By Robert Pearl, MD | | September 29, 2016

In my last column, I focused on how the business of healthcare, if left unchecked, would undermine the economic initiatives undertaken by our next president, whether they be Hillary Clinton or Donald Trump. As mentioned, despite the $3 trillion spent on healthcare each year, Americans are becoming less healthy, not more. This week I offer three specific recommendations that both candidates should adopt in their stump speeches, campaign promises and next two presidential debates.

1. Expand value-based payments for medical care

We have made some positive progress along these lines through increased enrollment in Medicare Advantage. In addition, the federal government and some large private payers have experimented with other approaches, such as shared savings through accountable care organizations and bundled payments for procedures such as total joint replacements. The ultimate destination, however, needs to be prospective global payment for defined patient populations, delivered by a defined group of accountable providers. By paying physicians and hospitals in advance for the care needed, we will align incentives to maximize prevention, avoid medical error, provide treatment sooner and minimize complications.

The next president should support the Centers for Medicare & Medicaid Services, not only in its current efforts to pay for value in Medicare, but also to commit to accelerating the transition to that new model. The days of paying as much for low-quality, inefficient medical care as we do for the best should be relegated to the history books. Otherwise, we will continue to perceive affordable cost and high quality as mutually exclusive. In practice, the best way to achieve affordability is to deliver the highest quality care, in the safest way, the first time.

2. Implement 21st century information technology throughout our healthcare system

The advances in IT since the turn of the century have been amazing. Today’s smartphones allow us to access the internet, send text messages and make video connections easily and often at no additional cost. Most of us demand this type of connectivity and access to information in nearly all aspects of our lives, but few of us can obtain it in the medical care we receive. As a result, most Americans unnecessarily miss work and school, experience delays in receiving the medical care they need and spend increasingly on out-of-pocket expenses. Across the United States, our failure to embrace modern technology in healthcare undermines productivity in the workplace and raises the total cost of care.

If our banking system lagged behind other industrialized nations in taking advantage of modern technology, you can be sure the presidential candidates would be quick to pledge to fix it. Healthcare should be no different.

Under the HITECH Act of 2009, the federal government invested $30 billion in incentives for healthcare providers to purchase healthcare information technology (HIT), particularly electronic health records (EHRs). Yet according to the Office of the National Coordinator for Health IT, 51% of doctors either don’t have an EHR or use the one they own only for billing and claims. But even those physicians who have purchased a system find they can’t easily exchange information with their colleagues in the community. The reason is that the vendors of these systems continue to make it hard for these disparate systems to interconnect electronically or “speak” to one another.

The presidential candidates should urge Congress to encourage testing and development of what are called Application Program Interfaces. If these are successful, then HIT systems would allow third-party developers to connect the software and create mobile solutions with the promise of improving medical care for all. As part of the process, Congress and regulatory agencies will also need to tackle the current arcane laws and regulations that limit the use of video and digital technology in medical practice.

3. Improve quality measurement and reporting, and make the information yielded easily accessible for all

If we truly want to be the best in the world in healthcare delivery, we need to measure outcomes, not just process, and learn from those organizations achieving the best outcomes today. The kind of subjective polls and magazine-sponsored popularity voting used for judging who are the best doctors in the United States should be reserved for the selection of high school prom kings and queens. We will increase value most rapidly in this $3 trillion industry only when we measure quality and can easily compare outcomes. Data is essential to determine the best approaches to solving medical problems. It also is necessary to figure out whether patients actually benefit from the care and the medications they receive, and if so, by how much.

We should be less interested in whether a patient had his blood pressure taken (a process measure) than in whether the person’s blood pressure was controlled at a healthy level (an outcomes measure). Ultimately, we need to establish which combination of approaches produces the lowest complications and death rates from stroke and heart attack, and make certain that all Americans receive that specific care. Even if every doctor and hospital, using only the scientific information currently available, matched the performance of industry leaders, we could rapidly reduce the incidence and mortality from these two critical events by 30%. Pledging to make improved health and increased longevity a goal would be a powerful election platform.

Opportunities for the future

Imagine if a hostile foreign nation came up with a new treatment, perhaps a gene therapy or a next-generation biological medication, that could save 100,000 American lives a year, and then refused to make it available to Americans in order to undermine our health, productivity and global competitiveness. We know what would happen. Our candidates would not only make major policy speeches in response, but also the debate moderators and Sunday morning talk show hosts would make it the first question they asked.

But when we fail to consistently achieve superior health outcomes as a result of failures within our own country, we don’t pay as much attention or even talk about it. When it comes to solving complex and difficult problems, we often wait for a crisis to strike before taking the difficult but essential steps to resolve the underlying issues. Maybe this time will be different. Hopefully, the candidates will speak out and unite the American public behind the promise of a healthier, more prosperous nation.

Healthcare policy experts recognize the shortcomings of the current model, and most agree on the next set of steps. Move from a fee-for-service to a pay-for-value approach. Advance from 20th century to 21st century information technology. Graduate from a fragmented delivery system to one that is integrated and coordinated. Those enhancements will save many more lives than any new drug or surgical procedure. If Trump and Clinton want more details about these ideas and opportunities, they can find it in “What Every Candidate Should Know About Health Care,” the recently released election primer from the Council of Accountable Physician Practices.

This article appeared on Dr. Pearl’s column on