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Opinion | Michael Wagner

The future of health care is already here

Tobey Hospital, in Wareham, holds multiple community classes, including for those with health problems and those recovering from a heart attack, heart surgery, or heart disease.
Tobey Hospital, in Wareham, holds multiple community classes, including for those with health problems and those recovering from a heart attack, heart surgery, or heart disease. handout

LAST MONTH we learned again that our national health care system is so beyond broken that it will require not one, but three billionaires and a world-renowned doctor to fix it. The venture — formed by investor Warren Buffett, Amazon’s Jeff Bezos, and JPMorgan Chase CEO Jamie Dimon and led by Boston surgeon and author Atul Gawande — will get to work on solving what ails us all.

Besides deep pockets, the business leaders have a serious motivation to fix the system — their companies have more than 1 million employees; health care spending in 2016 made up 17.9 percent of the economy and more than $10,348 per person, according to the US Centers for Medicare & Medicaid Services. That’s a $10 billion health care price tag.


Gawande’s work will undoubtedly be exciting and probably fruitful, but companies across the country don’t have to wait for the next big idea to start fixing our medical system. There are actions that we can take immediately that will create significant savings and health improvements. It will just require a new way of thinking and spending.

The first isn’t sexy, but it is real. More care needs to be delivered in the community. As the former CEO of an academic medical center, I know the importance of academic centers for clinical care, research, and teaching. But I also know that too much care is delivered unnecessarily in these halls.

In 2016, more than a third of all commercial payments to acute-care hospitals went to academic centers, according to the Center for Health Information and Analysis’ 2018 Relative Price report. Much of that care didn’t need to happen in Boston at Boston prices. And if it had stayed in the community, the savings would have been significant. For example, a service priced $8,900 at MelroseWakefield Hospital would be $13,800 at Massachusetts General, according to the same CHIA study. That’s a nearly $5,000 difference. These differences add up. In Massachusetts alone, if more care were delivered in the right place, our state, businesses, and patients could save millions.


Yes, lowering costs starts with keeping care close to home. But to do this leaders and employers like Warren Buffett, Jeff Bezos, Dimon, and Gawande will need to use their influence to change the mindset that local care isn’t as good as in the big city hospitals. Specialists in my health system, Wellforce, have successfully increased the number of patients and the severity of illnesses able to stay in the community. And we have academic specialists working with community specialists to perform neurosurgery in suburbs, not just in Boston. Complex care in the community is not only a possibility but a reality. It just requires us to deal in facts rather than outmoded perception.

It also requires us to think about spending our dollars differently. In the race to create worthwhile wellness programs, convenient urgent care centers, and the like, a critical fact has been overlooked: Five percent of the population generates 50 percent of health care spending. Addressing this means offering focused, coordinated care for the chronically and seriously ill by a team of providers who can help with everything from prescriptions to food stamps. This will become ever more important as the world’s population ages. According to the World Health Organization, by 2050 the world’s population aged 60 years and older is expected to total 2 billion, up from 900 million in 2015. Today, 125 million people are age 80 or older.


We need to expand the role of health care to encompass the social determinants of health, like housing, food insecurity, and poverty. Late last year, Boston Medical Center announcedit’s investing $6.5 million in affordable housing to improve community health and patient outcomes while also reducing costs. Hebrew Senior Life has been a pioneer in providing affordable housing to improve the health of the elderly. In other countries, for every $1 spent on medical care, $2 is spent on social care. In the United States it’s the opposite. For every $1 we spend on medical care, we spend a mere 55 cents on social health. Entrepreneurs like Buffett and Bezos know spending to avoid a problem is smarter than paying to fix it.

To transform the health care system, we need patients, physicians, and employers to think differently about the benefits of seeking care close to home. Insurance plans will need to incentivize people to do so. Academic medical centers must see the sickest patients and partner with local providers to keep care in the community. Primary care physicians will need to focus on cases that require the most coordination rather than on treating the common cold. Patients will get to know nurse practitioners, social workers, and other medical professionals in nonemergency situations.


The community care argument makes complete sense, but convincing people that local health care is high quality, more affordable, and accessible will take time. Backing the argument through the support of billionaires and thought leaders might finally make the idea stick.

Dr. Michael Wagner, former CEO of Tufts Medical Center, is chief physician executive at Wellforce.