The United States is facing a critical issue as it fails to fulfill one of its main responsibilities - ensuring the health and welfare of its citizens. This has led to a dismal situation where the nation cannot accurately claim to be successful. A recent report by the Commonwealth Fund, "Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System," has shed light on this problem. It reveals that despite spending the most on healthcare, the U.S. ranks lowest overall among ten wealthy countries in four out of five categories.

Unraveling the U.S. Health System's Failures

Access to Care: A Critical Shortfall

Primary care doctors in the U.S. are the worst-paid physicians, leaving medical school graduates with huge debts and a strong incentive to avoid primary care. This leads to a significant number of people being uninsured or underinsured, making it difficult for them to access timely and necessary care. As a result, many individuals delay seeking medical attention until their conditions become serious and costly to treat.In addition, the lack of an effective primary care infrastructure exacerbates the problem. Preventive screening and higher-quality disease management suffer, as there is a comparative absence of proper primary care services. This not only affects the health of individuals but also puts a strain on the overall healthcare system.

Administrative Efficiency: A Burden on the System

Current incentives in healthcare are not focused on providing the best care for patients but rather on revenue opportunities. Insurance companies and healthcare systems benefit from this, while patients are left at a disadvantage. The system is driven by short-term gains rather than long-term health outcomes, making business performance the primary metric for success.Furthermore, the consolidation of healthcare systems is driving up costs to patients. Larger systems are buying up previously independent practices, reducing competition and increasing prices. This adds to the complexity and inefficiency of the healthcare system, making it harder for patients to access affordable care.

Equity and Health Outcomes: A Disparate Picture

Health disparities are rampant in the U.S. healthcare system. Approximately 80% of health outcomes are influenced by social determinants of health, while only 20% are affected by actual clinical care. This means that factors such as socioeconomic status, access to resources, and environmental conditions play a significant role in determining health outcomes.Without adequate primary care from an early age for everyone, many individuals enter the Medicare years with chronic conditions and low health literacy. This increases costs and reduces the effectiveness of value-based care initiatives. It is essential to address these social determinants and invest in primary care to achieve greater health equity.

Pharmacists and Dentists: Part of the Ecosystem

The dysfunction in the U.S. health system extends beyond hospitals. Pharmacists and dentists also experience similar complications. Consolidation in the pharmacy benefit management and digital health spaces leads to high costs, administrative inefficiencies, and a lack of access to primary care.In dentistry, greater integration of oral health into the ecosystem would help build the bridge between oral health and overall health. Shifting towards value-based care would incentivize prevention and personalization in care, improving the overall health of individuals.

The Importance of the Patient-Physician Relationship

The one-on-one patient-physician relationship has been largely forgotten in the current healthcare model. Health systems and insurers focus on business concepts such as "productivity" and "consumer-driven wants," neglecting the importance of a trusting and mutually respectful relationship.This is especially evident in the failures of primary care. Only through such a relationship can patients safely navigate the complexities of modern healthcare. We need to incentivize primary care for both patients and physicians to ensure the best possible care.

Social Determinants and Value-Based Care

Investments must be targeted at enhancing socioeconomic factors, physical environments, and health behaviors to encourage greater health equity. Without these necessary steps, the effectiveness of value-based care initiatives is limited.Ensuring every American has access to a foundation of health knowledge and preventative care is crucial. This can help mitigate costs, reduce chronic disease burdens, and allow Medicare to better fulfill its mission for future generations.In conclusion, the U.S. healthcare system is in a state of crisis. Multiple interventions are needed at all levels to reverse this dismal track record and ensure the health and welfare of its citizens.

At the recent NCQA Health Innovation Summit, a remarkable event took place where industry leaders came together to explore ways of advancing healthcare quality through data solutions. This summit served as a platform for diverse leaders and innovators to collaborate and address crucial aspects such as value-based care, health equity, digital quality solutions, and behavioral health.

Uniting for Healthcare Quality at the NCQA Summit

Connecting Through Superpowers

The industry leader at the NCQA's Health Innovation Summit emphasized the extraordinary power of connecting with each other. This summit, with its diverse participants, aimed to bring together leaders and innovators around a common goal of enhancing healthcare quality. As seen at the 2024 summit, various topics were addressed, including value-based care and health equity.One panel, "Women in Quality," provided unique perspectives from five female healthcare leaders. Guzman moderated the discussion, highlighting the importance of community, leadership, and personal growth. Key themes like integrity, trust, and personal stories were emphasized.O'Kane, as the leader of NCQA, not only accredits health plans but also patient-centered medical homes, with a focus on quality and health equity.

Embodying Leadership and Integrity

The panel started with a crucial question about embodying leadership. O'Kane simply stated that showing up is key after 34 years in the job. The panel's insights included remembering that every day is a job interview, acting with integrity even when unobserved, leaning into personal traits to influence leadership style, leading with purpose, curiosity, and integrity, and balancing personal and professional roles.

Using the "Kitchen Table"

The concept of the "kitchen table" was discussed, emphasizing the importance of support networks. Guzman asked about the significance of the kitchen table and how it supports core values. O'Kane highlighted the superpower of women in connecting with each other and shared an example from another NCQA HIS panel. Harris' work on enhancing access to diabetes digital therapeutics showed the impact of data and personal connection. This example demonstrated how one can forget one's ego and focus on a greater cause.

Overcoming Imposter Syndrome

Building and leading a culture of quality, equity, and trust can be intimidating, especially for women who often struggle with imposter syndrome. The panel discussed how to overcome this, with responses ranging from leveraging unique perspectives to creating peer mentoring groups. O'Kane emphasized the importance of trust in building culture and the need to address the widespread contemptuous distrust in society.

Final Thoughts

The NCQA HIS session concluded with key takeaways for the audience. These included doing homework and asking specific questions when seeking mentorship, embracing one's power and creating paths for others, and being conscious of living in one's truth and the impact of simple acts of kindness. O'Kane's powerful answer to the final question emphasized the importance of living in all aspects of life and not being limited by work.Laura Beerman, a freelance writer for HealthLeaders, was present to capture these important insights.