My dad’s cancer has made it clear: Our health care system is sick
I’m driving my 90-year-old father to and from the doctor. It used to be the other way around, parents driving kids. I was a mostly healthy kid and teenager, but when I needed stitches or medicine, I was always impatient with the process, ready to go home, ready to start playing baseball again.
Dad is just as eager to get home now as I was then, but there are differences. He isn’t going to play ball. He’s heading home from MD Anderson as part of a treatment cycle for cancer. And he’s old enough that cancer isn’t the only disease we’re trying to help him manage; there are his congestive heart failure and failing kidneys, too.
As the CEO of a health plan connected to a large hospital system, I regularly hear stories about the challenges of patients trying to navigate the health care system. I fall into the trap we all encounter: We think that when it is our turn to go down the rabbit hole of health care, we will know how it all works, and we will do better than those who don’t live it every day.
But seeing it up close from a patient’s point of view has hit me: The system sucks.
My mom, wife, brothers, sisters, in-laws, cousins and even his grandchildren help in their own ways. But one of the things our dad needs most isn’t easily available: a treatment navigator or an experienced care coordinator. Some of our friends might encourage us with the reminder that my dad has me: After all, I run a managed care organization!
But having a son in the business, so to speak, only helps so much (besides, they think I am only worried about how much it costs).
Dad’s outpatient care is time-consuming. We check in with one health care person on one floor, pick up paperwork and then go see someone else on another floor. We wait a while. Another health care person visits with my dad. And then we go to another location to see someone else.
I sit with him and send text messages to my siblings about him and his care: “Dad’s lab results today are … ,” or “Dad needed a blood transfusion today” or “They want to change his medicine.”
Some of my notes are about our screwy U.S. health care system. It’s not just that we’re wasting time, going from one place to another, picking up one thing here, another thing there. The process is stressful and disorienting to the patient, and it often results in missed data and delayed or mistaken care.
The CEO in me is part finance guy, part health care guy. But at my core I’m a policy geek, always trying to figure out how we can do a better job delivering and paying for health care. In the industry, this is called the triple aim: simultaneously improving health outcomes, lowering costs and improving patients’ experience of receiving health care.
Undoubtedly, MD Anderson is doing amazing clinical work for a 90-year-old man with cancer; my dad talks about how kind his caregivers are to him, and we all believe they’re trying to deliver great service.
But the experience of the bigger system sucks for my dad and the whole family, and I am pretty sure no one has any idea of the cost. Between Medicare and a great Medicare supplement almost everything is “free.”
Sometimes we can go the Katy location, which is easier for him and me. But often we must go all the way to the Texas Medical Center, with all its trying traffic, parking hassles and confusion of which building, which floor, which station, which doctor.
I think about the triple aim and how much easier it would be to achieve if our clinics and hospitals were built around patients. Not just processes, but actual architecture. Imagine building a patient-docking station, and all the health care providers came to the patient. A very few machines are so big and complex they must stay in one location, but most modern treatment methodologies can be mobile. (This is not a knock on MD Anderson; this is every health system in Houston.)
Imagine Dad is in his patient station, a one-stop shop for his care today. Nurses and doctors come to him, visiting in person and even electronically through telemedicine. There’s no confusion about where to go next, no wondering if we’re on the right floor or why we were sent to this place when maybe we need to go find an elevator and go someplace else. His records — electronic and physical — stay with him.
Hospitals and giant ambulatory centers are expensive to build, and for more than a century they’ve been built from a physician’s point of view or from an administrative mindset with more consideration given to cost-centers and consolidating personnel than to the triple aim. We can build new hospitals oriented to patient care and the patient experience, but it will take a while to get them up and running, even with power hitters like Amazon, Brookshire Hathaway and JP Morgan Chase eager to take a swing at transforming health care.
In the meantime, there are still better ways of managing patient care and achieving that triple aim of lower costs, better care and higher patient satisfaction, and that starts with human beings thinking through and then physically fulfilling care coordination.
Imagine Dad with his care coordinator or treatment navigator. Not me or one of my siblings, but an actual care coordinator from his insurance company and connected to the hospital. This well-trained and compassionate person would greet my dad and be his human patient station. He or she would have today’s care list for him and do her best to bring care and caregivers to him on a schedule adapted to his needs.
With his care coordinator, my dad would mostly be part of a human patient station. And his care coordinator would help combat some of the negatives my dad — and every person who enters the health care system — faces: fatigue, confusion, missed data, needlessly repetitive conversations and long waits.
I don’t know that we can actually change the system in time for my dad’s health needs. But sooner or later, when your family or my family take us to our appointments, I hope they’ll take us to a patient docking station. We’ll hear, “Don’t worry, your care coordinator is here, and all the medical providers will come check-in at your station. We’ll make sure everything is taken care of, together.”
I was with my dad last week. This week is my youngest sister’s turn. Next week, our other sister will take him to his appointments. We will all make notes, remind the rest of us about a new medicine or a different doctor. And then it will be my turn again. I’ll take dad from one floor to another, one station to the next. He’ll be tired. Confused. We will talk about baseball, we still do, always, if for no other reason than to keep us both from stewing about the crazy system. And all the while I’ll be redesigning the hospital and writing the job description for his care coordinator. This has got to get better.
Ken Janda (@HealthyTexans) is President and CEO of Community Health Choice, Inc. (Community), a Houston-based, nonprofit managed care organization that provides innovative health insurance plans focused on low-income families. He teaches health policies as an adjunct professor in the Jones Business School at Rice.
As published by the Houston Chronicle http://www.houstonchronicle.com/local/gray-matters/article/My-dad-s-cancer-has-made-it-clear-Our-health-12552137.php