Panel, Conference Presentation
Patients: The New Economy of Healthcare
Milken InstituteCynthia Grossman, David Feinberg, Jen Horonjeff, Freda Lewis-Hall, Michael Loeb, Jessica Mega, Cindy Grossman
- Current Healthcare Economics & Disparity: The US healthcare sector is a $3.2 trillion enterprise representing 18% of GDP, yet the nation has a lower life expectancy (78.8 years) than peer countries despite an out-of-pocket cost of $9,500 per person annually.
- Structural Cost Inefficiency: US healthcare spending (18% of GNP) is approximately double that of other developed nations (9–11%), with 8% attributed to administrative costs compared to 1–3% internationally.
- The "B2C/P" Shift: Panelists advocate moving from a traditional B2B (business-to-business) model to a B2C or B2P (business-to-patient) model to align incentives, drive down costs, and improve value through direct patient engagement.
- Jen Horneyff (Savvy Cooperative) – Patient Ownership Model:
- Savvy Cooperative operates as a patient-owned, for-profit cooperative where patients are co-owners with voting rights and profit-sharing capabilities.
- The model aims to prevent extractive data practices by fairly compensating patients for industry consultations and ensuring diverse patient voices are heard in product design.
- Horneyff notes that understanding diverse patient populations, including marginalized groups, increases company profitability through better adherence and retention.
- David Feinberg (Geisinger Health System) – Anticipatory Medicine:
- Geisinger attributes only ~20% of health outcomes to medical care, emphasizing social determinants like food security, transportation, and genetics which comprise the remaining 80%.
- The system serves 500,000 meals annually to food-insecure diabetic patients, achieving a 2.5% decrease in hemoglobin A1c levels.
- Geisinger operates the world's largest genetic database combined with clinical data to predict health events before they occur (anticipatory medicine).
- Provider compensation is decoupled from volume; doctors spend a minimum of 40 minutes with patients aged 65+ and are not rushed, resulting in reduced ER utilization and hospitalizations.
- Freda Lewis-Hall (Pfizer) – Patient "Marriage":
- Pfizer has shifted from viewing patients as mere participants to "married partners" involved in every step of clinical trial design and execution.
- Ethnographic research revealed that complex consent forms (e.g., 20 pages) and emergency room environments were barriers to trial participation for sickle cell patients.
- Patients identified superior outcome measures, such as iPad interface speed for muscular dystrophy and fatigue levels for lupus, rather than traditional biomarkers like the six-minute walk test.
- The organization is leveraging wearables and remote monitoring to capture continuous data on symptoms like fever and arrhythmias without requiring patient travel.
- Michael Loeb (Loeb Enterprises) – Systemic Friction & Script Relief:
- Script Relief, a direct-to-consumer pharmacy discount program, has saved 15 million users approximately $3 billion cumulatively by exploiting price inefficiencies.
- The model highlights that 85% of prescriptions are generics, where patents expire and prices plummet, yet high markups persist in the insurance co-pay model.
- Loeb attributes high costs to structural friction and misaligned incentives among payers, providers, manufacturers, and tort attorneys.
- He cites the "Flintstones" nature of the healthcare system where 85% of the market is generic, yet the tort liability system forces defensive medicine (e.g., over-prescribing antibiotics) rather than judgment-based care.
- Jessica Mega (Verily) – Data Integration & Technology:
- Verily (Alphabet) focuses on extending care beyond the hospital, where 99% of patient interactions occur, by integrating health data directly to patients' devices.
- The "Onduo" joint venture with Sanofi provides real-time glucose insights to diabetic patients to personalize responses to food and medication.
- Project Baseline aims to unlock the estimated 15,000 CDs (or 15 TB) of health data per person currently siloed in health systems to create a comprehensive longitudinal health record.
- The strategy involves using machine learning to layer insights on top of raw data to reduce patient burden while increasing actionable feedback.
- Technological Disparities: Panelists contrast "Star Wars medicine" (advanced genetics, gene editing, AI) being delivered in a "Flintstones" system (e.g., clipboard registration in waiting rooms).
- Caregiver Impact: The panel acknowledges the growing burden on multigenerational family caregivers, noting that health system programs are beginning to support non-insured family members to prevent productivity loss and improve patient adherence.
- Future Metrics: A consensus exists that success metrics must expand beyond life expectancy and enrollment numbers to include "years lived well," quality of life, and meaningful living.
- Forward-Looking Predictions:
- Elimination of Waiting Rooms: Loeb predicts that within 10 years, traditional waiting rooms will disappear as care shifts to the home, driven by the efficiency of other consumer industries.
- Data Democratization: Mega and Horneyff anticipate the erosion of health data black boxes, with patients gaining control over their data and becoming central to co-designing solutions.
- Outcome-Based Reimbursement: Feinberg predicts a shift toward outcome-centric reimbursement models where providers are only paid if patients become healthier.
- Industry Disruption: Loeb warns that if the healthcare industry fails to modernize, external tech disruptors (referenced as "Stanford dropouts") will take over the space.