There's no one sure answer to reforming the American health care system

The American healthcare system is far from perfect, but there’s no simple solution on how to reform. At BenefitsPRO Broker Expo in Denver Tuesday, a panel of experts all agreed patients deserve better health education and care, but their opinions varied on the solutions.

The varied opinions came from the esteemed panel including Emma Fox, managing partner E Powered Benefits, Alan Cohen, co-founder and chief product officer at Centivo, and Tiffany Ryder PA-C, medical director, director of fiduciary services, direct care connect, MZQ.

One common thread on Tuesday was the disconnect that happens between the clinician community and insurance community. Ryder shared her stories as a provider in an ER and how she would correctly diagnose patients, but upon follow up they were still in pain. The problem? They couldn’t figure out why, for example, the medication prescribed was $600 so they decided to skip it.

“There’s a thousand iterations of this story,” Ryder shared. “[The common thread was] healthcare navigation questions, how to manage payments for the medical services. I did the best I could to educate the patients but realized I had no idea what I was doing. We don’t learn these things when we study medicine.”

Ryder realized she could not be an effective provider unless there was significant changes on the business side of healthcare.

Those financial challenges are the key to the next healthcare system, according to Cohen.

“There is no transformation without payment reform,” Cohen said. “We pay for volume: the more you do the more you get paid. Which actually means the worse you are as a provider, the more you get paid.”

But what how can we make sure patients are getting the care they need as well as not putting themselves into financial ruin. This is the key pillar in how Fox builds plans for her clients. She shared data points such as client income compared to all plan costs is how she is making the best decisions for her clients.

“What occurred to me when I was faced with filing medical bankruptcy is that I had insurance policy that’s main goal was to protect me from catastrophic financial loss and it did not achieve that,” Fox said. “I feel like that’s the responsibility of the consultant to be educating their employer partners that the people on the plan … are actually getting financial protection.”

But sometimes that’s not possible because the employer can’t afford a plan that rich, Fox said. Cohen shared that “most of your employer’s people are functionally uninsured” because they can’t afford the plan. Fox’s solution is making sure data is leading discussions to help avoid situations where employees can’t afford their care.

What is the solution? “It’s going to be different depending on the demographic of people you’re working with,” Fox said. There’s no one size fits all, but serving patients is the end goal.

Communication is the top pillar for Ryder. The solution to fixing the healthcare system to her means hearing provider challenges and using that information to strive for change.

“No one goes into medicine to make a bunch of money, there are such easier paths to that,” Ryder said. “We all want to help people.”