Organized outreach efforts to Congress, HHS, and CMS to educate on the opportunity to commission a public and private collaborative task force designed specifically to identify and analyze concrete opportunities for healthcare simplification and the coordination of simplification implementation efforts across public and private sectors.

Orchestrate efforts to reduce healthcare administration complexity, redundancy, and waste. Reexamine the role of health information technology to simplify patient to provider, provider to provider, and provider to payer care and financial interactions. Focused efforts to reduce administrative billing complexity and health plan benefit design to reduce the explosion of billing and treatment codes that providers and payers try to manipulate to their best advantage, in large part leading to higher costs and the increased use of prior authorizations before treatment. Billing reforms would enable more meaningful price transparency for payers, providers, and their patients. Simplified pricing and claims reimbursement processes across providers and health systems will dramatically reduce payer and provider administrative costs and related personnel and outside vendor costs.

The persistent fragmentation of healthcare reflects inadequate coordination between providers of care. A variety of conditions make it more difficult for primary care practices to coordinate care including that most PCPs spend little time in hospitals and use siloed electronic health records (EHRs) while insurance networks complicate choice...

... and coordination. Many specialists and PCPs report that they are not getting the information they need from other physicians or hospitals to provide high-quality care. Yet more than a decade ago the federal government created a healthcare secure email capability that has languished, saddling healthcare with ransomware attacks and fax machine technology. Simultaneously, 2018 marked the first time those 65 years or older outnumbered children under five globally. The prevalence of chronic conditions and multimorbidity affects more than 50% of those over 65, forcing many to become long-term care-dependent. Most would prefer to live in their own homes as long as possible. Homecare aided by telehealth and remote device monitoring is a cost-effective alternative to costly inpatient or residential care. The long-term sustainable opportunity for most seniors is nursing home diversion by progressively shifting longer-term care away from institutional to home care settings.

Healthcare is one of the only industries where those buying or selling do so without knowing how much it costs. It's typically not until the doctor receives the explanation of benefits (EOB) or a patient receives their bill that each knows the real cost. More than fifteen years ago electronic prescribing systems were created so that physicians could...

... not just send scripts electronically to the pharmacy, but before the script is even written downloading the patient's available prescription history across pharmacies allowing for medication reconciliation AND determining if the drug being prescribed is appropriate with no adverse indications AND determining from the patient’s insurance formulary the patient costs AND whether authorization is required. Yet due to siloed information and the complexity of formulary design and drug pricing, most patients still do not know the cost until they arrive at the pharmacy kicking off a daisy-chain of more work and delay for patients, providers, and pharmacists. WHAT IF electronic prescribing worked as designed and if that kind of process was expanded to include other healthcare services so that a doctor and a patient would know ahead of time what the real options and costs would be? How much cost and delay would be averted for payers, patients, and providers?

There exists almost a complete lack of understanding about how healthcare pricing is derived and the true costs to deliver patient care. There is little resemblance to actual costs associated with delivering services much less how to discern how those costs compare with the outcomes achieved. Hospitals in the United States...

... maintain chargemasters that contain the official list prices for all billable services. Prices vary widely across hospitals and on average are more than three times what hospitals are paid for treating a patient from insurance companies. Since providers do not fully understand their costs to reimbursement, they are unable to link cost to process improvements or outcomes preventing them from making sustainable cost reductions. More care or more expensive care does not necessarily create better care. Healthcare value should be measured in terms of patient outcomes achieved per dollar expended. While hospitals are supposed to start posting their prices, including their negotiated rates, it is difficult to see how transparency of prices that vary widely by patient and bounce all over the map with no relation to the cost to deliver those services in the first place, will lead to overall lower prices.

Drug spending in the United States is at an all-time high and still rising. Studies have repeatedly shown that the U.S. pays far more for the same prescription drugs than other countries. Patients in the U.S. are far more likely to report that they can’t afford their medications and half of all adults with lower incomes go without care because of the cost.

Reforming the pharmaceutical industry will provide an opportunity to address critical gaps in drug coverage, access, and affordability. Direct-to-consumer drug advertising has led to excess utilization and steering patient away from generics. Many experts, including the AMA, have called for the practice to end, But many are concerned about how far the federal government should go to reform the pharmaceutical industry out of concerns those efforts would stifle innovation. However, this ignores the fact that pharmaceutical companies have the largest profit margins of any sector among publicly traded companies. Given lucrative public and private marketplaces and the federal government subsidizing drug development through funding of research and development to stimulate innovation, even with lower prices, the pharmaceutical “industrial complex” will remain a focus of Wall Street and future investment.

Establish a renewed focus on Transitions of Care and how existing and proposed Health Information Technology (HIT) and Interoperability of medical records are being implemented. Launch a more profound dialog in understanding the challenges and opportunities of transitioning from unstructured text and consuming medical records from other...

... sources and leveraging capability such as basic artificial intelligence (AI) to help providers discern actionable data amid an increasing information avalanche. While the $35 billion investment from the 2009 stimulus legislation in HIT efforts have helped propel physician adoption of electronic health records (EHRs) through their required use in some settings, adoption has come at a huge cost and distraction for many providers, who continue to complain loudly about the new electronic administrative burdens distracting them from patient care. Thirteen years later, the interoperability of medical records and widespread exchange outside of individual health systems remains elusive. No standard National Patient Identifier connects electronic records and doctors universally still leverage business technology first deployed in 1964. The fax machine!