holistic protocol or are a traditionally educated Western doctor.
In addition to mental health concerns, I would also include occular health and dental, since those two are also often left out of traditional healthcare plans. Last I checked, my eyes, teeth and brain were all part of my body.
How would you define an “excellent healthcare provider”?
We asked this question to dozens of patients while filming our PBS documentary, “GAUZE: Unraveling Global Healthcare.” The consistent answer was an excellent healthcare provider was one who provided healthcare at a reasonable cost within acceptable timeframes and had successful outcomes. In the US, we know we have an issue with the affordability aspect but wait times are commensurate with those of Canada or the UK and successful outcomes depends on who is defining “success.” (For our film, we called various pulmonologists and gastroenterologists to request a new patient appointment: wait times were in excess of 10 weeks.) In Europe, this definition is rather consistent, per the Publisher of the International Journal of Healthcare Management, Paulo Moreira. In the US, definitions of excellence can include available parking/valet, proximity to home, and in-network status (Source: https://www.beckershospitalreview.com/quality/hospital-parking-has-significant-impact-on-patient-satisfaction-for-seniors-survey-finds.html)
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
The guitarist Christopher Parkening often said that perfection is unsustainable and so we must strive for excellence instead. In relation to healthcare systems, there is no perfect system. Each system has its faults. So, for any candidate or leader to point to the UK or Scandinavia, know that each will have deterrents whether that be excessive wait times, lack of funding/long term sustainability, or staffing shortages. However, each of us can pursue excellence individually and I do believe it is incumbent upon each of us to care for ourselves proactively to the best of our abilities and thus contribute something positive to our healthcare system. That means eating well, staying active, having a positive mindset and therefore doing our part not to overburden the system unnecessarily. Yes, providers, the government, and insurers must be held accountable to excellent standards but so should we, patient (consumer) hold ourselves. We don’t hear enough of how WE / YOU / ME are also responsible for our part in the system.
Are you working on any exciting new projects now? How do you think that will help people?
We are continuing to build out our algorithm to create the world’s first and only truly science back ranking system for hospitals. The US has a system in US News & World Report, but it is peer-review based, not based on clinical outcomes or hospital data — many people don’t realize this. Similarly, Yelp, WebMD, HealthGrades and a host of other consumer review sites are not any more objective (and, some have been proven to contain up to 1/3 fake reviews on their sites). Having a purely scientific, data-driven ranking of healthcare institutions would help clarify what it means to be well-regarded institution and what is simply conjecture and public opinion.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I keep up with what is occurring in international healthcare and therefore participate in ITIC — the International Travel Insurance Conference, as well as IMTJ — the International Medical Travel Journal. The editor, @KeithPollard, is a prolific writer and has a great pulse on what is going on around the world, as does Patients Beyond Borders founder @JosefWoodman. I also listen to the @MedTourTraining podcast hosted by Elizabeth Ziemba as well as Dr. Bernie Fernandez on The Health Channel on South Florida PBS. One of my favorite thought leaders is @MartyMakary from Johns Hopkins. Finally, my favorite book is the Bible and I’ve personally witnessed miraculous healing in my own family; prayer is powerful!
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.
We have to get healthcare pricing right — from medical equipment and device manufacturers to pharmaceuticals to providers and beyond. I say this as someone who has struggled with pricing within my own company. But, I’ve never had to discount something 97% (like the example of that $450 pharmaceutical I was prescribed) or write off invoices to a distributor who then sold my product to a consumer who bore not only my cost but additional cost as well. I liken this to the $1100 bill I received from a laboratory. The $1100 was the “published” price. I had a contractual $200 co-pay for labwork, whether the final bill was $200 or $2000. Interestingly enough, the lab gave my insurer a discount of $900. I still owed the $200 and paid the provider lab my contractual obligation yet insurance paid $0 (not to mention the $1300/month monthly premium I pay. I don’t even remember if I met my deductible of $3000 so maybe I paid the whole $1100 anyway until my deductible was met). My point is, what value did insurance provide and what is my $18,6000/year ($1300 x 12 + $3000) providing me, especially if the provider could pass that discount on to me directly? Making healthcare truly consumer centric by offering consumers transparency, logic, and consistency in pricing works in other countries, why not here?
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Thank you so much for these insights! This was so inspiring!