The real way to disrupt health care

Earlier this year, three of the most powerful CEOs in America – Warren Buffet, Jeff Bezos, and Jamie Dimon – made waves by announcing a collaboration to create their own health care company for their employees. A move like this is unprecedented, but the CEOs are betting on their technological capabilities, financial assets, and sheer market power to “disrupt” the health care market.

But what if they’re going about health care innovation the wrong way? As health policy professor Dr. Martin Makary points out in an op-ed in USA Today, the most promising health care disruption may not be new technology (in fact, technological advances in health care often make it more expensive). Instead, writes Makary, the three CEOs should focus on addressing the leading driver of health costs – unnecessary medical care. 

“Fixing the health care cost crisis will require addressing its leading driver: too much medical care” – Dr. Makary

Medicare spends billions on tests and procedures that are likely to cause more harm than benefit, such as colon and prostate cancer screenings for older adults, stents for stable patients, shoulder and knee arthroscopy, and much more. As Makary points out, getting better deals on medications and making care delivery more efficient would be significant improvements, but they wouldn’t stop the ubiquitous “more is better” culture in medicine that has made health care the behemoth industry it is today.

If you don’t believe Makary that unnecessary medical care is a problem, just ask doctors. When asked to estimate the amount of unnecessary care in their specialty, a majority of doctors (64.7%) answered that at least 15-30% of care is unnecessary. On average, doctors said that 20.5% of care is unnecessary.

Patients are increasingly noticing unnecessary care as well. In a recent survey from the National Poll on Healthy Aging, 25% of older Americans said their doctor often orders tests or prescribes drugs they don’t think are necessary. One in six survey participants said this happened within the past year.

As Bezos, Buffett, and Dimon formulate their plan we will be following closely to see whether they address the issue of unnecessary care, perhaps by rewarding providers that deprescribe appropriately, by emphasizing primary care over specialty care, and by using new models for measuring low-value care, to evaluate and cut down on harmful unnecessary care for their employees.