What do the Shkreli Award winners have in common?
The Lown Institute’s annual Shkreli Awards recognizes the greediest and most dysfunctional actors in health care. This year, the award “winners” ranged from a dark money PAC that fought surprise billing legislation, to hospitals that sued patients for medical bills, to an equity-backed nursing home chain.
However, winning a Shkreli Award is not the only thing these bad actors have in common. On the Relentless Health Value podcast, Lown Institute president Vikas Saini and senior vice president Shannon Brownlee discuss the common threads uniting this year’s Shkreli Award winners.
“Fraud is not the biggest problem in health care. The bigger problem is bad behavior that is perfectly legal and everyone thinks is okay.”Shannon Brownlee
One of the big themes of the Shkreli Awards this year was a conspicuous disparity between the way health care institutions market themselves and they way they behave– a phenomenon that Saini refers to as “schizophrenic compartmentalization.” This pattern was most obvious in the Shkreli winner Dignity Health, a hospital with the motto “Hello, humankindness” that forced a $900,000 on a new mother who was also a Dignity employee.
A main reason that hospitals’ stated missions don’t match up with their behavior is that, while hospital employees overall are committed to the mission, certain departments (such as billing and finance) are still playing by the rules of the game to make as much money for the hospital as possible.
“In health care, what happens is quite often senior leadership gets confused about how to parse the business side and mission side in a way that upholds their core values,” said Saini. “Our view is that it’s possible to do that, but it takes focus and a willingness to recognize the pitfalls.”
Another big theme of the Shkrelis was the consequences of private equity investment in health care. The equity-backed physician staffing organizations creating a lobbying group to defeat surprise billing legislation is a prime example. “We’re seeing more of people outside health care seeing opportunity [for profit] and diving right in, leading to behavior that’s pretty unconscionable,” said Saini.
What can we do about these systemic problems, that create conditions ripe for Shkreli-like behavior? Transparency is a key first step, especially around hospital behavior. “There are some hospital rankings out there, but they are not looking at things that really matter to communities,” said Brownlee. “We need a way of rating hospitals, not just based on how good you are at this particular surgery, but what you are doing for your community.
There are also ways we need to adjust the rules of the game through policy, by changing how we we pay for care, how we collect data about it, and how we monitor hospitals and other care providers.
For more on the Shkreli Awards, listen to the full podcast episode here!