“What we’ve seen should be a wake-up call to everybody”: Lown leaders discuss needed changes in healthcare

By Judith Garber | March 22, 2021

On the latest Race to Value podcast, a project of the Accountable Care Learning Collaborative, Vikas Saini and Shannon Brownlee joined hosts Dr. Eric Weaver and Daniel Chipping. In this conversation, the Lown leaders covered a broad area of topics, from Dr. Lown’s legacy, to the lack of coordination between hospitals, drivers of overuse, price transparency, and more…

You can listen to the full podcast episode on the RTV website, and read some of the podcast highlights below.

Hospitals after Covid-19

Saini and Brownlee discussed how Covid-19 has led to more cooperation between hospitals, but were skeptical that emergency measures would change the structural issues in the hospital sector.

“Will cooperation become the new standard automatically when Covid is over? I’m not so sure unless we start changing the way we pay hospitals, the way we regulate them, the way we legislate them,” said Brownlee.

“The way we’re organized our healthcare system and funded in particular the hospital sector is really not built for the purpose of addressing population health needs,” said Saini. When it comes to coordination, “the market has not, and in my view cannot, accomplish what we need it to accomplish,” he said.

“What we’ve seen with Covid is that health care can be too important to leave to the health care sector.”
Dr. Vikas Saini

However, they were hopeful that Covid-19 could be the catalyst we need for real change. “What we’ve seen I think should be enough to be a wake-up call to everybody — all stakeholders, not just payers and hospitals and provider groups, but legislators and other policy people and community and civic leaders,” said Saini. “What we’ve seen with Covid is that health care can be too important to leave to the health care sector.”

The Lown Index equity metrics

Saini and Brownlee also discussed the impetus behind the Lown Institute Hospitals Index and why they included such nontraditional metrics like racial inclusivity and pay equity.

“Our goal with the Index was to be aspirational. We wanted to ask things that weren’t being asked, measure things that weren’t being measured and reported on.”
Dr. Vikas Saini

What forces drive stark differences in equity scores on the Lown Index? For example, how could there be hospitals 20 min apart with such different racial inclusivity scores?

“Hospitals do a lot of things to affect who walks in their doors. It’s not like they just wait and sit there passively for whoever comes in the emergency room, ” Brownlee explained. “Some hospitals actively seek out, in particular, patients with good private insurance because it pays more…so they may advertise in a suburb nearby that has a high income, they may put a primary care clinic in a high-income neighborhood to try to feed people into the hospital.”

Even the entrance of a hospital can make it feel more or less welcoming, said Brownlee.

“What does the lobby actually look like, and does it welcome people of all races and all socioeconomic levels? Or does it basically say, ‘This is a hospital for rich white people and you probably won’t feel welcome here.'”
Shannon Brownlee

Trusting relationships as high-value care

Brownlee and Saini both are driven by the need to stop overuse harms. Brownlee said preventable harm from overuse needs to be a focus for the high-value movement going forward.

“We need to focus on preventable harm, the unnecessary risk patients face when they receive a service that is unlikely to help them. The harm stays the same even if the benefit goes to zero.”
Shannon Brownlee

Saini also spoke on the lessons he learned from Dr. Lown on the importance of knowledge and trust in avoiding unnecessary care.

“Knowledge, knowing that patient’s life and world intimately, is when I saw the magic. That is the height of efficiency, because you will almost certainly understand when something is a really meaningful new symptom, and when something is not,” he said.

“The relationship can be a balm for both parties to not get overboard with testing and treatment.”
Dr. Vikas Saini

To eliminate medication overload, serious cultural, educational, and policy changes are needed. This action plan offers recommendations for policymakers, health care institutions, clinicians, and patients across five key categories to reduce harm from multiple medication use. Suggested Citation: Eliminating medication overload: A national action plan. Working Group on Medication Overload. Brookline, MA: The Lown Institute, 2020. DOI: https://doi.org/10.46241/LI.YLBW4885

Pharmaceutical marketing is a significant factor in the growing public health crisis of medication overload, which puts millions of older adults at risk of preventable harm and premature death. This issue brief provides recommendations to reduce pharmaceutical industry influence by limiting pharma sales rep visits to clinicians and direct-to-consumer advertising.

This issue brief provides recommendations for clinical practice guidelines and electronic health records that would give clinicians the information they need to appropriately prescribe and deprescribe.