“We need to clean up our act,” says health executive for industry

Many healthcare companies talk about addressing high costs and healthcare equity, but too many fail to make an impact, says one healthcare CEO.

“We need to clean up our act. None of us are immune in this environment of ever-rising healthcare costs,” SCAN Group & Health Plan CEO Dr. Sachin Jain told Yahoo Finance at the 2022 All Markets Summit.

As an example of rising costs, Jane pointed to Pfizer ( PFE ) CEO Albert Burla’s comments to Yahoo Finance about raising the price of COVID-19 vaccines. Pfizer confirmed a recent report that vaccines that previously sold for less than $20 per dose could sell for between $22 and $42 in 2023.

“We need to take a hard look at what companies are doing, why they are doing it, and hold them accountable … to ensure that patients are protected. Because what I see over and over again is a lot of rhetoric that doesn’t necessarily match the actions of health organizations,” Jain said.

WASHINGTON, DC – OCTOBER 06: Activists protest the cost of prescription drugs outside the US Department of Health and Human Services (HHS) building on October 06, 2022 in Washington, DC. The demonstration was sponsored by the Make Meds Affordable campaign, which is calling on Health and Human Services Secretary Xavier Becerra to take action to lower drug prices. (Photo by Anna Moneymaker/Getty Images)

Even with increased investment in community partners and other equity strategies — which groups like America’s Health Insurance Plans are putting together to showcase the industry’s ongoing efforts — the combined impact is barely felt, Jain said.

“We have organizations that in the past have not necessarily prioritized these topics. You see a lot of talk … coming from all healthcare industries. Entities who say they believe in health equity say they believe in But when you actually look at the real investments they make, they are small and insignificant in the context of the broader challenges we face as a society,” said Jain .

And more organizations need leaders willing to make real investments, he added. “More than window dressing.”

The industry has long found ways to justify higher costs or engage in the blame game of pointing fingers at other sectors. Doctors blame pharmacy benefit managers (PBMs) for high costs and lack of access to drugs, drug companies also point to PBMs, saying they take too many discounts and don’t pass on the discounts they receive for favorable formulary positions. Hospitals blame medical device companies and equipment manufacturers. The list goes on.

Even mission-driven companies and nonprofits share the blame, Jain said.

“What we often see are mission-driven organizations hiding behind the rhetoric of ‘no margin, no mission,'” he said, adding that this helps the industry feel justified in its profit-seeking behavior.

“But ultimately (it) ignores the fact that the mission is not organizational sustainability;” the mission is community and public health, Jain said.

SCAN has seen real results. For example, SCAN has helped reduce vaccination disparities among blacks, Hispanics, and low-income people in the states where it operates. From February to August 2021, the gap between black and white members narrowed from 17% to 6%.

SCAN also recently launched a four-state LGBTQ+ plan that targets the specific needs of the group and focuses on providing a health network for older LGBTQ individuals. The idea, Jain said, is to give an increasingly tech-savvy older population the tools they need to live healthier lives and deal with the needs that have intensified as these people were younger and lived in a less progressive world.

But how can the industry as a whole create results?

“I think we’ve gone wrong over the past decades and healthcare has become this new normal where every sector of healthcare is trying to get as much as they can,” Jain said.

“And it’s frankly unsustainable and it’s unethical,” he added.

And now, with the passage of the Inflation Reduction Act, which will lower drug prices and increase Medicare benefits, Jane sees an opportunity for the industry to find its way out of misaligned incentives.

“I think there’s an interesting point in time where there’s an alignment of business interests as well as doing the right thing from a social justice perspective,” Jane said.

Follow Anjalee on Twitter @AnjKhem

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