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Carroll School of Management

Care Providers

Excerpt from remarks to Boston College’s Chief Executives’ Club of Boston

October 2, 2014

TAKEAWAY: Care Providers

Question: We interview, survey, thousands of physicians every year and have done so for 20 years. And we are getting spontaneous, unrequested comment from them in the last few years that signals a profound discouragement on their part. A recent survey we read said that 37% of physicians out of 100 would do it again. I’m wondering if you think they should be discouraged. If not, what do you say to them?

Response: I would be discouraged. The reason I say that is that, if you think about the artifact of what we’ve done with our most important industry is we’ve created so much interventions in this market called healthcare that there’s no way to navigate to a place that rewards you for quality, rewards you for productivity, rewards you for anything. The health plans now have a restriction on how much profit they can make. Now, what other industry in our country has got a profit goal established that you can’t go past by the federal government?

So the more efficient I get as a health plan, the more I have to give back to my consumers in the middle of this, as opposed to maybe we should have the health plans compete with each other in open markets that are transparent, where our employees can go online or anybody can shop for whatever they want to shop, and I’ll pick the partner that’s best for me.

The same thing in the physician world, when we go away from a market-based pricing regime and we end up with a reimbursement that’s set by a regulator, you end up with those kinds of distortions.  So the people that want to take care of our most vulnerable populations are the ones that are least rewarded.

The ones that are most rewarded are the ones that set up concierge medicine practices for all of the people in this room, charge you 10 grand a year and let you call them on their home phone or on their cell phone 24/7. Well, what does that do for the people that are on Medicare and Medicaid? Those people are going to be stuck in lines. That’s not the way our society should work.

I understand that it’s not affordable, that we’ve got to manage costs in our country somehow. But having the regulators do it arbitrarily with a pen, from my perspective, has no basis in any kind of reality.  And I’m not rewarded for being a great doctor or taking care of the people. I’m rewarded the same way as the person down the street that doesn’t have the same quality.