Healthcare pain points: A physician’s view

Record date: 03/15/2024
Air date: 05/22/2024

This is the first in our three-episode miniseries, "Road to Relief: Finding a Path to Accessible Affordable Healthcare." "Future of Risk" by Zurich North America dives deep into the challenges in the U.S. healthcare system and potential solutions to improve accessibility to quality and affordable care. 

Dr. Nina McIlree, Director of Wellbeing and Employee Experience, highlights issues such as rising healthcare costs, increasing bureaucracy, labor shortages, the pressures on physicians and the healthcare system that ultimately affects the patient. While strides have been made in healthcare delivery, significant hurdles remain. Addressing the need for a collaborative effort from all stakeholders to ensure quality healthcare.

Guest:

Nina McIlree, M.D.
Director of Wellbeing and Employee Experience
Zurich North America

Dr. Nina McIlree is the Director of Wellbeing and Employee Experience. Nina joined Zurich Insurance in 2005. As the Vice President of Medical Management in Workers Compensation Technical Claims, she directed and transformed the medical services supporting injured workers recovery and return to work. In December of 2022, she transitioned into her current role of Director of Wellbeing and Employee Experience where she oversees the creation and implementation of an integrated wellbeing strategy for this national insurance carrier.

Prior to joining Zurich, Nina worked for 10 years as a Physical Medicine and Rehabilitation physician with the Rehabilitation Institute of Chicago/Shirley Ryan Ability Lab. She completed her residency and two-year fellowship training at the Rehabilitation Institute of Chicago focused on Bone Mineral Metabolism and musculoskeletal rehabilitation. She received her Medical Degree at the University of Illinois, College of Medicine, and her undergraduate degree in Molecular Biology from Northwestern University. She is honored to be a board member of Shelter Inc. A non-for-profit organization dedicated to ending child abuse and abandonment. Personally, Nina is surrounded by a wonderful family that range from a 100-year-old father to an 18-month-old grandson. It doesn’t get better than that!

Host:

Farah Rehman
Head of Marketing and Customer Strategy
Zurich North America

Farah Rehman currently serves as the head of Marketing and Customer Strategy for ZNA’s Life, Accident & Health business. With over 20 years of experience, she started her career at AIG in product development, then moved to sales, internal consulting and ultimately marketing. At Zurich, she began in advanced marketing and led the life sales and marketing team, prior to taking on her current role. She has a bachelor’s in management information systems from the University of Houston and an M.B.A. from Rice University. Farah lives in Houston, Texas with her husband and daughter. In her free time, she leads her daughter’s girl scouts troop and loves traveling the world with her family.

(PLEASE NOTE: This is an edited podcast transcript, capturing speakers with natural speech patterns that may include incomplete sentences and/or asides, grammatical errors, verbal shorthand and some statements that may be less clear in print.)

Episode transcript:

FARAH REHMAN: Challenges in the U.S. healthcare system are creating a heavy burden for many Americans. In this three-part podcast miniseries, we're taking a deep dive into healthcare trends to better understand the problems, as well as potential solutions, that can help provide access to high quality, affordable care for everyone. Welcome to Future of Risk presented by Zurich North America. We explore the changing risk and resilience landscape, and share insights on the challenges that face businesses to help you meet tomorrow prepared. In this three-part podcast miniseries, we're taking a deep dive into healthcare trends to better understand the problems, as well as potential solutions, that can help provide access to high quality, affordable care for everyone.

I'm Farah Rehman. I sit in the Life Accident and Health team at Zurich North America. Today, I'm speaking with my colleague, Dr. Nina McIlree, known affectionately to us as “Dr. Mac.” She's our Director of Wellbeing and Employee Experience here at Zurich North America. Prior to joining Zurich, Dr. Mac worked for 10 years as a fellowship-trained physical medicine and rehabilitation physician with the Rehabilitation Institute of Chicago/Shirley Ryan Ability Lab. She is honored to be a board member of Shelter Inc. Which is a nonprofit organization dedicated to ending child abuse and abandonment. Nina is passionate about helping others improve their quality of life and function in all walks of life. Dr. Mac, welcome to the podcast.

NINA MCILREE: Thank you, Farah. So glad to be here.

REHMAN: So, we talked a little bit about your background, but can you talk specifically about your experience in healthcare and really how you've seen it change over time?

MCILREE: [I would be] happy to. As a physical medicine and rehab doc[tor], as I came out of training and worked through the ‘90’s [into the] early 2000’s, we really were looking at in my role. How do you help your patient who is facing a temporary disability, all the way through to permanent disability, get the care they need? We were starting to see accessibility issues. There certainly was the challenge of rising healthcare costs. It was leading to a lot of bureaucracy in the system and I would say that has not changed but has really increased.

Back in that timeframe… Medicare was coming out with more and more regulation on how they wanted to see care delivered, which was really driven by costs of the system. That has also increased. The rules, the challenges, and the stresses due to costs in the system have only magnified over this timeframe. Then the demand for documentation, inhibiting the ability to deliver quality care and having that time to be able to work with patients. I remember really being pushed to see more patients. That was just really starting in the ‘90’s and 2000’s to get a foothold to now.

You can walk in and docs are pushed to see so many patients that you might get 10 minutes of quality discussion and feel like you're struggling to get all your points covered. So, I think things that were over this last say 20 to 30 years, we saw the seeds, we saw the challenges and the pressures that were on docs on healthcare systems, but really impacting the relationship with the patient. And now as it's augmented over time, it's really the patient who has suffered. Trying to get care, trying to seek the care and the information that's needed has only become that much more difficult.

REHMAN: So, when you think about some of those challenges, especially now, as things have changed over time, and you think about what most Americans are struggling with when it comes to healthcare, what comes to your mind?

MCILREE: I think it really comes down to accessibility and cost… affordability and accessibility. That sounds like it's a simple, “Oh, it's just those two things,” but really that covers such a wide range of drivers that the average patient has to deal with. As we're seeing significant pressures in the healthcare system, whether it be labor shortages. We know nursing, for example, is significantly challenged because it's an aging workforce. I think the average nurses age right now is 52. So, we're seeing a consistent level of retirement and leaving the system.

While we have an incredible increase of need. We have an aging population that we know over the next 10 years or so, we expect to see a population growth of near 10%. But 42% of our population's going to be over 65 by 2034, which means that those high health-consuming aged population are going to need more and more support systems. The nurses, physicians, there's a labor shortage in physicians also, we're an aging workforce. We know that over 40% are going to be greater than 65 in the next decade.

So, all of those pressures, in addition to what we all feel. Healthcare is not immune to inflation. As we're looking at that labor shortage, we're also seeing it's hard to just keep the doors open. There's increased costs from supply chain shortages. All of that's driving inherent costs that's being ultimately felt by the average person just trying to be well.

REHMAN: So, there's a really important theme that carries all the way through, which is affordability and accessibility. Back to your point, when we think about that thread coming all the way back to that American. What are some ways that you've seen Americans try to handle that growing financial burden of healthcare as it kind of shifts towards them?

MCILREE: It's a very real pinch that everyone… I don't think anyone has escaped some element of this pressure, whether it be the increase in premiums over the last six years or so. We've seen deductibles going up 40 to 60% depending on if you're in the marketplace with the Affordable Care Act versus employee plans, all the way through to out of pocket costs.

We know for example, that the average American is starting to move towards not seeking the traditional healthcare model of preventive healthcare. Not getting in to see docs because of the cost, because of the mounting medical debt that they're experiencing. I've always had the perception that what the unexpected healthcare costs being the ER visits or an unexpected surgery.

But in reality, some of the surveys that are out there are showing that the medical debt is really being felt primarily or equally with lab and diagnostic tests that we need to get to find out what are the underlying health conditions we need to get care for. Primary care physician visits. The unexpected costs are causing people to avoid getting the care they need. If they are getting the preventive care because they can get into a primary care physician. They are avoiding the recommended follow-up care because of costs.

We know that pharmacy costs are going up significantly and so people are not filling prescriptions if they are having to make a decision between “Can I pay for these high-cost prescriptions or do I work to get food on the table?” Or they're cutting the pills to just try and stretch how long they can use the medication, even though they're not adequately dosing for their conditions.

All of that is leading to delayed care and the ramifications are increase in health conditions that need further care down the line. So, it's kicking the can down the line. Then those costs, because the conditions are worse, are going to be higher. It's a very vicious cycle right now. Some of the ways that people are going to meet that is we're seeing people only seeking care when they absolutely need it.

So, ER visits or what we're really seeing is the rise of urgent care. Getting sort of that “on the spot,” partly because it's accessible and partly because it's affordable….and don't get me wrong, urgent care centers have a really wonderful place and have filled in sort of a disruptive fashion. [They] have filled a very important place in the continuum of care right now because it's allowed people to get in and be seen by a physician followed with the nurse to be able to start to address conditions that they just are avoiding.

REHMAN: You spoke a moment ago about the importance of preventive care. Can you talk about how you've seen people getting preventive services change over time and what do you think the long-term impact of that is going to be?

MCILREE: Well, I'm actually going to answer the second part of your question first because it really is pivotal to why we need to change this. Preventive care services — these recommended guidelines — are based on the evidence that shows us if you catch certain conditions early in the disease process and — this is really true in all medicine — if you catch early in the disease process, we can have significantly better outcomes at a patient level and at a population level. So, these preventive care services are not just arbitrarily recommended. Unfortunately, if you look at the U.S. Department of Health and Human Services has put out some really concerning statistics.

In 2015, only 8.5% of the adult population age 35 and older were getting the recommended high priority… not even just all but high priority clinical preventive services that unfortunately decreased by 2020 to 5.3% of that population of 35 years and older receiving all those recommended preventive care treatment.

We really are moved away from what should be a proactive health management approach to really tackling now what we need to do with our own healthcare. And we're going to sort of “as needed approach,” for many reasons that we've talked about today of the stresses in the healthcare system. But, it's something we have to focus on and get back to of what do we need to do to prevent the health issues so that we can all lead better lives.

REHMAN: I think that number is astounding, especially if you package that up with what we talked about regarding people delaying or postponing care. It's just… it's a compounding problem anyway that you look at it, whether it's preventive or even worse, the delay of needed care.

MCILREE: Yes, completely agree. It's a vicious cycle right now.

REHMAN: Yes, we talk a lot about this accessibility and you kind of talked about one of those trends. Which is the growth of urgent cares and retail clinics really across the nation. The other thing that we've started to see and maybe it's that this need from need always comes opportunity. And there's been a number of companies, tech platforms, retailers that have recently entered the healthcare space in a variety of different ways. From your perspective, why do you think they're interested in this space? And who do you think they're trying to solve problems for?

MCILREE: I think your initial comment of out of necessity comes innovation ingenuity. These are trying to fill gaps that our traditional healthcare system cannot meet at this time. We've had a consistent phase of consolidation of healthcare systems. The sort of private practice model of physicians has really gone by the wayside and are getting consumed up into large healthcare networks. It has not met the need. This process of consolidation has not met the need of our average American who needs to get in quickly to be seen.

So, these newer ways of trying to package healthcare in a way that is accessible whether it be one of the really — I think — positive things that came out of the terrible process of COVID and the pandemic is the accessibility through telemed and digital platforms and the ability for the retail market to expand. For that, at the moment of time when you need it to be able to get in and be seen.

I think it's a good thing that we've challenged the traditional model. The traditional model isn't well stocked. We don't have enough physicians to continue that model. We don't have the nurses to continue that traditional model. So, these new ways of delivering care has allowed us to extend physician extenders in settings like the clinics that are in our retail centers have allowed us to give care where it's needed and when it's needed in an affordable model.

So, do I think it's the perfect model? No, I think there's going to have to be a lot of focus on the quality of the continuity of care, the ability for our digital platforms to start to bring together healthcare data so that if you're going to multiple points of service for healthcare, we can start to be able to share that and look at your entire healthcare history in a manner that allows us to learn.

If you can't spend an hour going over your history with your doc like we used to, then our digital platforms can much more efficiently do that. So, we're seeing the rise of healthcare portals that allow us to see that continuum of history, and hopefully, as we see multiple iterations of the digital platforms generative AI, we're really, I think in the future going to be able to make digesting healthcare histories much easier so that we can really focus on what's driving the issues that you're dealing with and much more proactively, managing those healthcare issues.

REHMAN: I think what's so interesting about that is that for sure, again, we know that we are in a really challenging time when it comes to healthcare costs. But there are some benefits when you think about how things used to be, 20… 30 years ago. To your point, to the way that healthcare is at least delivered today. We talked about affordability and accessibility which continue to have challenges but we've at least seen some strides made in delivery to help adapt to that situation. Is there anything else when you think back to 20… 30 years ago versus today in terms of shifts that you've seen that you could call out for us?

MCILREE: I think from a delivery model perspective, one of the things that is a positive is the accessibility of information. This goes from the medical provider side being able to access unbelievable stores of knowledge to drive better care decisions. What I'm not seeing is the time to really explain it to the patient and the ability for the patient to be an educated consumer of healthcare. That's very challenging and because we are not at a point right now where we have a continuum of care that truly is connected.

What is a challenge for the consumer? The patient has to be their own advocate. You have to go in an educated perspective, ask questions, force the conversation that allows you to understand what is the healthcare you need… it's a foreign language, right?

This is medical care delivery right now [it] is not geared to making it easily understood. We don't have time on either side. Whether it's the patient or the physician or the nurse, there's not a lot of time to explain what are very complex situations. When you're looking at: how do you move through to get the care you need? How do you advocate for yourself effectively to know you're asking the right questions?

I think those are the biggest challenges when you do a search for a specific health question, you're going to get multiple different answers. Not necessarily are they applicable to you. And I think that's one of the biggest challenges is to not waste what are our needed healthcare dollars on care that's really not appropriate for you. So, how do you go in and start to have those kinds of conversations? I think that's one of the bigger challenges right now is that adv advocating for yourself.

REHMAN: Yes, that makes a great point. I joke with my daughter's pediatrician that I am guilty of becoming doctor search engine — we'll call it — where I think I can diagnose her before he can and it's a running joke for us now.

MCILREE: Very true.

REHMAN: I want to pivot back for a moment to affordability because as you know, Zurich did its own research to better understand what Americans struggle with in terms of accessing affordable healthcare. In our research, we asked what the biggest pain points were and there's a couple that you mentioned, which is just the actual cost of the healthcare as well as the limited access as we may run into shortages of quality care.

But this one key driver, at least on the affordability side, really seem to be high deductibles, which we've seen, and you mentioned this. The typical increase over the last 6 years has been 40 to 60 percent. So, we've seen that increase. I just want to hear from you about how you see that impacting affordability and accessibility and delivery of healthcare.

MCILREE: Well, I think the trend towards the high deductible plan and or just high deductibles themselves, if it's not a true high deductible plan, I think scares a lot of people. Because it's a hundred percent out of your pocket until you hit that deductible and people are just struggling with, how do I meet those, those costs before my insurance ever kicks in?

Insurance is critical for covering the risk, but if you can't get that coverage until a few thousand out of pocket, many people cannot afford that. We know those unexpected medical costs that, you know, third, the people can't afford an unexpected $1,000 bill that hits them, whether it be ER or ambulance or diagnostics that you didn't expect.

Well, if you can't afford even that… then looking at a 1 to 2 thousand to 2,000 plus deductible is going to be a deterrent to your care. There's ways that employers are trying to help that with HSA’s and FSA’s, accounts that you can either put your post-tax or pre-tax dollars, but those are not readily accessible across all areas that have high deductibles. So, I think looking for those unique ways to help manage that risk with more affordable gap coverage, I think that is going to be critical moving forward. I actually believe that that's one of the challenges that we're working to solve for. So, can I actually ask you that question of… can you tell us about what we're trying to do here at Zurich?

REHMAN: I think what's really interesting is, you talked about, how there are a variety of different ways how someone could solve for this problem. Employers —to your point — use HSA accounts… their savings accounts. One of the things that we really focus on is supplemental health insurance. So, for us, major medical is so important and it's needed for all of your major medical needs.

But it still typically has a high deductible. So, to your point, the first handful of dollars, whether it's 500, 1,000, 4,000 or 5,000 dollars [that] can be completely out of pocket. And there are a number of products out there that can help fill that gap and make sure that you don't have this $1,000 hit for something that maybe you weren't expecting an accident or I had an experience with my daughter where it was a $200 bill just for a strep throat test and an office visit.

So, these products are really designed to work in side by side with a major medical plan to help kind of meet those everyday medical needs. Then of course you've got your major medical to support it. So that's just a couple of ways, but I think the fact that you've got HSA plans and savings plans out there are incredibly important as well. Dr. Mac, thank you so much for joining us today on Future of Risk. It was really interesting to hear your perspective, especially as a physician on where healthcare is headed in some of the trends that you're seeing.

MCILREE: Thank you so much. It's my pleasure, Farah.

REHMAN: And thank you also to our listeners, and stay tuned for the second episode in our series on where U.S. healthcare is headed. We'll be speaking with David Fike Zurich North America's Head of Life, Accident and Health, and Shane Foss, CEO of Hooray Health, both of whom are passionate about solving growing gaps in healthcare. This has been Future of Risk presented by Zurich North America. If you like the show, leave a comment or review wherever you get your favorite podcast. Or drop us a note at media@zurichna.com. We hope you join us for future episodes.