What if healthcare is not broken? And what if we're actually winning the opioid battle?
Here comes a counterargument to two widely held opinions: that the U.S. healthcare system is broken, and that we are losing the battle against the opioid crisis.
Instead, Dave Chase says, healthcare is already fixed because solutions exist to the industry’s biggest dysfunctions – and he has specifics to prove it, such as places in the U.S. that are turning around the opioid problem around entirely.
Chase, co-founder of Health Rosetta, is the author of the new book, The Opioid Crisis Wake-Up Call. And while there are bound to be plenty of skeptics to his argument, there’s also a lot to learn from considering his counterpoint to such widely-held perceptions.
Q. For starters, you make the case that "healthcare is already fixed," and now it's a matter of replicating those fixes. Can you elaborate?
A. When I say that healthcare is fixed, I mean that widely proven solutions already exist for healthcare's greatest dysfunctions. The backward incentive structure that pervades status quo payment and delivery options is being turned on its head by employers who are emphasizing value-based primary care, reinventing the way they design employee health benefits and using more informed purchasing strategies to leverage change across the industry. As the title of my book suggests, the opioid crisis is a wake-up call.
The opioid crisis has had tragic consequences across the country, and we also need to view it as a microcosm for the systemic failures of our health care industry – as well as, through examining the solutions that have actually proven effective, how to remedy health care's endemic weaknesses.
By looking at the ways employers, community leaders and health care experts are taking a stand against the opioid crisis and health care's status quo, we can eliminate the upstream causes of the current epidemic. As the rising benzos epidemic demonstrates, the opioid crisis isn’t an anomaly. Thus, we can’t fix it without thinking systemically.
Q. You also suggest that the American healthcare system is actually winning the battle against the opioid crisis. Given that many people will find that every bit as surprising as the idea that healthcare is already fixed, how are we winning?
A. It does sound surprising, because it's exactly the opposite of the narrative we're used to hearing. That's a big reason I wrote this book. to spread the good news about the healthcare revolution that's being spearheaded by everyday people all around the country. We're winning in places like Plumas County, California, which went from having the state's highest rate of opioid-related deaths per capita to the lowest – zero deaths, two years running.
We're winning with organizations like Rosen Hotels and Resorts, which has saved approximately $315 million on healthcare costs over the last 20-plus years and spent 50 percent less than the average employer, thanks to its emphasis on unlimited free primary care and transportation to appointments, and wise referrals to specialty care when it is necessary.
As much as we want to address those already enslaved by opioid use disorders, we have to go upstream to stop addiction before it starts. When there's proper primary care, such as at Rosen, there's no opioid issue. Their opioid prescriptions are at 1/6 the typical American employer despite having a workforce with physically demanding jobs. I'm gathering data on other employers who've also implemented proper primary care. I suspect they'll have a similar story.
Q. Since it’s our Focus on Innovation in September, what emerging technologies or business models do you see bringing about market transformation?
A. I'm really encouraged by the movements we're seeing from outsiders like Amazon, Apple and others venturing into the healthcare space. Their prowess in consumer-oriented, tech-driven retail, combined with their business acumen, can replace many of healthcare's standard business and technological models.
I also think when we look at ways different employers are contracting directly with healthcare organizations, that will upend the current relationships. Look at where the carriers are investing – it’s not in insurance. It’s in other parts of the value chain as they understand that they could get removed from the health benefits equation completely.
I'm also heartened by the innovations coming to the pharmacy benefit management sector. Slowly but surely, pharma's erstwhile "middlemen" are re-aligning themselves with purchasers' interests and providing more transparent pharmacy business.
Traditionally, PBMs work to increase insurers' profits off of different drugs – but if insurers are getting pushed to the margins by employers, PBMs are going to have to follow suit and become more consumer-focused. We're starting to see that as well.
Q. The subtitle of your book is "Healthcare is Stealing the American Dream." You refer to the opioid crisis as a self-inflicted wound in the text.
A. I use the phrase "self-inflicted wound" because unlike other public health crises of the past, like polio, HIV or ebola, our health care system has brought the opioid epidemic on itself through its misaligned incentives and flawed benefits purchasing structure.
As a result, everything that's come as a consequence of this system – from wage stagnation to inflated costs to fraud, waste and abuse – also fall into the "self-inflicted wound" category. Primary care has turned into little more than a revolving door of hurried appointments, unnecessary referrals for painful procedures and, subsequently, "quick-fix" prescriptions like opioids.
It's important to remember that opioids aren't even effective at alleviating most pain we experience. they just mask the symptoms, albeit less effectively over time. Other therapies, by contrast, like physical therapy and cognitive behavioral therapy, are shown to do the reverse. they reduce pain, with increasing efficacy upon each subsequent treatment.
So why doesn't our system promote the use of these therapies over the lower-quality drug-based treatments? Simple: The pills makes the health care system more money.
Q. You put a certain amount of faith in millennials because of their power to transform markets. How do you envision the healthcare market evolving as that happens?
A. Millennials are going to redirect the future of healthcare for the better. I see millennials differently than most others. they're conscientious, they make purchases that align with personal values – not just economic ones – and they prioritize their personal time as well as their personal choices.
All this is leading to a greater push for a more transparent, fair consumer-centrism in healthcare. companies that can't adapt to Millennials' ethical, economic and idiosyncratic demands just won't be able to compete in the new market.
Remember that in the next 5-10 years, millennials and post-millennials will make up 75 percent of the workforce. In many ways, the status quo healthcare system is designed as a perfect polar opposite to what millennials want and value. Whether it’s social media, smartphones or better food choices, we all ultimately want what millennials want.
Consumers shouldn't settle for anything less than the best in healthcare, and now with better technology, streamlined data integration and more efficient delivery options, we have the potential to save millions of dollars and improve millions of lives.
Health care incumbents are notoriously slow to change without a strong incentive from the markets. Millennials are providing that push. I commend them.
Q. Last question, the visionary one. When will health, hope and well-being be restored in our communities as you discuss in Part 3 of the book?
A. It's already happening. That's the good news. The caveat is that it can only continue to happen, and that well-being can only be replicated around the country, when people accept that they aren't powerless against the opioid crisis, and that it really is up to them to restore the American Dream. It will happen when we stop looking to Washington insiders or bureaucratic agencies to fix the problem for us.
The most powerful solutions for all of our country's greatest crises have come from the bottom up. from grassroots initiatives all across the country led by ordinary citizens clamoring for change. The opioid crisis is no different.
Of course there are times when we need effective legislation to codify those solutions, but they'll need to be devised and spearheaded by everyday folks who are simply sick and tired of healthcare making us sick and tired. It’s on us. The cavalry isn’t coming from D.C.