healthcare stakeholders at a glance
Before diving into some of my proposed policy recommendations in a future post, it’s important to create a shared understanding of the principles and players I’m considering. This post is an overview of the players, aka stakeholders. When we discuss complex issues, like improving healthcare outcomes, we view them from our limited perspective. I believe that if we better understand the various stakeholders (and their perspectives), we can better work together to develop solutions that make high-quality healthcare more accessible and affordable. Taking a holistic approach allows us to escape the rampant zero-sum-game mentality in most negotiations between the below stakeholders.
Stakeholders are individuals or groups who have an interest or concern with a particular issue or cause, in our case, healthcare. When I think about stakeholders, I think of patients, providers (including the provider support team), policymakers, and payors (insurance companies). I could take this a step further and include research & academia, technologists, etc., but we’ll keep it short and sweet. As the leader of a behavioral healthcare provider organization, here’s how I think about the main stakeholders in the healthcare system.
Patients are the consumers of healthcare. Talk of “fixing healthcare,” should center around improving patient outcomes. We want to move people along a continuum of suffering to flourishing. Treating acute symptoms may be necessary to reduce suffering, but at some point, healthcare should transition to helping create conditions for flourishing (aka addressing social determinants of health (SDOH)).
Providers are the folks who provide healthcare. I have a strong belief that if we want to improve patient outcomes, we must focus on provider well-being. There is an epidemic of burnout and moral injury in healthcare, especially in behavioral health. If we want to improve the lives of patients, we need to improve the lives of providers through increased training and manageable expectations (work-life balance).
Insurance companies (payors) play a MASSIVE role in our healthcare system. Dealing with insurance companies is one of the most frustrating aspects of building a healthcare organization. In building a better system, it’s essential to view payors as allies, not adversaries. Provider-payor relationships are often centered around rate negotiations and managing the revenue cycle. This is the main zero-sum game that I think we need to address. In behavioral health, finding in-network providers with availability can be daunting.
Policymakers and regulators, i.e., the legislature, NC Medical Board, NC Social Work Board, the Department of Health and Human Services, and accrediting bodies such as The Joint Commission create and enforce healthcare regulations. There is a vital role for the right regulations to help increase access and affordability to quality care, but too often regulation is myopically focused.
It’s also important to acknowledge that we are operating within a capitalistic society. Let’s be sure to acknowledge that money makes the world go round. When we talk about taking a stakeholder approach to addressing healthcare, we need to be realistic regarding the centrality of financial discussions. Payors want to save money. Providers want to make money. And patients want quality care that won’t cost them an arm and a leg. This is a very complex problem.
additional healthcare stakeholders
Provider support personnel are all non-providers working in healthcare organizations. These are the folks that maintain operations in hospitals and outpatient clinics. These are the folks who schedule patients, manage communications with payors, and handle a variety of other administrative functions. Patients and providers depend on support staff — e.g., patients don’t want a rude, hurried, overworked person on the phone when they’re scheduling an appointment, nor do providers want an ill-equipped administrative team communicating with pharmacies, labs, and other external parties.
Technology & ancillary services play a significant role in the cost, quality, and accessibility of healthcare. I predict a major technological evolution in healthcare in the next ten years. It won’t be fancier EHRs and telehealth platforms; it’ll be wearable technology that provides actionable data. We are at the tip of the iceberg when applying existing technology to healthcare delivery.
Lab testing, medical device, and pharmaceutical companies are essential to improving our healthcare outcomes. They are also major cost drivers — for patients, providers, and payors.
Innovation & research slowly trickle down into our ability to change the way we practice and the tools at our disposal. We are fortunate to be located in one of the most productive clinical and pharmaceutical research areas, (Raleigh-Durham-Chapel Hill). Staying abreast of the latest advancements and trends is important–no one is lining up for a lobotomy, right?
At the risk of beating a dead drum, I want to reiterate that everyone involved in the healthcare system should be focused on making high-quality care more accessible and affordable. Understanding the various stakeholders involved is one of the first steps in developing more equitable solutions.
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