1. What do you think is the biggest challenge with the United States healthcare system - and if you were in charge, how would you address it?

The for-profit health insurance industry as it exists today creates a series of perverse incentives to do more testing and expensive procedures, often at a personal cost to the patient’s wallet and health. Virtually all providers, hospitals, doctors, pharmacies, and pharmaceutical manufacturers operate in response to third party insurance reimbursements with procedures, medications, and cures positioned and priced to maximize reimbursement from health insurers. This dynamic has moved the focus of care from the patient to the provider’s revenue stream. I would immediately move to increase the alignment of reimbursements with patient outcomes.  


2. In your experience, what are the 3 biggest challenges you see people face when seeking healthcare or navigating the healthcare system?

1. Lack of accountable primary care: As more physicians engage employment through large regional hospital based systems, their patient interactions become shorter and shorter (typically 7 minutes). This has a negative impact on patient health in two ways:

The brief interaction often does not allow for a thoughtful analysis of the patient’s problem and may prompt doctors to just order more tests.

The primary care physician, because of such limited interaction, may not feel a sense of accountability or responsibility for their patient’s outcome. 

2. Because of a lack of primary care, the patient is left to wander the healthcare system and is often ill-equipped and ill-informed to make good decisions about their own healthcare. This is also a very expensive dynamic for patients, especially those with a high deductible insurance plan.

3. There’s no transparency to the pricing of healthcare services. Physicians are often unaware of the true cost of their care plans and recommendations. This prevents the market at large from becoming more efficient and passing on the resulting savings to consumers (patients).


3. Please share an experience that you or an associate has had navigating the healthcare system that opened your eyes to a need for a better process or better information.

Recently, I went to my local community hospital for a local MRI of my lower back. The administrative intake officer assured me that the hospital would take my insurance for this procedure. I had had a similar MRI one-year previously at a local imaging center for $824. I was thus shocked to receive a bill for $6000. Minus the $824 my insurer paid, the hospital was demanding an immediate payment on the balance of $5176. No apparent effort at any time was made by the hospital to share with me the true cost of this procedure or explain the reasoning for the high costs.


4. Mr. Rogers once said, "look for the helpers." Which individuals, institutions, companies, or advocacy groups do you see playing a role in helping us navigate the complex and opaque US healthcare system?

There are no “helpers” within the current conventional healthcare system. There are patient advocates, but the engagement of their services is often too little and too late in relation to the original problem and its related cost. Operating outside the conventional system are concierge physician practices, private health advisories, and companies like WorldClinic that restore accountability, source quality care, and enforce the need for transparency in pricing. However, in aggregate these firms have a very small voice in the national healthcare dialogue. 

By the year 2040, the biggest healthcare innovation will be what we currently call “connected prevention or primary care.” The idea behind this concept is straightforward: simple connectivity in the form of smartphones etc. will enable patients to pursue best practices in preventive care, i.e. exercise, diet, and medication compliance, as well as enable at-home tracking and management of simple chronic diseases like obesity, hypertension, and diabetes. This care will occur outside the walls of a hospital or physician’s office. In addition to connected primary care, the integration of intelligent care algorithms will remove a huge clinical burden from current primary care providers (which are in short supply and will remain so for the foreseeable future) 

Daniel Carlin, MD, pioneered WorldClinic’s innovative concierge telemedicine model after a decade of experience in demanding health care environments, first as a U.S. Navy Chief Medical Officer then as a refugee camp physician. Trained in surgery and emergency medicine, Dr. Carlin is board-certified in Emergency Medicine and holds a consultant-staff appointment at Lahey Clinic and Medical Center in suburban Boston.