International Business Times
Gail Zahtz featured in the International Business Times
As We Move Past Covid, Healthcare Transformation Expert Gail Zahtz Explains Our Opportunity To Do Better
By Daniel Lee
03/04/22 AT 8:40 AM EST
Healthcare spending has increased fourfold since 1970; in 2019 America spent $3.8 trillion on healthcare.
The current fee-for-service healthcare model creates incentives for ‘transactions of sickness’. Value-based care incentivizes keeping populations healthy at home.
Healthcare Transformation expert Gail Zahtz is spearheading the drive for a promising alternative.
As the pandemic took hold in spring 2020, grateful Americans embraced quarantine clapping as a way to celebrate the sacrifices being made by frontline healthcare workers across the nation. Many of those workers received up to a 20% pay cut on January 1 this year, according to Becker's Healthcare.
The pandemic highlighted the shortcomings of a fee-for-service payment model when the volume of elective procedures and services drops. It also shone a bright light on the significant racial and ethnic disparities in our healthcare system. But we didn’t need the virus to tell us that the fee-for-service approach is a terrible way to run a healthcare system. We already knew that it was perpetuating inequity and hurting patients, with some getting too much care, some receiving too little and others simply getting the wrong kind. We also knew that it was responsible for the skyrocketing costs in U.S. healthcare.
According to the Kaiser Family Foundation, health care spending totalled $74.6 billion in 1970. In 2000, this number had increased four-fold to $1.9 trillion and by 2015, health care expenditure had skyrocketed to a staggering $3.2 trillion. In 2019, before the pandemic hit, this number had reached $3.8 trillion. For many, that increased spend has not translated into better health outcomes. For Americans with health insurance, these costs translate into increased premiums and deductibles. And they’re the lucky ones.
Millions of Americans don’t have health insurance including coverage through Medicare or Medicaid. In fact, research suggests that between 2002 and 2015, fewer and fewer Americans of all ages, except for those in their 80s, even had a primary care provider.
One of the goals of the Affordable Care Act (ACA) was to move away from the fee-for-service model (which is, by definition, inefficient because the incentive is to wait until there is a sickness to be fixed, instead of keeping people healthy) to a value-based payment model, in which providers are incentivized to facilitate changes that create health and avoid sickness.
Gail Zahtz GAIL ZAHTZ
Zahtz has an analogy for the transformation before us. “ The best way to describe this ,” says Gail, “ is to suppose that everybody’s tripping on the sidewalk and breaking their arms. Fee-for-service would just keep fixing arms. Value-based care, on the other hand, would prioritize fixing sidewalks. The principle of health equity takes it a step further, and says ‘we’re going to fix the sidewalks everywhere.’ ”
Although strides have certainly been made in achieving this goal, and the move to a value-based system has enjoyed consistent support from the past three presidential administrations (as well as bipartisan support in Congress) progress has remained slow. As of 2018, the traditional fee-for-service payment still accounted for 70% of overall revenue in the healthcare system.
Now, in the post-pandemic landscape, as the Biden administration has made it clear that we should be taking care of all those Americans who have been left behind, and the Center for Medicare and Medicaid Innovation (CMMI) has signaled its intention to push for an accelerated transition, it seems that the time for equitable, value-based healthcare has finally come. Leading the charge for change and assisting companies, providers, and non-profits to navigate this transition is value-based healthcare transformation expert, Gail Zahtz.
Zahtz is a sought-after keynote speaker, value-based care consultant, and subject matter expert. Gail stresses that in order to succeed in the shift from fee for service to value-based contracting, “we need to shift from being reactive to proactive, and we need to reform an institution of sickness to one of wellness .” Health organizations have to do more than change billing and reporting systems . “Surviving and thriving in the new healthcare landscape will require a change in the culture of the entire organization from selling a service of sickness,” says Gail, “to sharing responsibility for the health of entire populations. As health systems are required to make these changes, all companies who sell and service solutions for provider organizations need to become partners in transformation.”
To guide organizations in making this transformation, Gail Zahtz brings a unique blend of deep professional expertise in the current regulations, coupled with an inspirational personal story from homelessness and very nearly death (stemming from late-stage cancer) to transformational leadership.
