Categories: ASHEcon

Opening Plenary: Riding the Winds of Change: Where Are We Going and How Do We Get There?

Sanjula Jain, PhD Student
Rollins School of Public Health
Emory University


Today in healthcare, we are at a time of incredible uncertainty, but also at a time of incredible change. In this opening plenary, Dr. Reed Tuckson – current Managing Director of Tuckson Health Connections and former Executive Vice President and Chief of Medical Affairs for UnitedHealth Group – highlighted that while economics continue to be the drivers of change, we must be cognizant of both where we currently are as a healthcare system and the direction in which we need to be headed.

In examining the major contextual forces defining today’s healthcare landscape, we cannot ignore the exorbitant spending growth burdening our system. Much of the rise in healthcare costs can be attributed to the “storm of preventable chronic illness” that is washing over our delivery systems. As a result, we are an experiencing an unprecedented rise in morbidity rates, the economics of which presents key implications for reform. In addition to the clinical factors of illness, an underappreciated driver of disease is the mounting poverty and hopelessness affecting Americans. This “sea of despair” further compounds the country’s public health burden as more Americans turn to opioids and other unhealthy behaviors.

Despite this reality, we will not be able to “medicalize” our way out of this situation. We will we never be able to afford the amount of medical care needed, nor is medical care alone sufficient for addressing our systemic inefficiencies. Thus, our ability to bend the cost curve while delivering high-quality care will depend on the direction of future actions. And yet, while initiatives such as To Err is Human have pushed us towards the Triple Aim and identifying strategies for building a highly functioning delivery system, we have been slow to implement the necessary innovations. Effective implementation of these strategies may also depend on the various lens in which stakeholders perceive the current health challenge. Where Medicare attributes current inefficiencies to the lack of care coordination, private payers point to administrative complexity. Nevertheless, as we think about the future direction of healthcare transformation, we must prioritize patient needs.

Looking ahead, there is widespread recognition of the need for patient-centered, population health care. However, as health economists and applied researchers we are charged with how to actually implement such a comprehensive population health model. We must consider how to put the whole puzzle together in which clinicians and public health professionals synchronize their efforts to address both the upstream and downstream determinants of health. To do so, we must prepare ourselves for a new era of genomics and precision medicine where we will be able to focus on the patient in ways that we’ve never been able to do so before. This new model for delivering health care will no longer be a one-size fit all solution; every market and delivery system will pursue different permutations of payment models and competencies. This new dynamic presents us with exciting new opportunities and challenges as we all play an instrumental role in moving the concept of a high-value healthcare from theory to practice.