Three Wishes for Genie to Improve the US Healthcare System. Digital Health Interviews: Neil Carpenter

Our Digital Health Interview series is heading to the heart of the United States — Washington DC, to meet our guest of the day, Neil Carpenter. Neil is a healthcare strategy and innovation consultant with a diverse background. In this interview, Neil shares his journey, perspectives on the U.S. healthcare system, the response to the COVID-19 pandemic, and his three wishes for healthcare improvement.

Neil Carpenter’s Journey

Neil’s journey into healthcare strategy and innovation began outside the healthcare sector. In his 20s, he gained invaluable experience working for GE, American Express, and the nonprofit organization City. This diverse background in various industries provided him with a unique perspective that greatly influenced his approach to healthcare.

I learned a lot about different industries. When I went into consulting after doing that, I did a lot of healthcare, but I also did several non-healthcare gigs and also worked globally. I think it informs my view of healthcare that I saw how other industries work, and that’s been a source of creative tension, let’s just say.

Evaluation of the U.S. Healthcare System

Neil believes that there is room for improvement in the U.S. healthcare system. He emphasizes the need for constant progress, pointing out that both cost and outcomes fall short of the desired standards. He acknowledges that comparing the U.S. to other parts of the world can be complex due to lifestyle differences, but identifies fundamental issues in the system, such as the presence of perverse incentives.

I don’t think anyone should be satisfied with it. Our cost and our outcomes are not what they need to be. If you’re banging down the Dorito chips every day, you’re going to be less healthy regardless of what the US healthcare system does. There are some real differences, but what’s fundamentally problematic in our system is we have a lot of entrepreneurship, which is great, but there are also lots of ways once you get that many people engaged and that much money on the table, you have a lot of perverse incentives. It’s always good to have a comfortable existence, but when you’ve got that much money, it can be just too tempting.

Response to the COVID-19 Pandemic

Drawing from his firsthand involvement in the COVID-19 response, Neil acknowledges the challenges faced. He believes that there were missed opportunities for collaboration and coordination. Neil emphasizes the importance of considering the health status of the population when assessing outcomes.

I was deeply involved in the COVID task force. We did our best, but missed chances for collaboration. The pandemic exposed our lack of preparedness and led to excessive spending on healthcare. The profiteering during the crisis was concerning, and the lack of a coordinated response system was frustrating. We need a structured approach, like a wartime reserve, to handle future crises better. It’s crucial to conduct a thorough study to revamp our public health strategies and ensure accountability for necessary changes.

Role of Technology in the Pandemic Response

While acknowledging the benefits of technology, Neil highlights that operational speed sometimes outpaces technological implementation. He stresses the need for personalized messaging for effective communication during crises.

Technology played a crucial role during the pandemic, but its implementation often lagged behind the urgency of operations. Customized messaging, similar to a 911 response, would have been more effective in persuading the public. Despite privacy concerns, we should leverage data to tailor effective communication strategies. Healthcare lags in utilizing basic concepts like A/B testing for messaging, unlike marketing tactics for less noble products. We need to actively combat the efficiency of negative messaging in social media by employing personalized and effective public health strategies, even if it means sacrificing some privacy concerns.

Three Wishes for Healthcare Improvement

• Healthcare Consumer Education: Neil emphasizes the importance of educating healthcare consumers, enabling them to make more informed decisions about their health.

• Integrated Care Delivery Systems: He calls for truly integrated systems where the entity responsible for care also takes financial responsibility, promoting more efficient and effective care.

• Virtual Care Expansion: Neil sees virtual care as a means to provide more choices for patients while also introducing healthy competition into the healthcare landscape.

First, we need healthcare consumers to be better informed. Patients often trust doctors without doing enough research, leading to unnecessary procedures and costs. We must shift toward value-based care and educate patients to make informed decisions.

Second, we should have integrated care delivery systems, where insurers and providers work together seamlessly. Our fragmented system wastes energy and resources.

Third, we must build a robust system of virtual care. Virtual care offers convenience, safety, and new choices for patients. It also fosters competition at a local level, improving healthcare options for everyone.

Value-Based Care and its Challenges

Value-based care is a topic Neil is passionate about. He emphasizes the need for a more radical approach, including capitation and realignment of the workforce. Neil believes that change requires taking risks and making difficult decisions, as the status quo won’t lead to meaningful reform.

Reminds me of that scene from The Untouchables, you know? “Don’t bring a knife to a gunfight.” That’s how I see value-based care, trying to maneuver in a system that’s not built for it. We need bold changes, like capitation — taking real ownership of patient care. The problem with our current system is the complex web of incentives, which often leads to unnecessary healthcare spending. I’m all for value-based care, but it requires accepting that some will lose out financially. We can’t just keep printing more money without considering the consequences. Implementing value-based care means some healthcare services will need to be reduced, which could lead to closures and staff adjustments. We need to be ready to make tough decisions, even if it means upsetting some stakeholders.

Transition to Value-Based Care

Neil advises organizations considering the shift from fee-for-service to value-based care to focus on:

• Addressing workflow at the provider level.

• Aligning the workforce for value.

• Establishing a data infrastructure for value-based care.

My friends in this field are tackling fundamental challenges related to provider workflow, medication reconciliations, and patient follow-ups. These foundational tasks are crucial. However, our healthcare system must also align with a value-based approach, which means reconfiguring the workforce, embracing technology, and defining clinical pathways that prioritize value. Under value-based care, doctors will have fewer choices compared to the fee-for-service system. The healthcare sector currently operates with a high degree of individual clinical freedom, unlike more regimented industries. To improve, we need to industrialize healthcare, introduce data-driven decision-making, and learn from patient and provider data. This may involve customization in patient communication and less individual autonomy but will foster a learning ecosystem similar to other industries. Achieving this transformation requires a robust data infrastructure, workforce realignment, incentives, and financial support.

Advice for Digital Health Startup Founders

Neil’s primary advice for startup founders is to thoroughly understand their space and be well-prepared when engaging with potential partners or clients. This deep knowledge will enable meaningful and productive conversations.

I tend to give a lot of advice, perhaps too much at times. With my extensive experience in healthcare and various levels of the industry, I often find myself expressing strong opinions. One core piece of advice I often give, which I recently emphasized at the Rock Health Forum, is the importance of thoroughly understanding the space you're working in and the people you're dealing with. Young entrepreneurs, though enthusiastic, often lack the deep industry knowledge needed for effective engagement. Investing time in thorough research and ensuring alignment can save both parties from wasted efforts and time.

Our previous episode was with Mendel Erlenwein: Value-Based Care Explained