TEDMED interview: A doctor who helps write health policy — and practices it

 

Kavita Patel

Kavita Patel, MD, is Managing Director for Clinical Transformation and Delivery, Engelberg Center for Health Care Reform and Economic Studies Fellow at the Brookings Institution. She’s also a practicing primary care internist at Johns Hopkins Medicine and served in the Obama administration as director of policy for the Office of Intergovernmental Affairs and Public Engagement in the White House.  

Dr. Patel will be moderating two TEDMED Great Challenges live events: Addressing Medical Costs and Inventing Wellness Programs That Work. TEDMED spoke with her about advising on health policy, and seeing its effects as a practicing physician.

What is the one thing all of the stakeholders have in common in the health care reform scenario?

No matter who you get in the room, everybody wants to know:  How can we do the most to control spending, but also to miminize unintended consequences?  That is universal.  As a doctor, I was thinking, ‘How can I minimize unintended consequences to my patients?” Another common issue – participants were all willing to put their own personal agenda aside, because they realized they were part of a much bigger conversation. People felt there was a higher purpose to this.

Do people bring their own health experiences to the table, even unconsciously?

We have this common joke in D.C.:  An ounce of information is not worth as much as a pound of anecdote.  So the joke is always that anecdotes and stories carry more weight.  Yet at the end of the day, we try to ask: If you had a personal experience that really motivated you, what can then can we learn from that is applicable to a lot of people?

You were part of the senior staff of the Health, Education, Labor and Pensions (HELP) Committee under Senator Ted Kennedy’s leadership.  Looking at the healthcare system in Massachusetts now, what can we learn from it as a nation? 

Massachusetts embraced the role of information dissemination broadly and put money aside for it. They knew that simply talking among themselves was not going to give state residents much information: How they could get insurance, what insurance means, why they should have it.  That’s something that’s lacking on our national level.

I’m really concerned about adults who just don’t realize they have options.  I think that wives and mothers who already shop for insurance will respond, but what about elderly men who have to sign up for Medicaid?  It’s really hard to get outreach to those people.  I’m a physician and employee, and the last time I chose plans, I found it’s not easy. We did all this work in health reform, and then there’s you, sitting in your house. How do we connect the two to go the final mile and make a difference?

I was saying to colleagues, ‘We should get Dr. Oz and Oprah to talk about health reform.’  That was a joke, but what if we could have some kind of informal spokesperson to help in the efforts?

Some employers are saving on healthcare costs by improving employee health with incentive programs. Everybody wins.  However, do we run the risk of putting companies in the position of being a healthcare “Big Brother?”

I do think that having these things in place will help employers think of things more broadly. It will create more incentive for employees if the plans are structured around more than, say, ‘Get your flu shot.’  That’s great, but it’s certainly not going to change the dynamic.  You also hope for some spillover effect.  If all the Fortune 50 companies have health and wellness programs, that might open the way for health plans to offer some of these wellness incentives themselves to improve their ability to contain cost and improve care.

Will we see companies who strive to hire only the healthiest of employees at some point? Is it happening already?

That was a concern that a lot of labor and patients rights group expressed, but in order to mitigate that we have to be transparent about how people might change hiring practices. And so far we haven’t seen that happen. Even outside of tax incentives, employers are stepping up and doing things because it’s the right thing to do.  We had very active conversations about making sure people don’t get lost in this process. If you are in a work environment where that’s happening, you need to be able to bring that forward without repercussion.

Why doesn’t the government have more healthy behavior incentives for its own employees?

One of the biggest sticking issues has been where and how we would roll it out.  How do you do something that affects one of the biggest employers in the world? We didn’t have the access to the very things we would talk about. But we didn’t have a gym that we could use; the White House didn’t have a gym. The White House, with leadership from the First Lady’s efforts, helped to secure a farmers’ market for the community around the White House to promote healthier eating.  But even that step took a lot of time and effort.

As a primary care internist, what were some of your own hopes as you observed the dialogue going into the construction of the ACA?

The hope I had was to get rid of the idea that the cost of treatment or insurance would prevent you from trying to be as healthy as possible. I saw it all the time; I saw that patients didn’t take their medicines or see a doctor because they couldn’t afford the co-pays. To me, that was where the reform hit reality. I thought, ‘There’s got to be a better way to do this. Can we make the system cost less and still be patient centric?’

Do you talk to your patients about cost?

I do. If someone comes in and wants a certain test or prescription that I know that is not necessarily the best treatment for what they’re asking, and it’s the more expensive one, I ask them, ‘What made you think about wanting this?’ 99.9 percent of the time they say, ‘I had a friend…’ or ‘I saw it on the television.’ We usually end up choosing another course, something better.  But that takes time. It’s far easier for a doctor like me to write the prescription or order the tests.  That’s the tension with controlling costs.

How did a family doctor end up in policy?

I had been doing research in mental illness and veterans, and my work caught the attention of Ted Kennedy, and one thing led to another.  D.C. seemed a very foreign place — I think it does to most of the country — but I’m tapping into my physician roots more and more each day, which gives me great insight that I’ve spent decades trying to gain.  So I’m coming full circle.

You can follow Kavita Patel on Twitter @kavitapmd. To join Thursday’s live event, follow the TEDMED Google Plus page.