I am writing this letter because for two months I tried to get ahold of Darryn Carter, a case manager at your company who was assigned to process a complaint I filed about care I received that I feel was harmful and irresponsible.
The legal and rational reason for this current writing is this: the letter I received from Darryn Carter rejecting my complaint claim stated that I have a legal right to see the documentation and evidence used to make the decision about my case. I would like to see that evidence file, and I have not been able to get in touch with Mr./ Ms. Carter or anyone else at Kaiser to send the file.
The emotional and human reason I want to talk with Darryn Carter–and I think it’s appropriate to share this reason too, given that you are a care provider–is that I believe I received bad care at Kaiser, and yet no one at Kaiser has ever listened to what I have to say about it, despite months of my trying to tell someone. My concern and frustration, which is so strong that it drove me to spend a Saturday writing this letter, is not primarily about the bad care I believe I received but rather the wholehearted dismissal that your organization has levied through an unnavigable bureaucracy. This dismissal has kept me up nights, sometimes crying, sometimes fuming, sometimes brooding, always feeling that special type of indignity reserved for a patient with a care provider who blatantly and systematically refuses to care.
Silicon Valley wants to love healthcare. The industry is enormous and full of inefficiency, which is to say, perfect for technology investment. So it comes as no surprise that venture money in healthcare technology startups has quadrupled since 2011 to $4.5BN in 2015. Moreover, the government wants to invite Silicon Valley-style innovation in healthcare. In January, CMS leaders stated that the next wave of EHR policy will focus on promoting startup innovation in healthcare by incentivizing open APIs and interoperability. Everyone agrees—so let’s just get going, right?
Here’s an important truth to recognize on the eve of what some like to call the “disruption of healthcare”: Silicon Valley and healthcare are fundamentally at odds.
In technology we fail fast, launch and iterate, proudly make mistakes and learn from them. In medicine, the first principle is “do no harm.” Entrepreneurs are obsessed with growth–exponential growth, hypergrowth, 10X growth–and the faster the better. Conversely, in healthcare organizations, progress is measured in months and years. My company is currently in Y Combinator, a three-month accelerator program. I have had phone calls with healthcare organizations that took longer than that to schedule.
In the future, doctors who provide better healthcare will be paid more. When a doctor gives good care, she will get credit. For factors out of that doctor’s control, she won’t be penalized. The patient, too, will be rewarded for taking care of his own health. In short, payments will align with good care, and good care will become more common.
This is the promise of value-based care, which is coming, according to almost everyone. Medicare is pushing it. Private payers are preparing for it.Top providers are tooling up.
And yet, the question lingers — how exactly do we measure quality? Today quality measurement is rigid, periodic, and manual. Here’s a peek behind the curtain of what we measure today — and what’s possible tomorrow.