Dear Donald Trump, Jonathan Bush Has a Tweet For You on Inauguration Day
As the 45th President and his team take office, I, like millions of Americans, have many questions about how Donald Trump’s initial phase of “repealing and replacing” Obamacare will pan out. Will the new approach ensure coverage for those who became insured through the Affordable Care Act? Can market forces be effectively engaged to improve care and access, all while reducing costs?
Yes, it’s a lot to tackle — not only in terms of how healthcare is paid for, which is the heart of Obamacare, but how it’s delivered. More broadly, however, some of these efforts are misplaced. The government must remember that their job is not actually to fix it all—some of the best solutions might actually come from outside of Washington. I am convinced that industry innovators can reconcile the challenge of covering more people, while also making healthcare better and more affordable. Rather than attempting to invent or regulate solutions for all that ails healthcare, government should create the space for these innovators to create them.
To kick-start this, the government must put forth what all innovators and entrepreneurs crave: data. Whether President Trump knows it yet or not, the government itself doesn’t share the cost and quality data associated with the millions of healthcare services that taxpayer dollars buy through Medicare and Medicaid. This data needs to be released, and not in the limited dribs-and-drabs fashion we’ve seen government commit to up until now. If the government under Trump would pave the path for improved, secure data transparency, they would drive a tidal wave of improvements—from improved price transparency for patients, to better informed decision-making by clinical teams, to an onslaught of innovation from entrepreneurs who thrive on real-time information. Information is power. This would be huge.
We can’t expect patients to shop responsibly for their care when they don’t have reliable and accessible information about cost and quality of the healthcare services they use. Today, individuals gain very little benefit for time spent attempting to shop. A little bit of consumer power—fueled by data transparency—would have a dramatic effect on how Americans make health decisions. It would also begin to ignite market forces and pricing pressure that could ultimately make healthcare better and more affordable.
The same goes for clinical teams. If we expect doctors to make decisions that are both clinically appropriate and financially sound, they must be empowered with information. This demands the power of a network, which largely does not exist in healthcare because the data to fuel it is scattered across thousands of different hospitals and institutions. This is something a coalition of innovators and entrepreneurs can fix, if government gives them the space and data to do so.
Beyond making healthcare data more available and accessible to all, a priority for the Department of Health and Human Services should be to encourage innovation by reducing regulatory overreach. Trump and his team must realize that government can bring down the cost of care through policies that offer doctors incentive for delivering healthy patient outcomes at lower cost. The government does not have to dictate the journey and methods that doctors must follow.
For example, doctors who are currently paid based on patient outcomes are not free to use innovative technology that improves care; they are required to use government-certified electronic health records and government-created mechanisms for health information exchange. Doctors are even prohibited from innovating around how they share and pay for access to critical patient information. While basic commoditization of information is commonplace in every other aspect of our lives (think ATM fees, where you pay a small amount for your bank to exchange information with another bank), this is prohibited in healthcare. The reason is outdated government regulation—created before the era of the Internet—aimed at removing undue influence over clinician referrals. The result is that we continue to wonder why more data isn’t available and why innovation has taken hold in virtually every industry except healthcare.
Finally, the federal government needs to get out of the business of designing health technology. The Office of the National Coordinator for Health IT is a small agency causing tremendous ripple effects in healthcare by dictating the specific features, functionality, and design elements of electronic health records that clinicians are required to use. This is akin to a government agency telling Apple exactly what the next iPhone should look like. As a result, even aspiring innovators devote the majority of their development resources to fulfilling government requirements instead of innovating to meet market and customer demands.
If the federal government is willing to unwind itself from the many inadvertently over-architected programs, which have unintentionally limited the industry’s momentum, entrepreneurs and innovators will happily redefine standards for technology and connectivity. And, with better information, patients and care teams will make the best decisions to improve the health of America and its associated cost.
To sum it up: @realDonaldTrump It’s the innovators, not Congress, that will make healthcare great again. Pls give them room.
Jonathan Bush is co-founder and CEO of athenahealth.