Many of us are disheartened by the state of health care
today. The solutions being proposed to
repair and reform it are not sustainable for physicians or patients. Every system functions from operating
principles that govern and direct its mission.
In order for us to understand why health care is dysfunctional, we need
to analyze and understand its business model as it relates to is mission.
Nearly two decades ago, physicians delegated the business of
health care to administrators and accounting experts to manage and run it. Unfortunately, their mission was in conflict with that of the health care system. Theirs was profit centric rather than
patient centric. They believed that
patient care interfered with generation of profit. They began to see time spent with patients as
a compromise of their mission. They
began to value numbers over people. Health care’s mission became disjointed
when two contrasting missions were being served. Profit became the dominating
mission for health care as business managers established control over
physicians and regulated and limited their time with patients for maximal
revenue.
When I worked in this system, I was unable to find meaning
in my work. I was also unable to
sacrifice my mission as a physician for the mission of health care
administrators. I was told that my work
in their health care system was a conflict of interest to their mission. My patients were staying well and not
generating enough hospital dollars. I
left traditional health care to create my own business model. As a physician who remains devoted to my
patients I wanted to create a model that generated value for both my patients
and my business creatively. I have
never sacrificed mission for profit. I run my business with good business
savvy, all the while devoted to my purpose as a physician. A health care business model risks losing its
way when it becomes profit centric. For healthcare
to be successful and sustainable, mission must never be compromised for profit.
Our health care system has lost its way.
We have many examples of profit driven health care in our
country today and especially in southeastern Wisconsin. These systems purport to care about health, but on
closer examination, we see otherwise – they rely on sick care. Health care is a
conflict of financial interest. Currently, the highest expense in health care are
administrative costs. Many layers deep,
administrators manipulate and control physicians, nurses and employees serve their mission of profit over health or care. This has demoralized
physicians and nurses and driven away patients. Moreover, it has increased the incidence of medical
errors, placing patients and physicians at risk.
Author and president of Business Ethics Magazine, Marjorie
Kelly, defines a business model that functions with this type of focus as ‘extractive.’ Its’ purpose is merely financial –
maximization of profits. Worth is extracted from workers to generate profit
by layers of administrative hierarchy.
The extractive business model is prevalent in most corporations
today. Outsourcing work to Third World countries
for cheap labor to increase profit-margin is extractive. Extractive economics are bad for our country’s
economy. It displaces domestic workers and
extracts as much work as it can from the remaining workforce to serve profit
margin. Extractive economics deplete
meaning from work. Employees find
themselves working merely to pay the bills for survival. They lose pride and meaning in their work. As
a result their physical and mental health suffers. We all pay the price for extractive
economics. The state of our country’s
middle class is a result of extractive economics.
The majority of health care systems function from this
extractive model. Health care employees are
currently working merely to meet quarterly projections. For health care to operate in this manner is
unethical. Health care’s mission is to serve and heal. When the vulnerability
of patients is used to generate profit, they are deeply harmed. The ‘care’ they
receive is motivated by the drive to maximize testing and treatment. Physicians are unable to diagnose and treat
cost-effectively when working for an administrative system based on extractive
economics. They must follow the rules of
the game to keep their jobs. Patients
are left with super-sized bills for mere symptom management. Administrative bonuses depend on this.
A ‘generative’ business model provides
services that generate value. Health
care based on generative economics focuses on health and healing rather than
maximization of profit. The focus shifts
from one of greed to one of service. Patient care is not provided at the cost
of profit, and there is a balance between both without compromising
either. A health care model based on
generative economics operates from the principles of sustainability. There is a fair exchange between doctor and
patient.
What this would look like in the health care system is already
visible at The Ommani Center for Integrative Medicine. Patient care as well as sound business
principles are utilized to serve patients cost effectively. In addition, the most cost-effective diagnostics
available in the community are recommended to patients. Small businesses in the community, such as
organic grocers, complementary practitioners and businesses dedicated to health
and sustainability that operate from a high standard-of-care, receive support
and collaboration by practitioners through patient referrals. Education and empowerment are of foremost
value and achieving optimal health at all levels is served. All retail profits are used to subsidize business
overhead to keep health care visits affordable for patients.
Practitioners work collaboratively with patients to uncover
the causes of illness and empower patient responsibility. The mission of health care is served and all
profits are reinvested to support the staff and employees of the Center. The business is also dedicated to the health
of the environment and recycles to reduce its carbon footprint.
The Ommani Center is a generative
business.
Those who administer the business of traditional health care
state that a mission centric model cannot succeed financially, that a generative
business model is not profitable.
Nothing could be further from the truth.
Shifting the focus of a business from profit to mission, from extractive
to generative can actually draw in more
revenue in service of its patients. In
addition, in a model like this, patients are truly served by physicians practicing
from heart without the demoralization they currently experience within an
extractive model of health care.
This is health care reform at the level of its core mission.
I believe this is one of the key solution’s to healing our
broken system of health care. This can also
restore the soul of our sacred vocation.
