RamaOnHealthcare November 10, 2023
We can do better, and the time is now.
Today, RamaOnHealthcare welcomes and sits down with Dr. Jeff Dobro, the Chief Innovation Officer at Transcarent. Jeff Dobro, M.D. leads efforts to design novel products and partnerships supporting end-to-end Member support services. His interests span from furthering evidence-based health initiatives to innovative opportunities that deliver trusted, simple, seamless, and connected solutions that drive value for clients, Members, and providers. Jeff is a board-certified Internist and Rheumatologist and an Associate Professor at NYU School of Medicine.
Jeff Dobro, M.D. Chief Innovation Officer, Transcarent
RamaOnHealthcare (ROH): Welcome to our Thought Leadership series! Please tell us how you feel about healthcare today and where we are headed as a country.
Jeff Dobro (JD): I am optimistic and expecting transformative new advances for healthcare across care delivery, patient experience, quality, affordability, and technology.
But let’s face it – the U.S. still spends much more per person than any other country worldwide, and our outcomes are among the worst. This just isn’t right. We’re doing our people a major disservice. We can do better, and the time is now. Change must come, and it will come, driven by employers who are spending their own money on their own people and can drive their healthcare programs in almost any direction they want. Consumers can now take much of their healthcare into their own hands with new technologies and broadening direct-to-consumer services.
We can do better, and the time is now.
These changes are happening now. Relentless cost increases are unsustainable, quality needs to be more consistent, and the experience in healthcare is amongst the worst in any industry. But we are now at that tipping point driving the sea change we all know must happen. We saw Haven take a run at the system, and the Haven story illustrates that change won’t come easily. However, Blue Shield of California recently announced plans to completely overhaul its pharmacy benefits manager (PBM) offering, estimating it can cut drug costs by 10-15%.
…the experience in healthcare is amongst the worst in any industry.
Providers are increasingly open to change. Consumers are taking more control of their health and care. Large employers are making aggressive changes in their health plans. At the same time, powerful technology, AI, and data analytic advances provide the impetus to power the changes needed to shift to a more sustainable and value-driven healthcare system.
Transformation of this massive system will meet resistance, but actual change is possible. I’m excited that we are at this inflection point, with effective and innovative solutions ready to deploy today that align with the goals of all these stakeholders. It will take companies like Amazon, Apple, Cost Plus Drugs, and Transcarent to drive that transformation – this is the iPhone moment for our industry!
…we are at this inflection point, with effective and innovative solutions ready to deploy today….
ROH: How has your background informed your point of view on healthcare today?
JD: I’ve been on all sides… provider, vendor, and employee benefits consultant. Stakeholders across the market are both eager and bracing for change. For the past 25 years, I’ve been intimately involved in driving improvements in our healthcare system, working alongside health plans, medical groups and health systems, employers, and solution providers. I’ve successfully developed creative solutions that impacted the many challenges we face from various roles, including: a practicing physician, a leader at health and care organizations such as Transcarent, One Medical, and RedBrick Health, and a senior advisor to a wide range of employers as a partner at both Mercer and Willis Towers Watson. I’ve also been lucky enough to lead an early-stage ACO management organization and witnessed what it takes to transform healthcare delivery on a value-driven basis truly.
Unfortunately, I’ve also had experience with many well-meaning organizations and solutions (ex: navigators, narrow point solutions, etc.) that have only added complexity and cost to the system without delivering the promised value. Yes, they may have been necessary to get us to where we are today, but they are not the long-term solution. I say, ‘Rather than keep navigating around the broken system, it’s time we solve the problems.’
‘…it’s time we solve the problems.’
ROH: We keep hearing that healthcare transformation is happening, but the system is becoming more complicated and “broken.” What do you think is happening?
JD: Yes, I agree. Let’s be clear, this is a $4T+ industry with at least 30% waste and widely varying quality across the country. Inertia, self-interests, and slow adoption of best practices and technology advances will continue to hamper the transformation to a true value-driven, more equitable healthcare system. No single constituent within the system can drive out the waste and cost alone.
Change is painful, and taking at least $1T out of the system runs up against the very structure of the current order. The more providers do, the more they get paid. When the health plans profits rise, the more costs increase and the PBMs continue to run a black box business that benefits from hidden fees and lack of transparency.
That said, folks in every area are doing things right. Civica Rx has successfully driven down the cost of insulins. Mark Cuban’s Cost-Plus Drugs has delivered a successful consumer drug affordability program where “everybody should have safe, affordable medicines with transparent prices.” Health systems nationwide are joining Transcarent to offer high-value, lower-cost medical services through unique employer-based offerings.
Countless industry surveys reinforce frustration, with people consistently saying healthcare is more confusing, complex, and expensive than ever before and is getting worse. The current patchwork of unaligned providers, nearly unlimited health improvement “services,” and open access to digital (mis)information has created a morass of disparate “solutions” and misaligned incentives that have added to the confusion that burdens the average person and those that pay for their care. The obstacles are well-documented. This is one topic that unites us as a country. No matter your background, we all have felt the frustration of navigating the healthcare system and the need for better access to high-quality care at lower costs.
…healthcare is more confusing, complex, and expensive than ever before….
ROH: The issues preventing a sustainable transformation of healthcare are many and varied, but as you point out, there are many well-intentioned, intelligent, and creative people diligently working to solve this. Who do you think is best positioned to lead the necessary change?
JD: As I noted above, we spend $4+ trillion on healthcare; that’s 20% of the GDP, and it’s expected to nearly double to more than $7 trillion by 2031.(1) This coming cost tsunami represents an unsustainable tipping point – the system must make a meaningful change.
With much of the healthcare spend being shouldered by employers, they are well-positioned to lead meaningful change. Employers last saw this rapid rise in healthcare costs in the 1980s and early 2000s. According to Willis Towers Watson (WTW), 54% of employers expected healthcare costs to exceed internal budgets in 2023.(2) In a post-COVID environment, managing employees’ healthcare has become a critical strategic imperative for employers, aiming to reduce costs and improve employee attraction and retention.
…54% of employers expected healthcare costs to exceed internal budgets in 2023.
With their large populations, purchasing power, and plan design flexibility, employers are demanding better solutions, and with their consultants, health benefits, and health services partners, they can drive the changes necessary to tame this system. Many of them are already leading the charge. These employers and their aligned partners are building innovative solutions that will lead to healthcare transformation.
ROH: What must employers do today to prepare for the upcoming change?
JD: As a hero of mine, Albert Einstein, once said, “We cannot solve our problems with the same thinking we used when we created them.”
Forward-thinking employers are engaging innovative health partners, like Transcarent, committed to keeping the people they serve at the center of their solutions, focusing on delivering superior health experiences, the highest quality of care, and lower costs. Employers will know they are on the right path when they find partners who have been purpose-built with aligned incentives to offer outstanding consumer experiences, drive successful engagement, deliver successful outcomes, and share meaningful financial risk to disrupt the status quo.
The Aon Health Survey, 2021 and Beyond report reflects these sentiments.(3) It reinforces that “plan designs that incentivize the use of high-quality, cost-effective providers and services are gaining traction to drive lower costs for employers and their employees while also improving health outcomes.”
ROH: What is Transcarent’s role in driving the transformation of healthcare?
JD: Let me start with why I decided to join Transcarent. I joined the team in 2020 because the organization was inherently built to work differently. We started fresh, with an orientation to address the breadth of healthcare’s problems without a reliance on “the way it has always been done.” Despite the many efforts of others, no one other than Transcarent has taken the necessary comprehensive approach of working with employers, payers, and providers to tackle the significant issues.
Transcarent was purposefully built from the ground up to be the One Place for Health and Care. We’re creating a new health and care experience that people love, measurably improves the quality of care, and reduces costs. By aligning our incentives with significant financial risk and those who pay for care, we are putting health consumers back in charge of their care – from the palm of their hand.
Our Care Teams and AI-powered care and support recommendation engines make it easy for our Members to find and use their employer’s entire benefit program suite, delivering high engagement while reducing the administrative burden on HR leaders. Through our personalized app, Members can get care in 60 seconds, find top-quality doctors, and access expert second opinions. From high-quality virtual primary care, top surgical care, and specialty care access – to transparent, affordable pharmacy benefits – Transcarent Members have access to a broad spectrum of care across the continuum.
Transcarent empowers employers to deliver health and care to their teams with a simple, fully configurable experience that enhances their existing benefits programs and health plans. With one contract, we provide trusted guidance and evidence-based resources to support everyday Member needs, confidently guiding them to the right level of care.
Transcarent empowers employers to deliver health and care to their teams with a simple, fully configurable experience that enhances their existing benefits programs and health plans.
We are driving change and will continue to do so, but we also understand that we cannot do it alone. We need everyone to join in. We invite all stakeholders, beginning with self-insured employers and those who work for them with the most at stake, payors, employer benefit consultants, and brokers, to help adopt and measure new approaches. As our CEO, Glen Tullman, says, “Innovation begins by doing something.” So, let’s get going and once and for all, solve for a better, more sustainable healthcare system and make it easy for people to access high-quality, affordable care.
As our CEO, Glen Tullman, says, “Innovation begins by doing something.” So, let’s get going and once and for all, solve for a better, more sustainable healthcare system and make it easy for people to access high-quality, affordable care.
ROH: Dr. Dobro, thank you so very much for sharing your insights and expertise with our Readers. We wish you all the very best in transforming healthcare!
About Dr. Dobro
When not redesigning systems of health, you can find Jeff kayaking or biking, reading novels, discovering new music, studying the latest advances in medicine, learning the ukulele, or hanging out with his family.
References:
1 “National Health Expenditure Projections, 2022–31: Growth To Stabilize Once The COVID-19 Public Health Emergency Ends”
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2023.00403
2 “2022 Best Practices in Healthcare Survey”
https://www.wtwco.com/en-us/insights/2023/01/2022-best-practices-in-healthcare-survey
3 “The Aon Health Survey 2021 and Beyond”
https://www.aon.com/2021-health-survey-results