Viewpoint: Healthcare is overrun with ‘middlemen, actors and sub-actors’

Molly Gamble (Twitter)

Healthcare is increasingly inundated with “middlemen, actors and sub-actors” — companies devoted to niche causes that promise to fill perceived gaps in the healthcare system, according to Sachin Jain, MD, president and CEO of SCAN Group and SCAN Health Plan.

In a column for Forbes, Dr. Jain contrasts today’s “Frankenstein healthcare system—pieced together inelegantly with no obvious logic” with the simplicity and power of the patient-physician relationship. Companies act as middlemen by inserting themselves between physicians and patients.

“What would happen if we instead paid doctors and their teams — the people closest to the patient — to do the same tasks and got out of the way? Just a thought,” Dr. Jain writes. Although middlemen may be necessary, he urges healthcare leaders to press them to demonstrate tangible and meaningful clinical benefit to patients. 

He notes that companies pursue healthcare leaders daily to identify deficiencies in patient care. “They ask us to let them fix the problem. More often than not, they (and their investors — often venture capitalists and private equity executives) ask us to pay them to fix the problem,” Dr. Jain notes.

Part of the paradox is that in aiming to close gaps, some of these middlemen create even more space between patients and care teams. For example, offshore call centers are seen as a solution for patients who are not taking medications.

“We spend time building trust with our patients, but somehow, they hope to convince us, a set of well-intentioned, but ill-informed, and ill-equipped strangers is key to ensuring that the patient we know and recognize will put faith in our diagnoses and prescriptions,” Dr. Jain writes.

Dr. Jain also notes that some middlemen play up alarm among patients, suggesting their solutions or technology offerings can detect health conditions that traditional imaging or diagnostics cannot. 

“Even Kim Kardashian has joined the crowd marketing full-body, cash-pay MRIs delivered by the company PreNuvo,” he writes. In August, Ms. Kardashian promoted Redwood City, Calif.-based PreNuvo on her Instagram, which offers elective full-body imaging ranging from $1,000 to $2,500 per scan.

“I shudder at the thought of alarmed women frantically trying to get care for a false-positive findings on scans for conditions that likely don’t exist. If only they’d stuck with their doctor.”

SCAN Group and SCAN Health Plan is one of the nation’s largest nonprofit Medicare Advantage plans. Dr. Jain said he would not only “be remiss and hypocritical, but also completely clueless” if he didn’t mention how regularly physicians see health insurers as the ultimate industry middlemen.

“Of course, health insurers exist because they promise the same thing as all of these companies — lower costs. We all want lower costs,” he writes. “Patients want lower costs. The government wants lower costs. Insurers want lower costs. So we hire middlemen to perform an array of functions that, we’re promised at least, will lower costs. And yet, he costs keep rising.”