'Our Whole System, To Me, Is Broken': Vern Buchanan Slams Medicare System, Calls It Too Expensive

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During a House Ways and Means Committee hearing before the Congressional recess, Rep. Vern Buchanan (R-FL) asked CEO of Senior Care Action Network (SCAN) Health Plans Dr. Sachin Jain, M.D., M.B.A. about prevention of medical issues before they begin.

Transcript

00:00Let me just start out, and I want to, Mr. Dr. Jan, yeah, is it Jan? Yeah.

00:08Jane, let me mention the idea you touched on prevention.

00:13We're spending $5 trillion as a country, that's the number I get,

00:18$2 trillion on Medicare and Medicaid.

00:20Seems like we're getting sicker at large, and we're spending a lot more money.

00:26It seems like everything's reactive.

00:28Instead, you get the heart disease, you get the obesity, then you try to deal with it.

00:33It just seems like it's so much more expensive.

00:36Can you expand a little bit more on your idea of prevention?

00:41Because it seems like the business that all of you are in,

00:45the more you make if you keep the folks healthy.

00:48And we're reacting once it happens.

00:51I'll just say one other thing.

00:53If someone's been in business a long time,

00:54one of the most important things is to get the incentives and the pay plan right.

00:59And part of the problem, our whole system, to me, is broken.

01:03We keep spending more and getting less, for whatever reason.

01:06And I just like to see if someone said you've got to be the CEO of your own health,

01:12we've got to have people take a little more responsibility or encourage them or help educate them

01:17to take more responsibility for their own health.

01:20But there's so much misinformation out there, it's not anybody's fault.

01:24But when you have 50 to 60 percent of the people in the country who are obese,

01:28they say 30 percent for young men, young ladies trying to go in the military are obese.

01:34They're talking about children at 20 percent or 18 percent obese.

01:38And that wasn't the way we grew up.

01:40So my point is I'm interested in your thought initially.

01:44You know, where are we at on this?

01:47Because if we don't change that paradigm, I don't see how we get ever where we're going.

01:53We'll never have enough money.

01:54Five trillion we're spending now.

01:56How much more we've got to spend for what we're getting?

01:59Well, thank you so much for the question.

02:02You know, I think about this question really in very personal terms.

02:06My father was diagnosed with diabetes in 1985.

02:09The first time that a physician or a medical student in this case, the medical student was me,

02:16referred him to a dietician was in the year 2006.

02:22And the reality is that we have a medical system right now that treats people when they become sick

02:29but does very little to actually prevent them from becoming sick in the first place.

02:33Bullseye.

02:34We will pay for expensive procedures on people's retinas.

02:37We'll pay for their dialysis.

02:39We'll pay for their cardiovascular interventions.

02:42But had we actually intervene on my father, who passed a couple of years ago in the 80s and 90s

02:47with lifestyle interventions, with a more intensive focus on actually counseling him on his disease,

02:54for pennies on the dollar, he might still be here today.

02:58That's the kind of thing that we try to do at SCAN for our Medicare beneficiaries.

03:02We try to think about their chronic diseases, intervene upon them early, get them the kind of supplemental benefits

03:08that they need to keep them healthy and well.

03:11I think there's incredible opportunities for us to intervene upon people and prevent things.

03:1665, however, is too late.

03:18When I meet our Medicare beneficiaries, they've had 65 years in a fee-for-service system

03:24where they've largely been disconnected from primary care.

03:27Or if they have primary care, we're focusing on treating their problems when they actually arise

03:33as opposed to actually slowing or delaying their progression or preventing them from happening in the first place.

03:40I think we have incredible opportunities through the Medicare Advantage program.

03:43Why do you think the whole thing on obesity has become such a big issue,

03:47especially when I think I've got 10 grandkids, 10 and under,

03:50and I'm very concerned about what they're eating or what they're doing.

03:54They don't have any of those issues now.

03:58But any kids, I don't like to see what's going on in that space.

04:02Dr. Miller, let me ask you, what's your thought on prevention?

04:05What more can we do? Is our system backward? We're reacting to the problem.

04:10It costs a lot more to react on stage 4 cancer or something

04:13than trying to prevent it in the first place.

04:16And so that's just the way I look at it.

04:18The way I want to run my life is that way.

04:20Someone said the first time you have the first heart attack,

04:24when you have your first heart attack, if someone has a first heart attack,

04:27half of them never see the next day.

04:29So I thought to myself 20 years ago, how do I not prevent that to begin with?

04:34So I'll get back to the whole idea of prevention.

04:37So thank you for the question.

04:39I think part of this gets around to how we can customize benefits

04:42rather than standardized benefits.

04:44We have special needs plans or SNP plans.

04:48We have ISNPs for institutionalized beneficiaries

04:51who live in skilled nursing facilities.

04:53We have DSNPs for dual eligibles who are eligible for Medicare and Medicaid.

04:58And then we have CSNPs for chronic disease.

05:00So I think actually CMS needs to invest some time and energy

05:04working to promote this marketplace

05:07so we can have customized health benefits to address chronic disease,

05:11to address those who are multimorbid and live in a skilled nursing facility,

05:15and also dual eligibles.

05:17We could have specialized benefits,

05:20specialized marketing and advertising regulations,

05:22and then, of course, customized network adequacy.

05:25So that way we can get the right patient into the right health benefits package

05:29and get the right care.

05:31But is it your thought?

05:33Should it be, is the system in your mind reactive,

05:36or should it be proactive

05:38and try to not let people get in the situation in the first place?

05:41Some of it's hereditary.

05:42I'll take that.

05:43But there's a high percentage.

05:45It's got to be the environment, the food,

05:47or something that we're, lack of activity.

05:50There's something going on in my mind.

05:52I agree wholeheartedly.

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