Q&A Part 1: Solving Healthcare’s Biggest Problems

Despite the progress made in recent years, the healthcare sector still faces many challenges that need to be addressed if we are to improve the quality of care and outcomes for all. In this important three-part series, Tom Spencer, Co-Founder and CEO of HealtheMed shares his vision of the future of healthcare, based on 30 years of physician management, managed care contracting and health care technology innovation.



1.What is the biggest problem to fix in our health care delivery system today?

Almost all the financial incentives in the health care industry are still aligned around caring for people who are sick. It is very hard for physicians to make a living by preventing sickness in their patients. Our company HealtheMed has answered the question “What would a health system look like that financially rewards doctors and their patient’s for being and staying healthy?”

2. Why hasn’t society been able to fix these problems?

It is a valuation problem. People are motivated by rewards. Today US healthcare rewards and compensates disease treatment. But people don’t want disease, they want good health. If the rewards shift to valuing better overall health, you will get better population health over time. For example, our system of care, Clinic@Home, rewards doctors for performing primary care in the home, and the preventative care they deliver stimulates better health in a highly vulnerable population.

3. How will the focus on “health equity” help?

I think whoever coined the term “health equity” was aiming at better access to disease treatment services. I believe a better term would be “healthcare access”, because at least it gets us closer to achieving true health equity. Unfortunately, until access to preventative health is properly compensated by CMS and private insurance companies, we will never have true “health equity.” When we launched Clinic@Home, our first priority was to crack this code and compensate preventative health in the home.

4. What happens if we don’t solve these problems?

The annual US Medicaid budget in 2023 is approximately $700 billion. States are in trouble because they have to balance their budgets and healthcare costs are out of control. The same challenges apply to Medicare. Eventually, patients with life threatening conditions will be refused care because the money has run out at the state level. If it does not change, the system will finally implode.

5. What are the biggest obstacles solving these challenges?

The biggest obstacle is a byproduct of human nature. If you’ve grown something to the size of $4 trillion between the payers and the providers, it’s really all they know. A value judgment needs to be made by healthcare leaders to overcome this inertia.

I believe this process is already underway in many states. We have a great example in the Minnesota Department of Human Services, which has embraced our innovative in-home care system,

Clinic@Home. Through Clinic@Home, we provide Medicare waivered clients with access to the preventative health care they need and reward doctors for providing care in the home.

That is a big step towards beginning to heal the healthcare system because the home is where 100% of chronic diseases that exist among this population are treated 90% of the time or more. Home as the center of care will cost a lot less than a hospital.



Click here to see Part 2 of our Q&A series.