Health insurance companies are evil, and other things people believe

What do the tooth fairy, traveling in Eastern Europe, and Google have to do with healthcare tech? Great question. Read on to find out.

The Tooth Fairy

As a kid, like many others, I believed the tooth fairy was real. It’s obvious now that there is no miniature creature in a pink sparkly tutu retrieving teeth and dropping quarters under my pillow as I sleep, but how did I come to know this? Well, it’s because I grew up and somewhere along the way, I learned the truth. Similarly, at some point along my healthcare technology career, I realized that health insurance companies aren’t evil and that healthcare is a business.

I also learned that sustaining a successful business and caring about our fellow humans are not mutually exclusive. I learned this through my six years at Epic and their mission statement of “Do Good, Have Fun, Make Money (so Epic can be around tomorrow).” This mission statement was the living, breathing spirit of the company, and before you tell me that I’m still drunk on the kool-aid, give me an opportunity to explain.

Traveling in the former USSR

The recent outrage against Epic CEO Judy Faulkner reminded me of a story from my undergraduate days. I am an anthropologist by background, and I had planned to get my Ph.D. in cultural anthropology and complete research on post-Soviet identity in Ukraine. To prepare for graduate school, I spent two summers in Western Ukraine learning the language and immersing myself in the culture. I made amazing friends and we frequently explored the region and visited neighboring cities and countries, like Kyiv or Krakow, which were easy to get to via bus or train.

One place we always wanted to visit but ultimately avoided was Romania. At the time, the shortest route from L’viv, Ukraine, to Bucharest, Romania, was via train. The problem, however, was the train tracks—see, the train track gauge in Ukraine is 1520 mm, while the Romanian railway uses 1435 mm gauge. Any train traveling between the two countries had to stop and spends hours changing wheels. For us on our short weekend breaks, this was an immense waste of time, so we didn’t attempt it.

The reason I was reminded of this story 10+ years later while reading about the exchange between Biden and Faulkner is because I believe what Judy was pointing out about healthcare technology infrastructure is not much different from the railway in Eastern Europe.

Just Google It

Many people believe that healthcare data and Electronic Health Records should work like Google (or Bing, depending on how you feel about the current headlines). You can search the internet for literally anything (tooth fairy riding a unicorn), and you can use your credentials in one system (Facebook or Gmail) to log in to thousands of others (LinkedIn, Pinterest, Asana, Trello, the list goes on).

Even if you want it to, healthcare technology doesn’t work this way (yet). Disappointing, I know, But what did Facebook and Gmail do first before they became the de facto authentication methods? They built their network.

Revisiting the Kool-Aid

I said earlier I would explain why my belief in healthcare isn't a result of being drunk on Epic kool-aid. In healthcare, I believe that no one is out strictly to turn a profit. Why the hell else would we willingly subject ourselves to such a cluster of an industry?

Is profit important? Definitely. Does profit allow us to continue to grow and do even more amazing things? Absolutely. Are profit and the bottom line the only thing we’re after? No. So let’s stop with the good/evil value judgment on companies and corporations like Epic, Cerner, Anthem, Aetna, and HCA, and move on to solving the problem at hand.

We have different stakeholders (patient, providers, payers) with various expectations around data format, access, and ownership. Based on my experiences, my guess is that Judy wasn’t saying that patients don’t have a right to their healthcare data. Rather, she was pointing out that releasing 10,000 pages of medical records will be a sloppy mess. Maybe .01% of the population would be able to read every page of their medical record and be able to make sense of it; most, though, would be utterly confused because there is no canonical framework with which to normalize data beyond Problem List, Medications and Allergies. Or maybe she was knocking Biden for not understanding the rulings that the ONC made while he was in office. We’ll never know.

Either way, my impression is that her commentary is not suggesting that patients don’t have the rights to their own healthcare data; rather, it's probably a comment on the usefulness of the data once it is liberated due to different systems and standards.

What do the tooth fairy, traveling in Eastern Europe, and Google have in common?

The way I describe today’s healthcare technology landscape is that we have a bunch of people who believe in the tooth fairy and think they can take a train from Ukraine to Romania TODAY without changing the wheels to match the gauge.

Before you berate me for discouraging “innovation” and “disruption”, let me clarify that I love innovation—it’s how we challenge the status quo. You know what I love even more? When change happens because we innovate and then implement in context.

So what do we do?

People like Judy, who have been in healthcare technology for decades, understand the core problem plaguing healthcare technology today: we’ve built different sized train tracks for different stakeholders over the years. We can’t just rip out the whole infrastructure and start fresh with the same size tracks. We have to figure out how to effectively leverage the existing infrastructure and make it work safely and efficiently. If we don’t, all the people trying to cross borders will continue to be surprised that the tracks are different. Some might get frustrated and give up while others might try to find workarounds to replacing all the train tracks (which is a billion dollar, multi-decade endeavor to do right).

Instead, my proposal is to build an ecosystem that capitalizes on investments we’ve already made in technology and people. What changes could you make today that would move us towards this vision?

Disagree? Drop me a line, I’d love to have a productive chat.

At Redox, our core focus is growing our network. We’re building a fast, scalable infrastructure that leverages existing interfaces and systems, making them accessible via our modern API. Tired of waiting for standards adoptions, we authored our own, and it works with whatever type of train track you use—FHIR, HL7, X12 or vendor APIs. Reach out to learn more.

By the way, I focused a lot on technology in today’s post, but I love talking about the human side of healthcare and believe in healthcare technology with a human touch.