Viewpoint: When it comes to sustainable healthcare in the United States, we’re on a collision course

We’re headed toward a dangerous tipping point as the supply of health care professionals severely lags behind the demand of our aging population. We have the largest population over the age of 65 in our nation’s history, and by 2030, it will reach 73 million¹. For a multitude of reasons, we will be facing an escalating shortage of nurses and doctors.  

After spending decades working within traditional health care models, we understand the nuanced reasons both the staff and network models can’t hold up under this pressure². The shocking lack of real incentives and effective clinical tools has led primary care physicians to be disillusioned and frequently burned out. This situation has resulted in a lack of attraction to primary care as a future career. Primary care is trapped in a vicious cycle.  

How we got on this path is not a mystery. 

The talent shortage is accelerated by the result of the slow, systematic disempowerment of primary care physicians (PCPs). By the nature of their structure, large hospital systems have gradually limited physicians’ decision authority and influence. Where PCPs were once drivers behind the wheel, they are now part of teams where they frequently become cogs within the wheel. The large scale and size of the staff model also limit the ability to implement physician-centric changes quickly.  

Network model physicians have similar problems. What they gain in speed to change, they many times lack in efficient technology, workflows and resources. This often leads to more burdensome administration and less optimal clinical outcomes.

There’s a scalable, sustainable safety lane.   

For almost a decade, my team has been designing, testing and scaling the exit ramp to a better way forward. It starts by helping existing physicians see the vision for the path to success. By providing this pathway, we can reignite a passion for primary care and start re-attracting the next generation of health care professionals we so desperately need for the future. When we help our primary care physicians, we’re helping them create better outcomes for each of our seniors; this is the safety lane we all need. The beautiful part is that this becomes a virtuous cycle

So how do we help existing physicians be who they want to be and do what they want to do? In my opinion, it requires a combination of re-empowering them and re-engineering the health care landscape.  

Re-empowering physicians is WHAT we must do.  

 Re-empowering our physicians starts with understanding why they practice in the first place. They practice because they are passionate about improving their patient's health.

So we must empower them by putting effective clinical decision-making back in their hands. We must enable them to make more informed decisions based on what’s right for each patient as well as transparent, real-time, actionable, data-driven insights.  

Re-empowering physicians must also include helping them become profitable again. The burn-out is real; we must do more to put out the flames. The health care ecosystem must show up with resources and tools that improve practice efficiency, reduce overhead costs, increase their ability to grow their panels and effectively increase their total compensation.  

Finally, re-empowering physicians must extend beyond their practice walls and into the broader clinical support ecosystems. 

Re-engineering the landscape is HOW we will do it. 

 Re-engineering the health care landscape for primary care physicians starts by streamlining data into actionable insights. Most of the administrative speedbumps stalling physicians derive from a lack of comprehensive, transparent patient data.  

Today, there is existing technology to provide continuous, real-time, data-driven insights powered by artificial intelligence (AI). Those AI-driven insights enable care teams to identify polychronic patients earlier, predict what kind of support they need, coordinate that care in advance and follow through continuously across the care journey. This cutting-edge technology is helping create new-world clinical outcomes. Insights give providers power, save them time and help them be more efficient. This needs to be the norm, not the exception, across the industry. 

Re-engineering the health care landscape requires extending physicians’ resources. Based on our experience, we can proactively identify the 18% of the polychronic patients who account for 74% of the institutional health care costs³. Once identified, we scale as the physician’s “personal extensivists” providing concierge-level care coordination to patients. This means 24/7 virtual care, in-home care provided by a clinical team, coordination with primary care physicians and specialists, and the support of other supplemental benefits like transportation to appointments.    

Here is one example of how actionable insights and transparent data can result in state-of-the-art patient care. An 82-year-old woman was identified as being at very high risk of hospitalization after seeing her urologist for a urinary tract infection (UTI). The urology office attempted to set up outpatient infusions at the hospital, but the hospital could not accommodate the high-frequency infusions required. Therefore, the urologist suggested she be admitted to the emergency room (ER).  

The woman called the care center for guidance and shared that she did not want to go to the ER. Using technology, the clinician was able to view the patient’s medication, history of frequent UTIs, and labs and urine studies confirming a rare type of UTI. Within 30 minutes, the clinician coordinated with the urologist and the member for home infusions and visits by a clinical team, preventing hospitalization and any potential hospital-related complications.  

By enabling more practice efficiency and effectiveness while providing physicians more care enabling resources, we create the capacity they need to deliver even better clinical outcomes with better operations and better financial results for both patients and the physician. Everyone wins. 

 We have a chance to get into a safer lane, but we have to act now. The dynamics behind the physician shortage are not being solved quickly enough. By re-empowering our physicians and re-engineering the broken health care landscape, we have the opportunity to reignite the profession and attract the next generation of primary care physicians we so desperately need for everyone’s future. 

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 Footnotes 

  1. Source: https://www.usa.edu/blog/nursing-shortage/ and https://www.leveragerx.com/blog/us-doctor-shortage/
  2. The staff model provides medical care to subscribers on an exclusive basis in a centralized medical operation, and the network model contracts with more than one independent physician group to provide health services. 
  3. Data represents a sample of our population stratification from 2021.  

JOHN KAO

CEO, Alignment Healthcare

John Kao is founder and CEO of Alignment Healthcare, a consumer-centric platform delivering customized health care in the United States to seniors and those who need it most, the chronically ill and frail, through its Medicare Advantage plans. Mr. Kao has had a long career committed to the health care industry and has served in executive roles at CareMore Medical Enterprises, The TriZetto Group, PacifiCare Health Systems, Secure Horizons USA, and FHP International. Mr. Kao believes strongly in the tenets of servant leadership and serves on various boards of non-profit organizations. He received his bachelor’s degree from Santa Clara University and his MBA from UCLA Anderson Graduate School of Management.

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