Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What do organized crime and health care have in common?

John H. Wasson, MD
Policy
May 8, 2019
89 Shares
Share
Tweet
Share

During college and medical school, my summer employment acquainted me with members of organized crime families. Now, reflecting on my full career as a primary care clinician, geriatrician, and researcher on health care delivery improvement, I have discovered that several insights from organized crime could guide medical professionals’ responses to our country’s health care crisis.

Organized crime and the U.S. health care industry have more in common than might be immediately apparent. Both provide goods and services for which there is high, mostly inelastic demand—conditions ripe for profiteering. Both market sectors have been subjected to tight regulatory controls, which likely provoked their matching supply-side consolidations to a few big players. And with such massive profits at stake, competition among the few remaining players escalated corruption in both sectors to previously unimaginable extremes — corruption is now estimated to consume a third of U.S. health care’s waste, the sum total of which is greater than the entire amount devoted to health care in 90 percent of countries globally.

So allow me to introduce Tony. A paragon of organized crime, Tony was an international union leader, an invited speaker at an Ivy League university and a candidate for a United States Cabinet position. Tony was laser-focused on maximizing financial gain, but his ambition never reached a level of greed that would have attracted too much attention or inflicted excessive damage on his host. Tony was eventually found guilty of extortion, bribery, and tax evasion, but he had cultivated friends in high places who submitted supportive requests for leniency to the authorities, and with this brand protection strategy, Tony served only three years of his 20-year sentence. Nonetheless, Tony’s indictment signaled the need for new methods and personnel, and the simple, cash-based money laundering and bribery of Tony’s day were aggressively adapted to the large-scale, untraceable currency transactions of today.

Considering Tony’s experience along with my medical training, clinical practice, and research, I suggest that U.S. health care could be guided by the following three lessons:

1. Don’t damage the host,
2. Protect the brand, and
3. Lead necessary adaptation.

With the total cost of U.S. health care approaching 20 percent of GDP, we all know that the holy grail in contemporary clinical practice is reducing costs while improving outcomes. As a clinician, looking at the enormous sums dumped into new initiatives and institutions that would never reach patients, I felt for a long time that I couldn’t do anything to stop the fiscal hemorrhaging. Like clinicians nationwide, I struggled to deliver continuity of care in a professional environment characterized by rapidly shifting alliances among professional guilds, hospitals, pharmaceutical interests, political entities, and investors.

But in 40 years of clinical practice, I observed that patients who lack confidence in their ability to manage their health concerns use a great deal of expensive care that they don’t actually need. So several years ago, my colleagues and I began designing and testing a simple method of leveraging health confidence to assess health risk and deliver the care our patients want and need, when they want and need it. We found that five patient-reported measures reflected our patients’ quality of life and were as accurate at risk stratification as computer-generated predictive analytics. These few measures also minimized our guesswork about what mattered to our patients and effectively directed our interventions. We called the five measures — low health confidence, bothersome pain, emotional problems, multiple medications and the sense that the medications are causing illness — the What Matters Index (WMI).

My colleagues and I have since found the WMI to be a feasible and ethically sound basis for care delivery. In line with what I learned from Tony, the WMI limits damage to the host, reducing the total cost of care by eliminating the insane patchwork of complex process and regulatory measures used to define health care “value” in favor of just five simple, easily remediable, cost-effective, patient-reported items. The WMI’s emphasis on what matters to patients also alleviates U.S. health care’s image problem among the general public. Moreover, the WMI’s aggressive adaptation of chronic care management away from the inscrutable algorithms that currently fail to identify many at-risk patients results in more effective and equitable care delivery.

To illustrate a WMI application that improves care and reduces costs, consider adapting treatment for the common chronic condition of high blood pressure. Currently, pharmaceutical interests ply a confusing array of products to clinicians who schedule more than 40 million visits each year for hypertension. As summarized by a commentator on a very large controlled trial: “Fixed-dose combination (polypill) therapy … is an effective, scalable strategy that improves adherence, and thus [blood pressure] control. This therapy also can be efficiently incorporated into multilevel interventions through simpler supply chains, fewer pills, and ultimately fewer outpatient visits.”

However, despite the advantages of polypill therapy, only 15 percent of poor hypertensive patients and 30 percent of the non-poor are health-confident and engage in regular self-monitoring of their blood pressure. For the vast majority of hypertensive patients who lack confidence that they can manage their health problem(s), our clinical experience has shown that improving their health confidence is the most effective motivation for patients to engage in regular self-monitoring. Thus, and for a broad range of chronic conditions, my colleagues and I have found that understanding what matters to all patients and helping them to become more health-confident improves care while reducing costs.

Of course, our profession needs to adopt other practices to reduce damage to the host and protect our brand. For the first goal, we could redirect hospitals’ public relations budgets into the education of medical students to reduce or eliminate the debt burden that pushes those students toward lucrative specialties and questionable billing practices, and we could accept the reality that many costly educational and training practices are based on irrelevant traditions and restrictive guild barriers. Toward the second goal, we need to work towards ending kickbacks, such as those that supported the current opioid epidemic, and we must report corruption.

In many ways, whether we recognize it or not, medical professionals benefit from the current system’s faults, as frustrating and exhausting as those faults can be. But if we are to maintain the respect our patients have generally afforded our profession over the years, we all need to get involved in developing better methods for delivering health services. So I hope you will encourage your patients to participate in WMI-based care delivery.

John H. Wasson is a geriatrician.

Image credit: Shutterstock.com

Prev

What volunteering during a crisis taught this medical student

May 8, 2019 Kevin 0
…
Next

How to manage narcissistic doctors

May 8, 2019 Kevin 13
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
What volunteering during a crisis taught this medical student
Next Post >
How to manage narcissistic doctors

More by John H. Wasson, MD

  • Telemedicine for proficient, longitudinal management of chronic conditions

    John H. Wasson, MD

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • What do cement trucks and health care have in common?

    C. Todd Staub, MD
  • Health care and the airline industry have a lot in common

    Abraham Morse, MD, MBA
  • Why health care replaced physician care

    Michael Weiss, MD
  • Health care is not a service commodity

    Peter Spence, MD, MBA

More in Policy

  • Unveiling the global pandemic threat: insights into risk factors and urgent measures for prevention

    Ton La, Jr., MD, JD
  • Why the WHO’s pandemic accord is critical for global health care

    Elizabeth Métraux
  • The revolutionary Kaiser-Geisinger deal: How health care giants are reshaping the industry and empowering patients

    Robert Pearl, MD
  • Unveiling the intricate link between housing costs and health care

    Harvey Castro, MD, MBA
  • Uncovering the truth about racial health inequities in America: a book review

    John Paul Mikhaiel, MD
  • Why affirmative action is crucial for health equity and social justice in medicine

    Katrina Gipson, MD, MPH
  • Most Popular

  • Past Week

    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • Physician employment contracts: the key to fighting burnout and improving working conditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • A tense family drama unfolds as a young daughter pursues unconventional career path

      Osmund Agbo, MD | Physician
    • Decoding the brain’s decision-making: insights for medical professions and strategies for success

      Harvey Castro, MD, MBA | Physician
    • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

      Jay K. Joshi, MD | Physician
    • Discover your true north: Navigating life’s confusions and embracing your path to success

      Tyler Jorgensen, MD | Physician
    • A revolution in patient empowerment: Working together to save our medical system [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Insomnia Symptoms Tied to Stroke a Decade Later
  • Studies Question Role of CDK4/6 Inhibitors in First-Line Advanced Breast Cancer
  • Full-On Reversal of Cardiac Amyloidosis Possible With Antibodies
  • Spell Check-Up: Do You Have the Skills to Pass This Spelling Test?
  • For Some, Sex Is Better Sleep Aid Than Pill, Small Survey Finds

Meeting Coverage

  • Studies Question Role of CDK4/6 Inhibitors in First-Line Advanced Breast Cancer
  • For Some, Sex Is Better Sleep Aid Than Pill, Small Survey Finds
  • Skipping Radiotherapy 'Seems Safe' for PMBCL Patients in Remission
  • Promising Gene Therapy for Overactive Bladder
  • Shotgun Sequencing of Small Intestine Reveals Species Tied to GI Symptom Severity
  • Most Popular

  • Past Week

    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • Physician employment contracts: the key to fighting burnout and improving working conditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • A tense family drama unfolds as a young daughter pursues unconventional career path

      Osmund Agbo, MD | Physician
    • Decoding the brain’s decision-making: insights for medical professions and strategies for success

      Harvey Castro, MD, MBA | Physician
    • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

      Jay K. Joshi, MD | Physician
    • Discover your true north: Navigating life’s confusions and embracing your path to success

      Tyler Jorgensen, MD | Physician
    • A revolution in patient empowerment: Working together to save our medical system [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What do organized crime and health care have in common?
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...