Robert Andrews Of The Health Transformation Alliance On 5 Things We Must Do To Improve the US Healthcare System
An Interview With Jake Frankel
Every Mom and Every Baby should get top-shelf care from conception to delivery.: The US has the highest maternal mortality rate among developed countries. For every 100,000 live births in the US, there were approximately 22 maternal deaths for every 100,000 live births In half of the countries, there were less than five maternal deaths per 100,000 live births. Currently, over 6 million women in the US live in counties where there are no hospitals or birth centers offerings obstetric care. The shortage is expected to only get worse in the coming years. HTA employers are aggregating data to identify and provide better care for the top 10% of high-risk employees and predict high-risk complications during pregnancies providing with critical insights for designing targeted mitigations programs leading to better maternity outcomes.
As a part of our interview series called “5 Things We Must Do To Improve the US Healthcare System”, I had the pleasure to interview Robert Andrews.
Robert E. Andrews is the Chief Executive Officer (CEO) of the Health Transformation Alliance (HTA), an original author of the Affordable Care Act, and a former member of Congress. As CEO of the HTA, Andrews oversees the strategic direction of approximately 70+ major corporations that have come together in an alliance to do one thing: fix our broken healthcare system and are responsible for more than 4 million employees in the United States with an annual healthcare spend of $40 billion. Through Andrews’ leadership, the HTA has launched value-driven solutions specifically designed to improve patient care and economic value through world-class data and analytics, pathbreaking pharmaceutical solutions, high-quality medical networks, and robust consumer engagement initiatives.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?
Prior to serving as CEO of the Health Transformation Alliance, I had the privilege of serving as a member of the United States House of Representatives for nearly 24 years. In my time in service, I realized that while public-provided healthcare (Medicare/Medicaid) is very important and makes up most of the volume in the system, employer-provided healthcare contributes most of the profit in the healthcare supply chain and that changes in one area affect the entire system. Because employers subsidize a large part of the system, their voices can and must be heard in transforming American health care toward greater outcomes for all. Our founders created the Health Transformation Alliance because we knew that coalescing some of the top employers in the country has the potential to be a very effective lever for change.
Can you share the most interesting story that happened to you since you began your career?
One day, my wife and I were adopting a rescue cat through a local non-profit organization. While we were awaiting the completion of the necessary paperwork, I asked the woman volunteering what she did for a living. She told me she was a stay at home Mom, but her husband worked for one of our HTA Member companies. I asked if he liked his job, and she said yes — in fact he had been offered a higher-paying job at a competitor company, but he had declined the offer. When I asked why, she said, “The company has great health benefits. Our youngest son has autism, and they take really great care of him, so we would not want to lose that coverage.” This story inspired and reminded me of what employers can do to make the health care system better.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
How much space and time do we have? My mistakes were (and are) many. One I remember often is that as a young candidate for Congress, I knocked on a voter’s door. The voter said hello and started to say, “I wanted to ask….,” but I interrupted her and proceeded to unleash a blizzard of my ideas about taxes, the education, foreign policy, immigration, and on and on. As the voter’s eyes glazed over, I finally paused, and she jumped in: “I wanted to ask if we could get the trash picked up twice a week instead of once….” Chastened, I was reminded that the best way to create and deepen a relationship is to listen to what the other person is asking and learn the problem they are trying to solve. I’m still working on this, but I’m getting there.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My Dad would tell me that “90 percent of the things in life you worry about, after they occur you ask yourself ‘why was I so worried about that?’” I have often found comfort and strength in his wisdom.
How would you define an “excellent healthcare provider”?
One who makes his or her patient healthier and cares about whether or not they achieved that better health. We need to build a system where providers — the vast majority of whom I believe fit this description — are rewarded and not penalized for this behavior.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I love Smart Brevity by Jim VandeHei, Mike Allen, and Roy Schwartz because almost all problems can be solved through clear thinking, but none can be solved without it. I love the Tipping Point by Malcom Gladwell because it reminds us how small changes can lead to huge shifts in behavior and thought. I love X (formerly Twitter) because it gives me a real-time snapshot of the culture in which we live.
Are you working on any exciting new projects now? How do you think that will help people?
Yes, HTA is working on a project that will help consumers and employers understand who the high value providers are for a given health challenge in a given geography — this is based on risk adjusted and clinically valid criteria. People should know as much about their knee surgeon as they do their phone plan.
Ok, thank you for that. Let’s now jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high-income nations. This seems shocking. Can you share with us a few reasons why you think the US is ranked so poorly?
We ranked so poorly because our current healthcare system is based on fee for service and is designed to react to crises rather than prevent negative health outcomes. An additional important reason is that access to care too often depends on income, gender, race, ethnicity and other social factors.
As a “healthcare insider”, if you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system?
1. Every consumer and payer would have access to and control of their health care data.: Last year, we worked with Leapfrog Group an HTA member, and Turquoise Health and recognized 472 hospitals for their efforts in demonstrating excellence in both patient safety and price transparency. These hospitals represent less than 20% of all hospitals and indicate the vital need for significant improvement in the US healthcare system.
2. Every Provider should gain income for great outcomes and lose income for poor outcomes.: At the HTA, we analyze and aggregate our data to identify, and risk adjust for highly effective and ineffective care for our employees and their families to understand where the best value is, and pay providers based on the outcome.
3. Every Mom and Every Baby should get top-shelf care from conception to delivery.: The US has the highest maternal mortality rate among developed countries. For every 100,000 live births in the US, there were approximately 22 maternal deaths for every 100,000 live births In half of the countries, there were less than five maternal deaths per 100,000 live births. Currently, over 6 million women in the US live in counties where there are no hospitals or birth centers offerings obstetric care. The shortage is expected to only get worse in the coming years. HTA employers are aggregating data to identify and provide better care for the top 10% of high-risk employees and predict high-risk complications during pregnancies providing with critical insights for designing targeted mitigations programs leading to better maternity outcomes.
4. Every Consumer should have both the opportunity and the obligation to take better care of themselves.: While we should always be mindful of genetic and socioeconomic advantages and disadvantages, it is both reasonable and imperative that consumers have access to and are at least partially financially responsible for diet, exercise, drug adherence and other factors critical to good health.
5. Every armchair expert who opines about bad care in the US should have to spend a few shifts in an ER, an ICU, a behavioral health center, a primary care clinic, or a nursing home.: I often read and strongly disagree with the assertion that the US has a bad health care system. The US has a great healing and care system, supported by millions of dedicated men and women. We have a disjointed and irrational economic and regulatory infrastructure on which our health care system must operate. That’s what needs to change.
What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
Transformation will happen when the parties who pay the bills insist that things change. That’s why HTA is here — to work with others who see the mission as we do.
The COVID-19 pandemic has put intense pressure on the American healthcare system, leaving some hospital systems at a complete loss as to how to handle this crisis. Can you share with us examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these issues moving forward?
We’ve seen the U.S. healthcare system struggle due to a lack of qualified care providers. We can address this problem through more seats in medical and nursing schools, and more value based care. Imagine that health care worked like worker’s comp policies. Through premium variability, businesses are aligned to provide safer workplaces for their employees, as they are incentivized to provide “better outcomes” for their dedication to their workers. Our healthcare system doesn’t work this way — there are currently no incentives for PBMs, carriers, and providers — they get paid the same amount of money regardless of the patient’s outcome. There is no “incentive” to keep people out of the hospital which needs to be addressed moving forward.
How do you think we can address the problem of physician shortages?
Obtaining education is highly expensive as most people have to put themselves in great debt and that pushes them towards the highest paying specialties. In particular, we need to better compensate primary caregivers. If the provider is paid on the condition of their outcomes, and if that becomes the mode of payment, then the income of the primary caregiver will rise and the number of these caregivers will rise, leveling out the shortages and current imbalance.
How do you think we can address the issue of physician and nurse burnout?
Not to be a broken record, but if providers were paid more for better outcomes and shared in the savings inherent in avoided strokes, heart attacks and other crises, budgets would support physicians and nurses and help alleviate burnout.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most people, what would that be? You never know what your idea can trigger. 😊
Our country has never been more burdened by bitter political and cultural divisions, and this troubles me deeply. In response, I try when appropriate to listen to and show respect for a person with whom I am likely to disagree. I truly believe that random acts of mutual respect can tone down the enmity that punishes us all and can lift us to a level of civility that will enlighten us all.
How can our readers further follow your work online?
You can follow me on LinkedIn @RobertAndrews and can follow the great work the Health Transformation Alliance is doing to improve the future of healthcare on our website and company LinkedIn page.
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.
Robert Andrews Of The Health Transformation Alliance On 5 Things We Must Do To Improve the US… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.