How Our HealthCare System Needs To (And Can) Change

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What if we reimagined the health care system so it was incentivized to keep people healthy instead of just treating them when they got sick? That’s the discussion Andy has with Congresswoman Suzan DelBene (WA-01) and Accountable for Health CEO Mara McDermott on this week’s episode. They take a look at efforts both in Congress and private enterprise to move to a care system that puts patients first and emphasizes quality over quantity. Plus, how and where these changes are already working and will benefit you.

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Suzan DelBene, Mara McDermott, Andy Slavitt

Andy Slavitt  00:18

This is In The Bubble with Andy Slavitt. Welcome to our Monday episode. Thanks for all the emails keep them coming. And the Illuminati Today is my What if episode? What if imagine, if you will, that we had a really healthy country, and a really well functioning healthcare system, probably hard to imagine what that is and what that would look like. But that’s what we’re going to explore today. Because we need it, we desperately need it. So work with me on this, we have a healthcare system. Now, that works in the following way. When you get sick, you access the healthcare system, and they do stuff for you. Sometimes by the time you get to it, it’s too late. Sometimes the what the healthcare system does to you just kind of repairs you a bit and get you out of the hospital or out of the doctor’s office, kind of with mild or nagging complaints. Very rarely does the healthcare system work to help you maintain your health, keep you healthy, prevent you from getting sick? We’re just not oriented that way. Very rarely does it say to someone in their 40s, let us help work with you now. So you can live better in your 60s and 70s, which is I think, a more enlightened view of how healthcare system would work. And the reason for this is many fold. But it’s really because we’ve got a lot of money and expense designed into a system that is rewarded for doing more things for you. Doing more tests on you, giving you more medications, giving you more surgeries keeping you in the hospital. That is a quantity based healthcare system more and more and more and more and more. And not surprisingly, what effect does that have on us? Well, it keeps us away as long as possible. Because we don’t like that stuff happening to us. And when we stay away, it is not because we are actually staying healthier. It’s because we’re avoiding learning what’s going on in our bodies. So now here’s the work with me part. Here’s the web part. And here’s what we’re going to talk about today with my two guests. What is health care system worked exactly the other way? What are the health care system was about health and not care? What if the health care system was rewarded and designed to find something that was about to happen to you and prevent it prevent your blood sugar from going up, prevent your arteries from getting clogged, prevent Alzheimer’s and dementia from taking hold, prevent a mental illness before it became so excruciatingly challenging that it became too hard to deal with. But really got to stuff early, maybe even before an inkling that there were things that were wrong. That wouldn’t be a quantity based system that will be a quality based system, quality of your life. Quality of your well being quality of your later years. And your interactions with the healthcare system would be very different. You’d be interacting probably more using technology from home to just check how you’re doing. You’d be interacting more with people in the community. They may be prescribing activities like walking and hanging out with friends, as opposed to really dire things that are happening in big scary buildings. Healthcare systems can work that way. Ours doesn’t. But it doesn’t mean that it can’t. There was some groundbreaking research from an organization called the United States of care, full disclosure. I was one of the founders of that organization about five or six years ago. I’m not involved with it today. It’s run by a wonderful, wonderful CEO named Natalie Davis. We’ve had her on the show before we’ll have her on again. They did some groundbreaking research on what it is that Americans want from the healthcare system in a really transformative sense. Not give me this small change, but what do I really want from how health and healthcare would work? And the answer was people actually want a system that works easier for them and focuses on the quality of their life, not in the quantity of things done to you. Pretty interesting. Okay, so how do we get there? Myra McDermott is the CEO of an organization called accountable for health. And Suzan DelBene is a congresswoman from the First District of Washington, that be the state of Washington because Washington DC has no congressman or Congresswoman Suzan DelBene is pioneering efforts to transform the health care system within the Congress. And she is leading a set of quiet but steady members on this quest on this journey, and why do I say quiet? Because what we tend to hear from Washington is not about this better system. But it’s about the fights we have between Republicans and Democrats on things like Obamacare, and single payer and repealing Obamacare, and whatever else it is that pulls people apart. But there’s a set of people, a political people, I believe, who say, Stop talking about the politics and start talking about how we make the healthcare system better. That’s what Congresswoman del bene is doing with the emphasis and push coming from Mara McDermott. So if you are still with me, and you are interested in a topic like this, this is a great show. It’s a great show that follows nicely after our episode with Zeke Emanuel, which I think you can listen to talks a little bit about changes for the future of healthcare. But I love this one. And it’s exactly the kind of creative original new programming that you should find it in the bubble. And it’s a special Monday episode for you. Here goes

Andy Slavitt  07:06

Congresswoman Suzan DelBene. Welcome to the bubble.

Suzan DelBene  07:10

Thank you excited to be here.

Andy Slavitt  07:12

And Mara McDermott. Welcome to the bubble.

Mara McDermott  07:16

Thanks for having me, Andy.

Andy Slavitt  07:18

Mara, maybe I’ll start with you. You know what Americans think about their health care. A lot comes to mind. You know, we’re on the back of a pandemic, bit through plenty of crises. We all go through personal crises or our own lives, we’ve got a healthcare system that’s expensive. We’ve got aging parents and kids with needs, it just doesn’t quit. And it’s, of course, very expensive system. And we all pay that price, too. But there’s been a recent study on what Americans really want from the healthcare system that I found very interesting. Tell us about it.

Mara McDermott  07:53

Yeah, so our colleagues at the United States of care have shared some research with what Americans want out of their health care system. And to me, and Andy, I’d love to hear your thoughts. But for me, it really confirmed a lot of what I hear every day and talking to people about their experiences with healthcare, which is that it is confusing. The expectation and baseline assumption is that it’s going to be hard to access and a difficult experience. It is not patient centered enough, it is not attentive enough to their needs, their and their total care needs, right, not just the immediate health care need, but also the social needs and other things that play into people’s health. Another interesting, I know some of the frame for our conversation today around is around value based care. And we’ll certainly get into what that is. But another interesting takeaway for me from that study was that people really don’t respond well to the term value that that terminology in particular is signaling for them. A, you know, bargain or kind of low, low quality option when I think many of us have been historically using the term value based care to mean something very different. So lots of great takeaways there and excited to dive into this topic today.

Andy Slavitt  09:04

One of the headlines that seemed most interesting to me, was this notion of what Americans want is more of a healthcare system that focus on the quality of what they get, than than simply quantity. Was that surprising to you? And can you just talk about, what do you think that headline really says?

Mara McDermott  09:28

That’s not surprising to me? I think more and more Americans are experiencing health care, that feels duplicative, right, like they feel like their providers are not talking to each other. They’re answering the same questions over and over again, I’m sure that you and the congresswoman have people in your lives who have had those experiences, right, very, very frustrating experiences. So that focus on quality and I think, you know, maybe reading into it a little bit more outcomes, what is happening to you as a result of that. because it wasn’t surprising to me, I think it is very nice to have it articulated and that way, and enables us to kind of focus some of the policy incentives differently.

Andy Slavitt  10:09

Interesting. Congresswoman del bene, first of all, for those who don’t have the pleasure of doing you know, your work, tell us a little bit about yourself and your district in your, your time in Congress.

Suzan DelBene  10:21

Sure. I’m from the great state of Washington and have been in Congress since 2012. And I serve on the Ways and Means Committee. And one big area on the Ways and Means Committee has been looking into issues of health, Medicare, specifically, to make sure that we continue to have health care that works for everyone. And I think, as we look at this conversation, understanding what we can do to continue to make sure people are getting quality health care that they’re getting great outcomes, that our system is adapting to the world as we learn what works and doesn’t work. And we need policy to help do that to to make this all work. So I think there’s a huge role we can play in policy to help incentivize providing great care.

Andy Slavitt  11:08

You know, if I were to stop someone on the street, and say, when you think about healthcare, and Congress, what comes to mind? I bet that for most people, they’d say, Well, maybe the effort to repeal the Affordable Care Act, or Obamacare, or maybe the effort to pass Medicare, for all, you know, would be what they’ve come up with, they would probably tend to think about how Congress focuses on either expanding coverage or reducing coverage as the case may be. And in either those, those two examples, your work is really focused in a really different area, which is the quality of what people experience in the healthcare system and how to make that system better. Can you talk a little bit about the part of Congress’s work on health care that people don’t see that effort that’s not so focused on those headline grabbing issues?

Suzan DelBene  12:10

Well, absolutely, I think, one, a patient experience and a quality experience is really important. And when we talk about a quality experience, it’s making sure that we are using the tools that we have in our healthcare system to give people the best possible health care resources that are available throughout the country. And to do that takes a lot of things. When we talk about the patient experience, part of that is making sure providers, their doctors and nurses and health care professionals are able to do the work they need to do. One thing we also look a lot in Congress is how bureaucratic this system has become where providers spend so much time doing paperwork on things, they don’t have time to actually do the work that they went to school to do to help patients. Um, So collectively, I think that make sure the resources we’re putting to healthcare system are giving us a great return, giving taxpayers a great return giving patients a great return giving providers great return, better outcomes are all the things that we need to be looking at. And I believe in a bottle, kind of where we look at what’s working, and what’s not working. And we adjust, then maybe one of the challenges we’ve had in healthcare for a long, long time is we kind of keep doing things the way we’ve always done it, because it’s easy to leave things that way. But we have a huge opportunity to do things better, and to make sure we incentivize movement towards quality care. And that’s what I think Mara was talking about the very beginning, what can we do and what you saw in the survey? That’s what patients want to see. I think that’s what people want to see across the country we want to see for ourselves and for our family members. So what how can we make changes in policy to incentivize that change to a system that’s kind of become ingrained in fee for service in doing stuff, not necessarily looking at outcomes.

Andy Slavitt  14:11

Mara, the last decade or so, there have been efforts, there have been policies, there’s been laws passed, there’s been things done by various administrations, to start to tackle this issue that people have addressed here of wanting to see a more quality driven system than a more quantity driven system. And want to just get, make sure that I understand and the audio understands the general contract what we’re talking about here, which is that today, a doctor or a clinician of any type will essentially get paid as much money as as many things as they do, regardless of what happens to the people under their care. And that what you’re saying jesting here is that if say a doctor’s taking care of 100 people, if at the end of the year, those 100 people have seen improvements in their health, then that’s how we should be looking to pay for health care. And if they have seen the worse, your deterioration under health, then that should be reflected as well. So is that roughly the kind of thing we’re talking about? And if so, we’ll correct me where I where you think he’s got it wrong. But what works and doesn’t work about that? What have we learned?

Mara McDermott  15:34

Yeah, I think that’s roughly right, that we are trying to move away from incentivizing more things being done to people and towards better population health outcomes. And we’ve seen a lot of success out of accountable care organizations in achieving that. In terms of specific things, I think we’ve seen be successful, more care coordination. So people who are discharged from the hospital, for example, you know, we’ve all we’ve all been in a situation, you have somebody discharged from the hospital, they go home, they don’t know what to do. In an accountable care organization, you would see a provider, maybe visit that patient at home, reconcile their medication, make sure that their home is safe, or their return from the hospital, and that they have a follow up appointment. So those are the types of successes we’re seeing in terms of care delivery, there are also cost savings to the Medicare program. And to other payers, I think we’ve gotten perhaps overly focused on that as a metric of success. You know, when when I talked to my parents about their experience with Medicare, savings to Medicare, maybe lower on the priority list than that care experience and transforming the way that care is really delivered. But I think we’ve seen successes across the board in terms of specifically expanding access to more primary care, after hours appointments, that care coordination, transitioning and coordinating across care settings, better health outcomes. So we are seeing, you know, population health improve in these areas where we have robust ACO adoption, and lower cost.

Andy Slavitt  17:09

So you’re saying that the evidence is that in the last few years, and since people have been trying out these different approaches, doctors and their care medical teams are actually providing more services and taking care of people in a more coordinated way, when they’re getting evaluated based upon the health of the population.

Mara McDermott  17:32

That’s right, we see a lot of evidence of that and expansion of services. And I would say for not to get too wonky. But for traditional Medicare fee for service, Medicare ACOs are able, for example, to deliver some of that what we would think of in Medicare Advantage language as supplemental benefits. So to make that concrete, meals, transportation connection to community based organizations that are not possible or likely in a true like fee for service based environment where it’s you know, you come in, I do my one piece of your health care and send you on your way. This is a more holistic approach. That is giving folks access to more services than they would have had in a in a fee for service based reimbursement system.

Andy Slavitt  18:17

Congressman, is that the idea? Is that where we think the answers are headed, is that where Congress and the the folks that you’re working with in Congress would like to see things move?

Suzan DelBene  18:31

Yeah, we want to make sure the incentives are there to focus on quality care. And since right now, the way kind of payments work, they’re really focused on fee for service, it makes it harder for providers who want to provide comprehensive care, like Maurice talking about, because they aren’t necessarily rewarded for that. And so that’s where these alternative payment models have come into play. And what we need to do a Congress is make sure that those actually do reward. Focus, like accountable care organizations are delivering these comprehensive services, make sure that they are reimbursed appropriately for the great work they’re doing. And we know just in 2021 ACOs generated $3.6 billion in gross savings. That’s hugely important because not only getting better outcomes, we’re saving money. And that’s money that can go towards continuing to make sure we’re serving populations providing more services. But when you don’t get paid to coordinate care to make sure that you follow up after a patient, that particular procedure, then we don’t see those great outcomes. So we need to make sure our payment models are consistent with great outcomes. And we’re still working on that. We have that in place. There’s more we can do. There’s legislation we’re working on now that I’ve introduced in the past, and we continue to work on to make sure that we support these models, so that folks are rewarded for doing a great job. And that’s work that we need to do in Congress to make sure they’re rewarded for that and have the right incentives.

Andy Slavitt  20:19

Let’s take a quick break. And we’ll come back and talk about whether or not these efforts enjoy bipartisan support or whether they’re like everything else in the healthcare system, we’ll be right back. I want to ask you about some of that legislation. The second but I’m curious about something else. One of the things that frustrates me probably frustrates a lot of people. It’s how it seems like every time a healthcare issue a services, it immediately becomes partisan, that for whatever reason, the health of people in this country is a political issue. And it shouldn’t be surprising, because we’re in a very polarized time. And there probably aren’t a lot of issues that don’t get polarized. yet. I think here it feels like we went the whether it’s Medicare for all or whether it’s, you know, Obamacare, is really difficult to find people who are of different parties embracing and agreeing in these ideas. Is that the case here? Or is this an area where actually, you’re finding that Democrats and Republicans have some level of agreement, and there’s some hope of some really bipartisan progress.

Suzan DelBene  21:51

This has actually been very bipartisan to your point, which is important and very refreshing, because we really should be continuing to work together to move a health care system forward, that works for the American people in all areas. And we can do that, by actually looking at the results, we see looking at what’s working, what’s not working and move forward. But there have been kind of these ongoing efforts to kind of whiplash, I would call it to say, if that was your idea, then I gotta get rid of that and put my idea in place. I think one of the nice things here is we have data, we see what’s working, we have the information, how patients feel, we understand how providers feel about being able to provide comprehensive care. And we have bipartisan support for legislation to make sure we continue to move the right financial models forward to help incentivize quality care. So that’s very, very helpful for all of us that we can come together to do that and do something that will really move our healthcare system in a direction that’s great for patients. And as I said, also great for the folks providing health care, because that’s why they wanted, they want to do a great job too. And they want to make sure they have the time to do that. And making sure our financial models do that mean that they’re not kind of focused or told, you got to just do stuff, because that’s the only way we can keep the lights on. Instead, we’re gonna be rewarded and financially rewarded for doing great jobs for our patients.

Andy Slavitt  23:23

So if the study that Maria refer to getting from United States of care is a call, if you will, for change to say that we want a experience, it’s more focused on our needs and our relationship with our care team. We want that I think Mara the example used is really a terrific one, which is, hey, you know, what, I just got discharged from the hospital, someone calling me or my mom and making sure that she knows how to change your bandages, okay, and that she gets the follow up medication she needs and that she has the instructions and a follow up visit so that she doesn’t end up back in the hospital. Needlessly, we’d all want that to happen. And I think that’s what what the survey is telling us. So let’s talk about some of the legislation, Congresswoman that you have proposed in the past and that you’ve reintroduced the value Health Care Act in 2023.

Suzan DelBene  24:14

Absolutely. That’s the value in Health Care Act is to create those models, the incentives to help health care providers be able to provide comprehensive care and focus on quality of care and quality of outcomes. We saw that back in 2017. Health and Human Services, the inspector general, there did a report that showed that 98% of accountable care organizations, Medicare’s main value based care model that we’ve been talking about met or exceeded quality measures and outperform fee for service providers on over 80% of quality measures over a three year period. So we have data showing that the phone Because moving to these types of models, really has great outcomes and deliver savings, what our legislation does some of these incentives that were put in place to help people provide care quality care incentives to use an ACO model, some of those are expiring, some of the incentives need to be adjusted so that we can continue to help healthcare systems that are trying to move, to provide quality care, but have to go through a lot of change in terms of how their models work, we need to make sure that they have the incentives to be able to do that. So our legislation is to help people go through that kind of transformation and make sure they’re financially healthy while they go through that and that they’re rewarded with their success. And part of that reward when they’re able to save money and have better outcomes, they get some of that savings back. And they can use that to continue to help in providing great health care for their population, providing great health care, in terms of coordination of care, like Mara was talking about earlier. So we want to make sure that those incentives stay in place. And that’s what our current legislation is about to make sure we can continue to move in that direction, and that the financial changes as folks go through that aren’t the obstacle for them being able to provide quality care.

Andy Slavitt  26:24

How should we think about the portion of people in the country that can expect to be cared for in these, you talked about these as models, and you talked about Accountable Care Organization, as a model. And I take that to me, and it’s a way of medical community working together, and having a shared incentive to keep people healthier? More what portion of the public has been in models like this? And how will some of the legislation that Congresswoman debate is talking about, potentially accelerate that.

Mara McDermott  27:03

So in traditional Medicare, it’s about half of the population that’s now in some form of alternative payment model. And as you both know, the administration has set forward a goal of having all Medicare beneficiaries in an accountable care relationship by 2030. That, like we talked about with the bipartisan support for these.

Andy Slavitt  27:25

Let me just just clarify, I’m sorry, you’re talking about about people who are 65 and over, or who have a disability. And there’s, you know, 10s of billions of people we’re talking about, that are covered by by that program?

Mara McDermott  27:38

Yes, thank you. I was just going to say that that is a bipartisan goal, we’ve seen previous administrations have similar goals of getting everybody across programs and Medicare. And you know, most everybody in Medicaid into these types of accountable care models, lots of efforts with commercial payers and employer sponsored coverage. So I think what we’re seeing is, is broad enthusiasm to move as many people as possible, as quickly as possible into these forms of accountable care models and sort of a better patient experience. And the legislation that the Congressman was talking about is an accelerant to do that. So I think what we’ve seen historically is that Medicare is the leader. And many other payers follow the example that Medicare sets, because of that, the number of people and sort of the consistency that it sets as a bar. So I think that legislation and other bills that will continue that transformation, and then to move it along more rapidly, will make a big difference in terms of adoption of this model of care.

Andy Slavitt  28:42

So do you see a point where all the care in the country or substantially all of it is out of this sort of quantity based system? And in a system like the one you’re talking about, is that going to happen, say in the next decade? Or is that too much? It’s too much of a projection?

Mara McDermott  29:04

I mean, I hope so I hope we can get there. I don’t know if that’s 10 years or 15 years or or, you know, something more, but I think we are making steady progress. I think that there are things that Congress can be doing in the short and long term to continue to accelerate that progress. Building on those incentives, like we’ve talked about this work doesn’t happen overnight. And it does take some investment, to get providers to talk to each other and have electronic medical records that communicate and share information. None of that is easy, and none of that is fast. But what I would say, Andy is we see just a ton of enthusiasm in the provider community. And you’re hearing it in the United States of care survey from the patient or consumer community around these goals and that something different is needed and is wanted and more quickly. So I remain optimistic that we’re going to get there that everybody will have the opportunity to participate in a better health care. Are experience and therefore receive better health outcomes as a result.

Andy Slavitt  30:05

Alright, let’s take one more break. And then I want to come back. And I want to play devil’s advocate a bit on what people should be worried about in this new fangled approach to you’re trying to hoist on us here. And then I want to talk about some of the other topical things going on, such as the new drug goes epic, whether that’ll be paid for, for everybody how people might get that. We’ll be right back. But let me play a little bit of devil’s advocate, just to help understand the nature of changes such that there’s always some unintended consequences. I think people feel relatively insecure about changes to the way the healthcare system works, you know, might they lose something that they have? And, of course, there’s always bad actors, which Congress has to always be be wary of that someone will try to take advantage of a new system in some way. So there are obviously safeguards that you’ve got to think about, Congresswoman, are there things that come to mind that concern you or that should be a concern to the mind to the public? I’ll give you one example of questions been asked of me, which is, if doctors are gonna get paid more, if their population is healthier, if I get sick, are they going to drop me? And so I think there’s those kinds of concerns that could take something that well, it sounds pretty good at the high level, but then, when you get into some of the details people might worry about so how do you think about what concerns might people have or safeguards? You know,

Suzan DelBene  31:59

I think the real important things are the metrics that we put in place to make sure that we measure what the experiences that’s provided to make sure that they are continuing that there isn’t an incentive to just say, Oh, if someone’s not feeling well, that we dropped them, making sure that this is about comprehensive care of everyone, it’s not about not providing care. It’s about doing a great job of provided coordinate care and quality. And so the focus is on the outcome, not that someone might be sicker, because of the various reasons, but are they getting the best health care to provide the best outcome, and that’s where the incentives need to be. And that’s why as we work on legislation, and it’s and it’s important that we continue to make sure that folks are rewarded for that. Right now, we are spending more and more money on health care, and we are not seeing improvement in outcomes for patients. So you also talked about where we’re at today, people can do a lot of things, they can provide a lot of services. But just doing that, and the money we spend on that doesn’t mean that people are getting better health care, either. So I’d say the current system isn’t the Northstar that you look at saying it’s providing great care, I think, we know there’s a way that we can bring healthcare together providers together to do the work that they really want to do and provide comprehensive care and we can reward for those. So the incentives are to make sure that patients actually get better and are getting the best care they need. And that’s really what we’ll continue to work on. And make sure is the guiding light for the work that’s happening here. And, and right now, frankly, providers can’t always get a accurate picture of a patient’s health because they’re only looking at one piece of it. And so if we can look at things comprehensively, we have much better outcomes across the board. And many of the cases, we have folks with chronic diseases where that management is so important. And we’ve seen with ACOs, and with folks who are implementing comprehensive models, this ability to be able to do a better job of managing chronic care. So I think fundamentally, to your point, it’s going to come down to any one individual’s experience with their health care provider. And if they have a better experience, that’s where they’re going to want to continue to be. And that’s why we see movement to different types of organizations because people are getting the type of health care that better serves their needs.

Andy Slavitt  34:39

Let me close close by asking you about a big topic in healthcare. Today. Probably the sneaky number one topic on people’s minds, which is the coverage of these new medications ozempic And we’ll go V for those who don’t know, you probably living under a rock These are medications that were originally one of them for diabetes, the other for weight loss. And there’s a new study out, which shows that there is in a controlled randomized trial, I believe, a 20% reduction in heart disease outcomes, which is a major, major, major major among people with obesity. And so there’s a big push starting to say, hey, these drugs ought to be covered for everybody, because they keep people healthy, they will prevent heart disease, people will be in a more healthy weight, they’ll prevent people from getting diabetes in the first place, you can hear all of the arguments, of course, the reality is that these medications costs $1,200 or so per month for a patient and you can imagine the expense to the Medicare system alone, let alone you know, all Americans. And, of course, if you stop taking the medication, the medication no longer no longer works. And so we don’t have long term studies yet on how long people should be on these medications. This, of course, seems to be an issue that seems to be going to be crashing in front of us, that we’re going to have to deal with. And if it’s not this, there’ll be other things, which is very expensive, evidence based medicine that science tells us will keep us healthier, but will be very, very expensive to pay for. So as to leading health policy experts who’ve been working on complex issues long term. I’m just curious, what your thoughts are maybe Mara, starting with you? How should the country think about this? There’s going to be an awful lot of pressure for these things to be covered?

Mara McDermott  36:51

Yeah, I certainly don’t have it have the answers for that? I would say from a accountable care perspective, the drug spending piece is really the next frontier. I think that hasn’t been tackled yet. And it’s something that many of our member companies have been thinking about for a long time. But feeling we certainly don’t have answers. It’s such a complicated problem. And you brought up two examples. There are certainly others that we’ve tackled as a society recently around Alzheimer’s and other things. So not a real satisfying answer. But I agree with you that it is a huge problem. And when we need to bring into focus more.

Andy Slavitt  37:26

Is Congress starting to talk about this, congresswoman?

Suzan DelBene  37:30

I think we’re talking about it, the public is talking about it. So it’s a broad conversation. I think there’s multiple aspects you have to look at from one is making sure that we’re providing preventative care, how do we make sure people stay healthy in the first place? Sometimes, certain types of drugs don’t necessarily they may treat symptoms, but they don’t necessarily cure the underlying problems that maybe we could do prevent it in a preventative way, you know, help make sure that folks don’t get diabetes, or heart disease or other things by doing great preventative care ahead of time. And so that’s one of the examples where some of the work that we can do and make sure when we have comprehensive care is make sure preventative care is happening to help. We have incredible breakthroughs, scientific breakthroughs. I, I started my career as a scientist doing biomedical research. I mean, there are great breakthroughs happening right now, we need to follow the science understand where these new treatments and therapies can be impactful and help where they can’t, or other or other uses, are there other things we can do that give better outcomes for patients. And look at that. So this is going to be something that’s constantly evolving, and with the rate of innovation, we’re going to see many of these types of issues comes up. So it’s not a one size fits all. But they’re definitely a part of what we can do to provide health care to folks. And you know, some things can be expensive, but they might be cheaper than the other types of care that folks are getting. And that’s also relatively we have to understand kind of where that that fits. I talk, you know, I’m the co chair of the kidney caucus, and we talk about kidney disease and dialysis, which is incredibly expensive, if there are things we can do to help people so they don’t end up with you know, renal disease don’t need to be on dialysis, etc. That to be huge savings across the board and huge savings for Medicare, for example. So all of these things kind of are interconnected. So I’d say it’s a complex question and I probably a complex answer. But I also think that we’re fortunate that we have some incredible new innovations coming to the table that are going to really have an impact on healthcare going forward. And we can also do always do a lot of great work with preventative care at the beginning, because that might be the best outcome of all.

Andy Slavitt  40:08

Yeah, no, not not an easy question. For sure is our healthcare system as it exists is cost us a lot of money. And when there are breakthroughs, the public’s going to want them. It is challenging, and I suspect more guidelines and rules will need to be developed my own gas as to say who are these treatments appropriate for where are they really beneficial? To your point? Maybe where do they save money down the road? What things should people be doing first before they go on a treatment like this? But there’ll be certainly pressure and and gamesmanship, right if people want to be on these medications. And look, if you told someone who has a difficult time losing weight, that they could reduce their chances of dying prematurely if heart disease by 20%. And they’ve got kids and maybe grandkids someday that they want to see, that’s an awfully compelling thing. So not easy. I have one other one for you Congresswoman was particularly because you’re located in Washington State. So this is something that’s close to your world, which is AI. The other topic that I think is a big topic in Congress, and it’s a big topic in healthcare circles, which is how to think about the appropriate use of artificial intelligence, generative AI, particularly when it comes to healthcare, people are experimenting with all kinds of things. Now, are there any conversations underway? And whether the state of those conversations and how do you think about AI and and what its power and its pitfalls are

Suzan DelBene  41:37

absolutely lots of conversations, and I think a lot of learning happening right now, as folks are trying to understand the impact that AI can have in so many different areas. When we talk about healthcare, I think we’ve already seen, we’re talking about breakthroughs, huge breakthroughs, because a lot of understanding and kind of diagnosing disease, what causes certain types of disease, what types of treatment works, means going through tons of data. And one thing AI can do is sift through that data much more quickly and kind of understand where there are anomalies in that data that may actually pinpoint areas that we can focus on to provide treatment, even out our way we’ve seen great research, we have the Fred Hutchinson Cancer Research Center here, you know, they’ve been able to go through tons of data and see that one type of cancer that we thought was one type of cancer is actually five types of cancer. And that if you treat them differently, you get better outcomes, as opposed to assuming they were all the same. Those are the types of things that I think AI can really help us dig into more deeply, more quickly and get an incredible outcome. We also know that we have areas where folks are trying to understand what types of treatments should be available, we have insurance plans with prior authorization, delaying care, because they have to look at it, what if we can move that more quickly. So we make sure that people are getting access to the care they need. And we can show that, you know, moving forward in a certain way is a common regular review used type of procedure, so that we kind of get rid of some of these backlogs that are in place. But one thing that I think is critically important underlying this, and not just in healthcare, but healthcare, maybe a very cute area is privacy is very critical. And AI is driven by data. And one thing we have to do is also make sure people’s data is protected. We don’t have a federal data privacy law in our country, I think that’s very, very important. We have protections for health care, but it’s really more of that data that your doctor has, it’s not necessarily the data that your watch is tracking on your health. And so we have to be thoughtful as lawmakers too. And I don’t think we’ve done enough here to put other rules of the road in place like on privacy so that your privacy is protected, your healthcare information is protected. And then also use AI in ways that we can to, to dig in and come up with new types of treatments and cures.

Andy Slavitt  44:19

You know, you just made a great argument for why we all need to elect really smart, highly functional, intelligent representatives like yourself, because these issues are not easy, and they’re not gonna get any easier and and you want a functional Congress who could talk about these matters and dig into them and regulate them appropriately. Because this is complex stuff. I don’t think anybody knows how it’s gonna turn out. Mara, I want to give you the last word. Maybe you can just close by giving us a sense of what the agenda is for the next year, plus going forward to push for some of the really transformational things that you’ve been championing. Along with Congresswoman in health care, what are the things to watch for now that the public is sort of attuned to this effort in these initiatives? What should people be paying attention to? And if they’re so inclined, how can they lend their support?

Mara McDermott  45:18

Sure, well, I think the most immediate thing is to pass the value in health care act by the end of the year. So I would put in a plug for that. Beyond that one we are looking for I’m working on legislation that will accelerate this transformation we’ve talked about today in Medicare and Medicaid, folks who want to get involved in those efforts could certainly check us out at accountable for We’d love to connect, I think for those in your audience who are involved in accountable care, whether that is receiving that care, providing that care pushing for policy, the most important thing to me right now is to connect with your members of Congress, your local representatives, and tell your stories. As we’ve talked about today, this language gets very wonky, and it gets very technical, and it’s payment. And it’s benchmarks. And it’s all these things. But at the end of the day, what we’re talking about as a better care experience, for the provider and for the patient. And the more that our advocates, and people who are having these experiences can share what is happening on the ground, how that transformation feels how what that looks like, in real terms, the better offer, we are all going to be an accelerating this movement.

Andy Slavitt  46:35

Well, thank you so much, both of you, I hope that people listening got a sense of that there are people pushing for a better health care system, underneath kind of the very public fights that they may perceive to be happening at the level of, you know, Bernie Sanders, when he’s on the show, talking about the things he champions, but that there is a undercurrent of place where I think it’s quite encouraging to hear that there’s bipartisan interest in creating a healthcare system that just easier for people. And it gives people more of what they want. And the fact that it can do that and show some financial savings, I think is pretty hopeful. And I don’t think people are used to hearing about hopeful things in health care. So I’m going to summon all of the listeners by wishing you incredible good luck in pushing for this agenda and to keep us posted. And in the bubble. Thanks for being on the show.

Mara McDermott  47:31

Thanks, Andy.

Andy Slavitt  47:45

Thank you so much to Congresswoman DelBene. Thank you so much, Mara McDermott. I really hope you learned a lot from this episode. We’re going to continue to go deep here as we’ve got new stuff to report. But give me your feedback. Send. Send us your emails. Terrific guests. Terrific show another one on Wednesday. Dan Buettner. A real treat. He’s the Blue Zones guy. Then we’ve got Labor Day coming up. Or as I guess it’s now being called AI day. I don’t know why they changed the name. It’s weird. And then we got new shows in September. Lots of them, including a great one with Caitlyn Jenner Lena, coming up talking about what’s happening with this very interesting new variant that could be hitting us in the winter wave. Or maybe not. Maybe it’s a successor to homoclinic. Or maybe not. We will see. Anyway, I know what you’re thinking. Not going to hear from Andy again for a week. But you’d be wrong. But you’d be wrong. Get here from you get in two days. Isn’t that great news. I know. I miss you guys too. All right. We’ll talk to you Wednesday.

Andy Slavitt  48:55

Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Martin Macias and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.

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