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Tuesday, January 31, 2017

The Price is not right. Indu Subaiya speaks out

apropos, see my prior post on Tom Price.

Indu Subaiya, to the Senate Finance Committee: Vote “No” on Tom Price: a perspective from the innovation community; January 30, 2017
Honorable members of the Senate Finance committee:

My name is Indu Subaiya, MD MBA and I am Co-Chairman and CEO of Health 2.0, the largest healthcare innovation conference and network in the world. I submit this letter to oppose Tom Price’s nomination for Secretary of Health and Human Services.

We know that the ACA reduces barriers to health care for millions of Americans, but what many don’t know is that it also fuels a vibrant segment of the private sector, the health technology innovation economy.

In a decade of working alongside thousands of healthcare innovators globally, and in chapters in over 40 US cities from Nashville to Boston, Dallas to Chicago, we have never seen our healthcare system adapt so beautifully to reward private enterprise while saving lives and taking care of our most vulnerable without the heavy hand of government.

Dr. Price appears to be a well-intentioned, educated man, but he has been out of both the practice of medicine and a transforming health care industry for too long to lead us in this dynamic market. Appointing him to architect a replacement plan for the ACA would be like hiring a dinosaur to build a space station.

What healthcare needs today is a pragmatic voice who can put pedal to metal on the progress that’s begun, who can work on reforming the ACA dispassionately with business leaders, entrepreneurs and patients represented in equal proportions, and who understands the healthcare innovation economy.

But Dr. Price is far too polarizing in his politics to be taken seriously by the diverse and moderate mainstream on both sides of the aisle. Those of us fixing healthcare on the ground have blasted silos, left partisanship at the door and figured out how to advance a common interest. Ask Republican Governor Charlie Baker, Republican former Head of the ONC, Dr. David Brailer, Chelsea Clinton of the Clinton Foundation, Mark Bertolini, CEO of Aetna, Bernard Tyson, CEO of Kaiser all of whom we’ve warmly welcomed on stage at Health 2.0 not just as speakers but as partners in the work of transforming health care.

Dr. Price on the other hand has never reached out to our community, and he’s had a decade to do so. Instead he has represented the Association of American Physicians and Surgeons, seen as a fringe group promoting self-interest, technophobia, and a “doctor knows best” philosophy. That era in medicine is over. The era of shared decision making, data transparency, evidence-based medicine and providers as partners in care and innovation is here. Our era needs a Secretary of HHS who will command the respect of the brightest lights in the healthcare innovation economy and Dr. Price is just not that person.

What do I mean by the innovation economy in health care? I am not referring to the old generation of electronic medical record companies (EMR) that indirectly received incentives under the HITECH act. I’m referring to the more than four thousand new companies and many more thousand jobs that were created in response to the ACA’s imperative to make health care more accountable for its outcomes. These companies have applied the best of American business and technological ingenuity to support doctors in their workflow and decision-making, to promote collaboration among caregivers, to avoid redundancy in testing, to improve patient safety and to allow patients to take more responsibility for their health and care.

As a sector, they’ve raised over 19.8 billion dollars in venture capital since 2011 because investors could bet on the momentum of a system aligning around the best interests of patients for the first time in history. What happens when you leave the doctor’s office or hospital has always mattered to individuals and families; but now it made business sense.

All this capital isn’t just lining the pockets of Silicon Valley startups. Economic development corporations in New York City, Massachusetts, Detroit, and Louisiana are making long-term, strategic investments in the health technology innovation economy to attract innovative companies to set up shop in their cities to provide badly needed solutions and to be powerful engines of job growth.
That’s great you say. We’ll keep this thriving and virtuous economy alive, we’re just going to get rid of the individual mandate, some nasty corporate penalties and poorly run exchanges that limit choice and raise premiums for patients and we’ll handle pre-existing conditions with hiving off those patients into separate pools. But that’s a fool’s errand.

It was precisely because the ACA widened the tent of coverage that new private sector markets were created. It was precisely because of exchanges that Americans woke up to the fact that you need to take responsibility for your health and spend your pre-deductible dollars wisely, and private sector businesses rose to the occasion to build tools to educate consumers on managing health care expenses and decision-making.

Overstretched health systems also see innovative technology as a way to do more for patients with less overhead, to reach people in rural areas and at home cheaply and effectively, to refer repeat visitors to the ER to a lower cost option in the community. Hospitals like Massachusetts General in Boston, Cedars Sinai in Los Angeles, Dell Medical Center in Texas, UPMC in Philadelphia and New York Presbyterian in New York City all have either started their own or participated in health technology innovation programs to test new models of care delivery in partnership with the entrepreneurial community in healthcare.

It was the ACA’s imperative to take care of a wider and more diverse population that created demand for new products to address the social determinants of health that are killing our small towns: caregiving burden, mental health, substance abuse, food insecurity, health literacy, social support for the elderly and so much more. These social ills normally depend on inefficient government programs. But thanks to the ACA, for the first time entrepreneurs have paying customers for solutions to these issues. Customers like public health departments, community clinics and hospitals. At the national conference we run on health innovation, the session on “Community Health” normally draws a handful of do-gooders. This past year you couldn’t get in the room if you tried; it was packed with entrepreneurs. The ACA had succeeded in creating a market for doing well by doing good.

The train of progress toward a healthier America and a more efficient health care system has left the station. If confirmed, Dr. Price would waste time trying to run after it only to get run over by it. We have better Republican candidates to choose from who have worked shoulder to shoulder with patients and innovators, who’ve been part of the transformation of American healthcare on the ground, not in DC and not in the ivory tower.

Don’t appoint him because you are comfortable with him as a congressman and a doctor. Neither role prepares him for this job. Don’t appoint him because the AMA endorsed him. The AMA is a friend to the innovation community but it speaks for a minority of physicians. You have already heard from thousands of doctors who aren’t involved in politics who oppose this nomination. Take your time and don’t rush this vote. Let’s fix what’s broken together without taking a wrecking ball to progress. On behalf of those of us with real experience making positive change in the trenches of health care, I ask you to vote “no” on Tom Price.

Thank you for your consideration.

Indu Subaiya, MD MBA
CEO, Health 2.0
Indu Subaiya, MD, MBA is the Co-Chairman and CEO of Health 2.0, a leading conference series and network for innovation in health care.

Indu is scary smart, and someone I've characterized as "the most cheerful person in all of health care." When she speaks, we do well to listen carefully.

Also relevant to health policy reform, my prior post "Put patients back in control of their health care."

BREAKING: Price confirmation for HHS Secretary advances without votes from Democrats
By Virgil Dickson  | February 1, 2017
The Senate Finance Committee has approved U.S. Rep. Tom Price as HHS Secretary in a vote that excluded committee Democrats.

Price's nomination still needs to be voted on by the full senate, which is likely to approve him along straight party lines. The vote took place during an executive session of the Senate Finance Committee called by Chairman Sen. Orrin Hatch (R-Utah)...
We are probably going to lose this fight, but we should press it forward in the full Senate nonetheless.

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